Addressing Drug, Biotechnology, and Device Companies’ Payments to Physicians: the Thai National Health Assembly

We have frequently discussed how financial relationships among physicians, other health care professionals, and health care academics, on one hand, and drug, biotechnology, medical device and other health care corporations may have adverse effects on patient care and medical teaching and research.  A first step towards addressing these relationships would be their full disclosure.  Here in the US, Senators Grassley (R-Iowa) and Kohl (D-Wisconsin) have been pushing for a Physician Payments Sunshine Act which would require all such companies to disclose all such payments.  Whether it will become law, as part of health care reform legislation or independently, is now anyone’s guess.

Since we are based in the US, we tend to discuss such issues from a US viewpoint.  Just to show that these problems are global, and that some countries may have more fruitful approaches to them than others, see a recent article from the Bangkok Post on the run up to the Thai National Health Assembly:

Over-prescription of pills and medicines by doctors under pressure from pharmaceutical companies is being condemned by senior doctors ahead of a national health assembly on the issue this week.

In some cases, drug sales representatives were criticised for wearing ‘inappropriate outfits’ and offering gifts to secure orders.

Doctors say they are quite prepared to join any public sector moves to end unethical drug promotion to protect patients and cap soaring national health care costs and irrational drug use.

At a forum on ethical criteria for promoting medicines, physician Prasert Palittapongarnpim, of Chiang Rai’s Prachanukroh Hospital, said big pharmaceutical firms use many different methods to encourage doctors to prescribe their drugs.

They range from small gifts and stationery to lucrative luncheon lectures, seminar sponsorships and overseas trips.

Dr Prasert said he was once offered a huge sum of cash by a drug salesperson to change his drug order.

Some senior doctors also tell their medical students to buy drugs of smaller dosages so they can increase the size of their orders.

At the close of the Assembly, the Bangkok Post reported:

Curbing the influence of pharmaceutical firms on doctors topped the agenda of the three-day National Health Assembly which ended yesterday.

A better regulation was needed to govern the promotional activities and the sale of medicine to solve the problem of unnecessary and excess drug prescription by physicians, the annual health forum was told.

Unethical sales of drugs were among 11 health-related issues discussed during the second National Health Assembly (NHA2009).

Suwit Wibulpolprasert, the assembly’s chairman, said the problem of over-prescription was rampant and worrying.

There are doctors who only place orders with a firm offering them lucrative inducement packages in return, such as overseas trips and expensive gifts.

‘We need to have a regulation which would require these drug firms’ sponsorship to doctors to be made public,’ said Dr Suwit. He said a group of experts were working on a bill to prevent a conflict of interest between doctors and pharmaceutical companies. When ready, it would be submitted to the national drug system development panel, chaired by the prime minister, for consideration.

Dr Suwit has recommended that an independent body be set up to monitor and report the unethical behaviour of doctors and concerned agencies until the enforcement of the new law.

One would think that having a National Health Assembly would orient health policy more towards the issues concerning people and patients rather than those pushed by health care corporate CEOs (as we discussed here).  Of course, here in the US, we have nothing that resembles the Thai National Health Assembly.  Maybe if we did, legislation like the Sunshine Act would get a more favorable reception.