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Over €6.6m paid to healthcare professionals by pharma

Pharmaceutical companies paid over €6.66 million to healthcare professionals (HCPs) in Ireland last year, according to data compiled by the Medical Independent (MI) from the transfer of value (ToV) register operated by the Irish Pharmaceutical Healthcare Association (IPHA).

Some 44 pharmaceutical companies participate in the ToV register, including five companies that are not members of the IPHA. The payments relate to registration, travel, and accommodation for clinical conferences, and/or fees and expenses for work undertaken.

Named HCPs disclosed payments amounting to over €3.996 million. In addition, payments of more than €2.663 million were aggregated in cases where HCPs refused to have their name disclosed.

An IPHA spokesperson said HCPs’ experience and expertise play “a vital part in informing the pharma industry’s work on new treatments for best patient care and outcomes”.

“In the interest of greater transparency, IPHA has urged HCPs to grant such consent. Our preference is to see consent rates of 100 per cent. Although we significantly are off this, the trend is positive with rates increasing from 55 per cent in 2015 to 64 per cent in 2018.”

This consent rate relates to disclosures of payments from IPHA member companies only.

The IPHA said it is committed to boosting consent rates and is “reviewing how this can be facilitated”.

In 2018, the total ToV amount from pharma to healthcare professionals, healthcare organisations, and towards research and development, was more than €29.8 million. In 2017, the figure was over €30.9 million.

There are hundreds of HCPs, mainly doctors and nurse specialists, listed on the ToV website. However, there is no function to search for a named practitioner across the 44 individual company pages. 

MI emailed a number of doctors in relation to higher-end payments noted by this newspaper, which they had consented to disclose. In particular, MI asked how they guarded their prescribing practice in the context of engagement with the pharmaceutical industry.

In regard to disclosures of €13,254 from Shire and €9,783 from Sanofi, Dr Gregory Pastores, Consultant in the Metabolic Service, Mater Misericordiae University Hospital, Dublin, stated: “The payments are honorariums for presentations (including internationally – given based on my expertise in the field and having been involved in clinical trials while based in the US) and/or advisory board meetings.”

Dr Pastores said decisions regarding treatment are made by committee after clinical indications are noted in the application form. These are approved in accordance with treatment guidelines, if deemed appropriate. Many patients started their treatment in childhood, he added.

In relation to a disclosure of €12,789 from Novo Nordisk, Prof Carel le Roux, Physician at St Vincent’s Private Hospital and Co-Director of the Metabolic Medicine Group, University College Dublin, noted that he worked in a specialty with very few treatments. Prof le Roux’s expertise is in metabolism and obesity.

“Thus my interaction with pharma can’t really change what I prescribe as we have no medications that are reimbursed by the HSE…

“The majority of the money I have declared is for my role on national and international advisory boards. Thus we are influencing pharma probably more than they are influencing us because of the early stages of treatment concepts for obesity. I am also doing some teaching at national and international symposia at meetings to teach obesity experts regarding our own latest research. This is often supported by industry.”

In regard to a disclosure of €11,852 from Roche, Consultant Oncologist Prof Seamus O’Reilly, Cork University Hospital, wrote that the amount related to “education meeting attendance and also sponsorship for education for trainees”.

Prof O’Reilly outlined that he followed clinical practice guidelines, such as those from the European Society of Medical Oncology, and “our group has a policy of prescribing biosimilars or generics where available”.

In regard to a disclosure of €9,625 from Celgene, Prof Oliver FitzGerald, formerly Consultant Rheumatologist at St Vincent’s University Hospital, Dublin, stated that he was asked to chair the steering committee for the Celgene-sponsored meeting ‘Rheumatic Diseases – From Bench to Bedside and Back Again’.

“This involved >30 hours of work including multiple telephone conferences, slide preparation, and review, together with chairing and of course attending the meeting in London. My prescribing practice was not altered by this activity as I have only rarely prescribed a Celgene product. Furthermore, I retired from clinical practice at the end of 2018.”

In regard to a disclosure of €6,053 from Pierre Fabre, Cork-based Consultant Obstetrician/Gynaecologist with a subspecialist interest in urogynaecology, Prof Barry O’Reilly, stated the funding covered “conference attendance over the last few years at international meetings as their guest and key opinion leader”.

“I personally don’t think this influences prescribing patterns of mine as there are a number of drugs that I would prescribe for particular conditions that I commonly deal with and I have dealt with a number of companies over the years in a similar manner, whether it be conference attendance, research, or as a key opinion leader,” he outlined to MI.

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