In a major departure from industry practice, GlaxoSmithKline,
the sixth-largest global drug maker, announced
Tuesday that it will no longer hire doctors to promote its drugs.
The company also will stop tying compensation for sales
representatives to the number of prescriptions written for drugs they market. The
changes will be made worldwide over the next two years.
The
New York Times broke the news late Monday. But the company said it will continue to pay doctors for research, consulting and
“market research.” It will also continue to provide unsolicited funding for
continuing medical education activities run by “independent” groups.
Glaxo’s move is more evolutionary
than revolutionary, the last step in a dramatic reduction in its spending on
physician speakers in recent years. Some competitors have shown no signs of
letting up.
Glaxo first began reporting its
payments to doctors in 2009. During the last nine months of that year, it spent
an average of $15.4 million per quarter on paid promotional talks, according
to ProPublica’s Dollars for Docs database of
pharmaceutical company payments to physicians.
Spending on promotional speaking dropped to $13.2 million
per quarter in 2010, to $6 million per quarter in 2011 and to $2.5 million in
each of the first three quarters of 2012, data
show.
That’s an overall decline of more than 80 percent.
By comparison, Forest Labs,
a much smaller drug maker, spent more than $9 million a quarter on physician
speakers last year.
Earlier this year, Glaxo
spokeswoman Mary Anne Rhyne wrote
in an email to ProPublica that the company’s promotional spending
tracks with new drugs or new uses for existing products. “That activity has
been relatively low in the past year, so spending for speaker programs has been
lower, too,” she said.
Glaxo’s well-known drugs include Advair for asthma, Lovaza for
high triglyceride levels and Avodart for prostate enlargement. It also makes
the diabetes drug Avandia, which was subjected to tough restrictions from the
FDA in 2010 because of concerns about heart risks. The FDA recently eased those
restrictions after reconsidering the risks.
The top recent speaking programs for Glaxo
involved Advair and Jalyn,
which treats problems with urination for men with
enlarged prostates, Rhyne said earlier this year.
In an email this morning, Rhyne
said the company had taken a number of steps to change its sales and marketing
practices in recent years. “This is the next step of that evolution,” she
wrote.
Pharmaceutical companies have faced increased pressure as their payments to doctors have been made public, in
part through efforts like Dollars for Docs. More than 15 drug companies report their
payments to doctors for speaking, consulting, meals, travel and research under
Corporate Integrity Agreements with the federal government that arose from
settling lawsuits alleging unlawful marketing.
Beginning
next year, every drug and medical device company will have to make payments to
doctors public under the Physician Payment Sunshine Act,
a provision of the 2010 Affordable Care Act. Some experts have said that such
transparency will discourage doctors from accepting payments, a contention
supported by some doctors themselves.
“Many people have wondered, what difference will it make?” asked Susan Chimonas, a research scholar at the Center on Medicine as a Profession at Columbia University. “Will it clean up practices, or just allow the status quo to continue so long as there is transparency? Glaxo’s move is giving us an early answer – and reason for optimism. The saying about sunlight being the best disinfectant – that’s exactly what we’re seeing here. The Sunshine law is working.”
The American Medical Student
Association has called on medical schools to adopt
strict policies limiting pharmaceutical company interactions with faculty. And
some doctors themselves are calling on peers to be transparent with patients.
They have created a website called Who’s My Doctor: The Total
Transparency Manifesto.
Still, some doctors continue to accept
hundreds of thousands of dollars in payments from the
pharmaceutical industry.
Glaxo’s chief executive Andrew Witty told the Times yesterday
that the changes were being made “to try and make sure we stay in step with how
the world is changing. We keep asking ourselves, are there different ways, more
effective ways of operating than perhaps the ways we as an industry have been
operating over the last 30, 40 years?”
“Today we are
outlining a further set of measures to modernize our relationship with
healthcare professionals,” Witty said in a press release.
“These are designed to bring greater clarity and confidence that whenever we
talk to a doctor, nurse or other prescriber, it is patients’ interests that
always come first. We recognize that we have an important role to play in
providing doctors with information about our medicines, but this must be done
clearly, transparently and without any perception of conflict of interest.”
The British drug maker has faced intense criticism of its business practices. In
July 2012, Glaxo agreed to pay $3 billion, a record,
to settle criminal and civil claims “arising from the company’s unlawful
promotion of certain prescription drugs, its failure to report certain safety
data, and its civil liability for alleged false price reporting practices,”
the& U.S. Justice Department announced.
Glaxo also agreed to plead guilty to two counts of introducing
misbranded drugs, Paxil and Wellbutrin, into
interstate commerce and one count of failing to report safety data about
Avandia to the Food and Drug Administration.
The company
also has been under fire for bribing doctors in China to prescribe its drugs
and using travel agencies to cover it up. In July, the company said that
some senior executives in China appeared to have violated Chinese law.
Amid these
troubles, Glaxo has also been more transparent than
some of its peers. In October 2012, the company said it
would disclose its clinical trial data to researchers — another industry
first.
“We’re
increasingly realizing that the more you can make this an open enterprise, the
more likely you are to be able to get an advance which allows you to make a
medicine,” Dr. Patrick Vallance, president of pharmaceuticals research
and development at GlaxoSmithKline, told The New York Times. “I think we recognize
that you learn as much about the medicine after it’s launched as you knew
before.”
Look up your doctor’s financial ties to pharmaceutical companies here.
