Abstract
Financial dependencies and advertising tactics have the potential to erode the independence of medical professionals and influence their clinical decisions. Described in Chaps. 2 and 3, most of the literature on undue pharmaceutical industry influence in medicine discusses unethical marketing practices and how doctors are either bribed by companies or seduced by sales representatives. Since most research focuses on individual greed as the basis for corruption and bribery, most laws and regulations seeking to curtail industry influence concentrate on legally making transparent, minimizing or prohibiting exchanges of money between companies and individual physicians. While rules that curtail financial ties and constrain advertising practices are an important step towards minimizing industry influence and maintaining medical professional independence, the regulations have fallen short in that financial relationships between doctors and pharmaceutical companies prevail, if only being hidden by physicians and the industry alike.
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Notes
- 1.
https://transparantieregister.nl/Wat-wel-en-niet-geregistreerd: “For participation in meetings, healthcare providers can receive a travel, subsistence and subscription fee from a company for participation in this meeting. Individual hospitality will be part of the CGR’s transparency rules from 2015 and these relations will be published for the first time in 2016.”.
- 2.
OECD statistics: https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC#.
- 3.
Health: Health Care Resources: Remuneration of health professionals: https://stats.oecd.org.
- 4.
- 5.
It is important to note, that the data regarding payments to healthcare providers includes payments made to nurses (3%), pharmacists (3%), and payments made to veterinarians (less than 1%). All other financial relationships concern medical doctors, the majority of which are specialists (Transparantieregister Zorg 2015, 2016).
- 6.
There is some slight variation between the exact amounts paid to doctors listed in the CGR report and de Volkskrant’s data for various types of sponsorship/service agreements. The journalists explain that this is because a complete list of physicians in the Netherlands is not accessible to the public, and that the list of physicians had to be constructed from a so-called “care card” and through the Dutch Patient’s Organization. Additionally, journalists excluded general practitioners, vets, nurses, and dentists, and also chose 16 specialists whom they deemed high prescribers, excluding specialisms less interesting to industry (i.e. pathologists). Despite variations in methodologies, the amounts roughly converge with that of the CGR data, both in amounts, but also percentage dispersion. For additional confirmation I also contacted the CGR directly, who confirmed that the data from de Volkskrant were accurate (confirmation via email from CGR representative 17 May 2017).
- 7.
It is also interesting to note that the industry funding of medical associations for sponsoring medical educational events resembles this analysis in so far as the medical associations that received the most funding for medical event sponsorships also reflect a similar preference for specialist area (e.g. dermatology, cardiology, rheumatology, internal medicine, etc., see Chap. 8).
- 8.
https://www.drugs.com/international/pantoprazole.html. Accessed 15 Nov 2019.
- 9.
A specialist may prescribe a drug, but if the medication is such that the patient has to take it for longer periods of time i.e. anti-cholesterol medication, then the patient simply goes to the GP to have the prescription re-filled.
- 10.
CRO Quintiles merged with IMS Health in 2016, and since November 2017 is known as IQVIA (www.iquivia.com), specializing in service provision across the board: medical research and development, real-world value outcomes, commercialization, and technology.
- 11.
Hungarian Continuing Medical Education database OFTEX: https://ww.oftex.hu.
- 12.
Congressline website: https://www.congressline.hu.
- 13.
See table on payments to Hungarian medical Associations: Hungarian Gynaecological Society received 86,614 HUF of which 100% went to sponsoring of a medical educational event.
- 14.
Magyar Nőorvos Társaság IV. Szakmai Továbbképző Tanfolyama, 2017 május 26–27, Siófok, Hotel Azúr: https://www.congressline.hu/mnt2017/szakmai-kiallitas.php.
- 15.
- 16.
- 17.
Besloten Vennootschap (NL), Egyéni Vállakozó (HUN).
- 18.
Beroepen in de individuele gezondheidszorg (individual occupational registration number).
- 19.
https://transzparencia.org/kozzeteteli-adatok. Accessed 23 July 2019.
- 20.
25 being the minimum, being that subsidiary firms might also be subject to transparency regulations without being listed on the AIPM website. Those disclosure reports are in turn available on separate subsidiary websites.
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The Netherlands
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Laskai, A. (2020). Institutional Corruption of Medical Knowledge Application. In: Institutional Corruption Theory in Pharmaceutical Industry-Medicine Relationships. Studies of Organized Crime, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-030-44790-8_9
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