A GlaxoSmithKline decision to stop paying doctors for prescribing its medicines has highlighted the overly cozy relationship between the pharmaceutical industry and some Canadian doctors and led to calls for more transparency.

The president of the Canadian Medical Association says the British drug company’s policy, announced earlier this week, was a welcome development that would focus attention on the issue.

“For those folks who may be a little too cozy with industry, this might be a wake-up call that times are changing,”  Dr. Louis Hugo Francescutti said in an interview with CBC’s The Current.

'It’s somewhat embarrassing for the pharmaceutical industry that a company has made the move to stop paying doctors before the medical profession has decided to stop accepting money from pharmaceutical companies to promote medications.'— Dr. Nav Persaud

GlaxoSmithKline has been implicated in a bribery scandal involving its sales representatives in China and paid a $3-billion US fine in the U.S. for marketing drugs for unapproved uses and withholding safety data on other drugs.

The company has changed its business model and will stop paying its sales people based on how often doctors prescribe its medications. It will also cease the practice of paying doctors to give talks about products or diseases, and stop paying for doctors to attend conferences.

Francescutti, an emergency room doctor, says GlaxoSmithKline's move will likely be a catalyst for other drugs companies to change their policies.

“This is the tip of the iceberg. Other pharmaceutical industries will have to justify why they continue to do it when one of their peers has not done it. I’m sure there’s talk going on in that industry as to what their next steps are,” he said.

Sunshine laws in U.S.

In the U.S., under the Obamacare plan, new “sunshine laws” have been enacted that will result in publication of how much money individual doctors receive from pharmaceutical companies.

Francescutti said the CMA has proposed similar sunshine rules for Canadian doctors, but  has not had any action from legislators.

The CMA is not a regulatory body — that role is up to provincial colleges of physicians and surgeons. And a complaint has to be lodged with the college before it is likely to reprimand an individual doctor.

Francescutti said the pharmaceutical industry is skilled at building relationships with doctors and recruiting them for drug trials and seminars that introduce other doctors to new products.

“Their profit motive is going to be driven by research that tells them how to change physicians' prescribing habits and they do it very well, they know how to do it. We in the profession have to understand that we have to always be acting in the best interests of our patients,” he said.

Among the perks doctors may receive from drugs companies:

  • Vacations in the Caribbean.
  • Free lunches for their entire clinic.
  • Expensive gifts.
  • Opportunities to publish research paid for by the pharmaceutical industry.

One Toronto physician, Dr. Nav Persaud, believes the kinds of changes made by GlaxoSmithKline are a good first step.

Why hasn't medical industry moved?

“I also think that doctors never should have been paid by drug companies to promote medications. I believe doctors should be focused on care for patients, and you can’t focus on being paid by drug companies and care for patients at the same time,” he said.

He is keen for the medical profession to take a more active role in exploring its ties to the pharmaceutical industry.

“I also think it’s somewhat embarrassing for the pharmaceutical industry that a company has made the move to stop paying doctors before the medical profession has decided to stop accepting money from pharmaceutical companies to promote medications," Persaud said.

Francescutti said the CMA has had guidelines on the issue since 1991, but admits there might be doctors who “maybe at times develop a relationship that’s too close with the industry.”

He said the GlaxoSmithKline case could promote greater transparency and a Canada-wide discussion on the issue.

“I think it’s the start of something very promising.”