Pharma payments to medical oncologists under the microscope

By Megan Howe

12 Aug 2020

Almost a third of Australian medical oncologists and haematologists receive payments from the pharmaceutical industry, a rate three times higher than the average for specialist physicians, new research shows.

The authors of the study say the findings are a reflection of the influence of industry in funding development of expensive novel cancer therapies rather than the behaviour of doctors in accepting payments.

Researchers analysed payments from the pharmaceutical industry to doctors in different specialities between November 2018 and April 2019, based on data provided to the Disclosure Australia website, as required under the Medicines Australia Code of Conduct.

Over a six month period pharmaceutical companies paid a total of $7.3 million to 2775 medical practitioners.

The study in the Internal Medicine Journal estimated that 31.7% of all Australian medical oncologists and 30.9% of clinical haematologists received payments in the six-month period, compared to 11% of other internal medicine specialist physicians, and only 1% of GPs, trainees and other non-specialists.

Medical oncologists received the highest total payments of any of the specialist groups studied – $1.03 million, followed by endocrinologists ($758,648), cardiologists ($722,663) and haematologists ($719,565).

In all, 240 of 757 medical oncologists received payments that ranged from $190.90 to $38,461.82, most commonly for travel costs and service fees such as consulting and advisory panel payments.

Neurologists received the highest median payments of any speciality, of $2415, followed by $2131 for medical oncologists, which compared to a median of $1376 for all internal medicine specialists and $709 received by non-specialist medical practitioners including GPs.

The study authors said cancer physicians were targeted by industry because oncology is the therapeutic area with the most lucrative new drugs being launched.

They acknowledged that some interactions between physicians and the pharmaceutical industry were “unavoidable”, but cautioned that “any interaction creates a conflict of interest”.

“It is in the interest of patients to have access to major clinical trials, and these are frequently designed and sponsored by drug companies. Novel medications are often accessed by patients directly from drug companies ahead of federal funding, with cancer physicians acting as the prescribing intermediary,” they noted

Lead author Dr Adrian Pokorny, a medical oncologist at Royal Darwin Hospital, told the limbic that the study highlighted the extent of pharmaceutical company influence, rather than criticising the behaviour of doctors who received payments.

“I have a lot of respect for all oncologists and don’t think ill of any of my colleagues,” he said.

While it was impossible for specialists to avoid interaction with pharmaceutical companies, Dr Pokorny said receiving payments meant there was potential for bias in prescribing.

Oncologists in the US were more likely to prescribe some anti-cancer drugs over their competitors, such as sunitinib, dasatinib and nilotinib, if they have received payments from the drug’s manufacturer, despite no clear evidence of direct clinical superiority, the study authors said.

Dr Pokorny said his personal policy was never to meet pharmaceutical company representatives, so he had not been offered any payments.

The COVID-19 era of telemedicine and online conferences had offered an alternative way for doctors to be involved in international conferences without any need for travel, he suggested.

He will present the findings at the Medical Oncology Group of Australia (MOGA) online Abstract and Poster Program for Medical Oncology Advanced Trainees and Young Oncologists later this month.

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