Drug companies pay doctors over A$11 million a year for travel and education. Here’s which specialties received the most
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Drug companies are paying Australian doctors millions of dollars a year to fly to overseas conferences and meetings, give talks to other doctors, and to serve on advisory boards, our research shows.
Our team analysed reports from major drug companies, in the first comprehensive analysis of its kind. We found drug companies paid more than A$33 million to doctors in the three years from late 2019 to late 2022 for these consultancies and expenses.
We know this underestimates how much drug companies pay doctors as it leaves out the most common gift – food and drink – which drug companies in Australia do not declare.
Due to COVID restrictions, the timescale we looked at included periods where doctors were likely to be travelling less and attending fewer in-person medical conferences. So we suspect current levels of drug company funding to be even higher, especially for travel.
What we did and what we found
Since 2019, Medicines Australia, the trade association of the brand-name pharmaceutical industry, has published a centralised database of payments made to individual health professionals. This is the first comprehensive analysis of this database.
We downloaded the data and matched doctors’ names with listings with the Australian Health Practitioner Regulation Agency (Ahpra). We then looked at how many doctors per medical specialty received industry payments and how much companies paid to each specialty.
We found more than two-thirds of rheumatologists received industry payments. Rheumatologists often prescribe expensive new biologic drugs that suppress the immune system. These drugs are responsible for a substantial proportion of drug costs on the Pharmaceutical Benefits Scheme (PBS).
The specialists who received the most funding as a group were cancer doctors (oncology/haematology specialists). They received over $6 million in payments.
This is unsurprising given recently approved, expensive new cancer drugs. Some of these drugs are wonderful treatment advances; others offer minimal improvement in survival or quality of life.
A 2023 study found doctors receiving industry payments were more likely to prescribe cancer treatments of low clinical value.
Our analysis found some doctors with many small payments of a few hundred dollars. There were also instances of large individual payments.
Why does all this matter?
Doctors usually believe drug company promotion does not affect them. But research tells a different story. Industry payments can affect both doctors’ own prescribing decisions and those of their colleagues.
A US study of meals provided to doctors – on average costing less than US$20 – found the more meals a doctor received, the more of the promoted drug they prescribed.
Another study found the more meals a doctor received from manufacturers of opioids (a class of strong painkillers), the more opioids they prescribed. Overprescribing played a key role in the opioid crisis in North America.
Overall, a substantial body of research shows industry funding affects prescribing, including for drugs that are not a first choice because of poor effectiveness, safety or cost-effectiveness.
Then there are doctors who act as “key opinion leaders” for companies. These include paid consultants who give talks to other doctors. An ex-industry employee who recruited doctors for such roles said:
Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations […] If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.
We know about payments to US doctors
The best available evidence on the effects of pharmaceutical industry funding on prescribing comes from the US government-run program called Open Payments.
Since 2013, all drug and device companies must report all payments over US$10 in value in any single year. Payment reports are linked to the promoted products, which allows researchers to compare doctors’ payments with their prescribing patterns.
Analysis of this data, which involves hundreds of thousands of doctors, has indisputably shown promotional payments affect prescribing.
US research also shows that doctors who had studied at medical schools that banned students receiving payments and gifts from drug companies were less likely to prescribe newer and more expensive drugs with limited evidence of benefit over existing drugs.
In general, Australian medical faculties have weak or no restrictions on medical students seeing pharmaceutical sales representatives, receiving gifts, or attending industry-sponsored events during their clinical training. They also have no restrictions on academic staff holding consultancies with manufacturers whose products they feature in their teaching.
So a first step to prevent undue pharmaceutical industry influence on prescribing decisions is to shelter medical students from this influence by having stronger conflict-of-interest policies, such as those mentioned above.
A second is better guidance for individual doctors from professional organisations and regulators on the types of funding that is and is not acceptable. We believe no doctor actively involved in patient care should accept payments from a drug company for talks, international travel or consultancies.
Third, if Medicines Australia is serious about transparency, it should require companies to list all payments – including those for food and drink – and to link health professionals’ names to their Ahpra registration numbers. This is similar to the reporting standard pharmaceutical companies follow in the US and would allow a more complete and clearer picture of what’s happening in Australia.
Patients trust doctors to choose the best available treatments to meet their health needs, based on scientific evidence of safety and effectiveness. They don’t expect marketing to influence that choice.
Barbara Mintzes, Professor, School of Pharmacy and Charles Perkins Centre, University of Sydney and Malcolm Forbes, Consultant psychiatrist and PhD candidate, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Joy of Movement – by Dr. Kelly McGonigal
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We know that exercise is good for us. Obviously. We know that that exercise will make us feel good. In principle.
So why is that exercise bike wearing the laundry instead, or the weights bench gathering dust?
Dr. Kelly McGonigal explores our relationship with exercise, both the formal (organized, planned, exercise that looks like exercise) and the informal (ad hoc, casual, exercise that looks like just having a nice time).
Moreover: she starts with the why, and moves to the how. The trick she plays on us here is to get us very fired up on the many tangible benefits that will make a big difference in all areas of our lives… And then shows us how easy it can be to unlock those, and how we can make it even easier.
And as to making it stick? Exercise can be addictive, and/but it’s one of the few addictions that is almost always healthful rather than deleterious. And, there are tricks we can use to heighten that, thresholds that once we pass, we just keep going.
She also looks at the evolutionary tendency of exercise to be connection-building, as part of a community, friend group, or couple.
And, yes, she gives attention also to undertaking exercise when circumstances aren’t ideal, or our bodies simply won’t allow certain things.
In short: if any book can get you shaking off the cobwebs, this is the one.
Click here to check out The Joy Of Movement on Amazon today, and get your body moving!
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Optimism Seriously Increases Longevity!
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Always look on the bright side for life
❝I’m not a pessimist; I’m a realist!❞
~ every pessimist ever
To believe self-reports, the world is divided between optimists and realists. But how does your outlook measure up, really?
Below, we’ve included a link to a test, and like most free online tests, this is offered “as-is” with the usual caveats about not being a clinical diagnostic tool, this one actually has a fair amount of scientific weight behind it:
❝Empirical testing has indicated the validity of the Optimism Pessimism Instrument as published in the scientific journal Current Psychology: Research and Reviews.
The IDRlabs Optimism/Pessimism Test (IDR-OPT) was developed by IDRlabs. The IDR-OPT is based on the Optimism/Pessimism Instrument (OPI) developed by Dr. William Dember, Dr. Stephanie Martin, Dr. Mary Hummer, Dr. Steven Howe, and Dr. Richard Melton, at the University of Cincinnati.❞
Take This Short (1–2 mins) Test
How did you score? And what could you do to improve on that score?
We said before that we’d do a main feature on this sometime, and today’s the day! Fits with the theme of Easter too, as for those who observe, this is a time for a celebration of hope, new beginnings, and life stepping out of the shadows.
On which note, before we go any further, let’s look at a very big “why” of optimism…
There have been many studies done regards optimism and health, and they generally come to the same conclusion: optimism is simply good for the health.
Here’s an example. It’s a longitudinal study, and it followed 121,700 women (what a sample size!) for eight years. It controlled for all kinds of other lifestyle factors (especially smoking, drinking, diet, and exercise habits, as well as pre-existing medical conditions), so this wasn’t a case of “people who are healthy are more optimistic as a result. And, in the researchers’ own words…
❝We found strong and statistically significant associations of increasing levels of optimism with decreasing risks of mortality, including mortality due each major cause of death, such as cancer, heart disease, stroke, respiratory disease, and infection.
Importantly, findings were maintained after close control for potential confounding factors, including sociodemographic characteristics and depression❞
Read: Optimism and Cause-Specific Mortality: A Prospective Cohort Study
So that’s the why. Now for the how…
Positive thinking is not what you think it is
A lot of people think of “think positive thoughts” as a very wishy-washy platitude, but positive thinking isn’t about ignoring what’s wrong, or burying every negative emotion.
Rather, it is taking advantage of the basic CBT, DBT, and, for that matter, NLP principles:
- Our feelings are driven by our thoughts
- Our thoughts can be changed by how we frame things
This is a lot like the idea that “there’s not such thing as bad weather; only the wrong clothes”. Clearly written by someone who’s never been in a hurricane, but by and large, the principle stands true.
For example…
- Most problems can be reframed as opportunities
- Replace “I have to…” with “I get to…”
- Will the task be arduous? It’ll be all the better looking back on it.
- Did you fail abjectly? Be proud that you lived true to your values anyway.
A lot of this is about focusing on what you can control. If you live your life by your values (first figure out what they are, if you haven’t already), then that will become a reassuring thing that you can always count on, no matter what.
Practice positive self-talk (eliminate the negative)
We often learn, usually as children, to be self deprecatory so as to not appear immodest. While modesty certainly has its place, we don’t have to trash ourselves to do that!
There are various approaches to this, for example:
- Replacing a self-criticism (whether it was true or not) with a neutral or positive statement that you know is true. “I suck at xyz” is just putting yourself down, “Xyz is a challenge for me” asks the question, how will you rise to it?
- Replacing a self-criticism with irony. It doesn’t matter how dripping with sarcasm your inner voice is, the words will still be better. “Glamorous as ever!” after accidentally putting mascara in your eye. “So elegant and graceful!” after walking into furniture. And so on.
Practice radical acceptance
This evokes the “optimistic nihilism” approach to life. It’s perhaps not best in all scenarios, but if you’re consciously and rationally pretty sure something is going to be terrible (and/or know it’s completely outside of your control), acknowledging that possibility (or even, likelihood) cheerfully. Borrowing from the last tip, this can be done with as much irony as you find necessary. For example:
Facing a surgery the recovery from which you know categorically will be very painful: with a big smile “Yep, I am going to be in a lot of pain, so that’s going to be fun!” (fun fact: psychological misery will not make the physical pain any less painful, so you might as well see the funny side) ← see link for additional benefits laughter can add to health-related quality of life)
Plan for the future with love
You know the whole “planting trees in whose shade you’ll never sit”, thing, but: actually for yourself too. Plan (and act!) now, out of love and compassion for your future self.
Simple example: preparing (or semi-preparing, if appropriate) breakfast for yourself the night before, when you know in the morning you’ll be tired, hungry, and/or pressed for time. You’ll wake up, remember that you did that, and…
Tip: at moments like that, take a moment to think “Thanks, past me”. (Or call yourself by your name, whatever works for you. For example I, your writer here, might say to myself “Thanks, past Nastja!”)
This helps to build a habit of gratitude for your past self and love for your future self.
This goes for little things like the above, but it also goes for things whereby there’s much longer-term delayed gratification, such as:
- Healthy lifestyle changes (usually these see slow, cumulative progress)
- Good financial strategies (usually these see slow, cumulative progress)
- Long educational courses (usually these see slow, cumulative progress)
Basically: pay it forward to your future self, and thank yourself later!
Some quick ideas of systems and apps that go hard on the “long slow cumulative progress” approach that you can look back on with pride:
- Noom—nutritional program with a psychology-based approach to help you attain and maintain your goals, long term
- You Need A Budget—we’ve recommended it before and we’ll recommend it again. This is so good. If you click through, you can see a short explanation of what makes it so different to other budgeting apps.
- Duolingo—the famously persistence-motivational language learning app
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Why We Sleep – by Dr Matthew Walker
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- We all know sleep is important.
- We all know that without it, we’ll suffer rapid cognitive decline.
- We all know approximately what we’re supposed to do to get good sleep.
So what does this book bring to the table? Mostly, deep understanding (written from the perspective of a career in sleep science) presented in such a way as to be applicable, by you, in your life. Stop sabotaging yourself before you even get out of your bed in the morning!
Hustle culture champions early mornings and late nights, and either or both of those might be difficult to avoid. But to make what you’re doing sustainable, you’re going to have to make some informed decisions about looking after your #1 asset—you!
Dr. Walker writes in a clear and accessible fashion, without skimping on the hard science, and always with practical application in mind. All in all, we can’t recommend this one enough.
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The Stress Prescription (Against Aging!)
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The Stress Prescription (Against Aging!)
This is Dr. Elissa Epel, whose work has for the past 20 years specialized in the effect of stress on aging. She’s led groundbreaking research on cortisol, telomeres, and telomerase, all in the context of aging, especially in women, as well as the relationship between stress and weight gain. She was elected member of the National Academy of Medicine for her work on stress pathways, and has been recognized as a key “Influencer in Aging” by the Alliance for Aging Research.
Indeed, she’s also been named in the top 0.1% of researchers globally, in terms of publication impact.
What’s that about stress and aging?
In her words,
❝Women with the highest levels of perceived stress have telomeres shorter on average by the equivalent of at least one decade of additional aging compared to low stress women❞
Source: Accelerated telomere shortening in response to life stress
We say “in her words”, as she is the top-listed author on this paper—an honour reserved for the lead researcher of any given study/paper.
However, we’d be remiss not to note that the second-listed author is Nobel Prize Laureate Dr. Elizabeth Blackburn. What a team! Maybe we’ll do a spotlight feature on Dr. Blackburn’s work one of these days, but for now, back to Dr. Epel…
What does she want us to do about it?
She has the following advice for us:
Let go of what we can’t control
This one is simple enough, and can be as simple as learning how to set anxiety aside, and taking up the practice of radical acceptance of what we cannot control.
Be challenged, not afraid
This is about eustress, and being the lion, not the gazelle. Dr. Epel uses the example of how when lions are hunting gazelles, both are stressed, but both are feeling the physiological effects of that stress in terms of the augmentation to their immediate abilities, but only one of them is suffering by it.
We’ll let her explain how to leverage this:
TED ideas | Here’s how you can handle stress like a lion, not a gazelle | Dr. Elissa Epel
Build resilience through controlled discomfort
Don’t worry, you don’t have to get chased by lions. A cold shower will do it! This is about making use of hormesis, the body’s ability to build resilience to stressors by small doses of controlled cortisol release—as for example when one undergoes thermal shock, which sounds drastic, but for most people, a cold shower (or even an ice bath) is safe enough.
You can read more about this here:
A Cold Shower A Day Keeps The Doctor Away
Connect with nature
You don’t have to hug a tree, but you do have get to a natural (or at least, natural-seeming) environment once in a while. Simply put, we did not evolve to be in the urban or even suburban settings where most of us spend most of our time. Getting to be around greenery with at least some kind of regularity is hugely beneficial. It doesn’t have to be a national park; a nice garden or local park can suffice, and potted plants at home are better than nothing. Even spending time in virtual reality “nature” is an option:
(you can see an example there, of the kind of scenery this study used)
Breathe deeply, and rest deeply
Mindful breathing, and good quality sleep, are very strongly evidence-based approaches to reduce stress, for example:
Practice gratitude to build optimism
Optimism has a huge positive impact on health outcomes, even when other factors (including socioeconomic factors, pre-existing conditions, and general reasons for one person to be more optimistic than another) are controlled for.
Read: Optimism and Cause-Specific Mortality: A Prospective Cohort Study
There are various ways to increase optimism, and practising gratitude is one of them—but that doesn’t necessarily mean abandoning realism, either:
How To Practise (Non-Toxic) Positivity
There are other ways too, though, and Dr. Epel discusses some with her friend and colleague, Dr. Elizabeth Blackburn, here:
Want to learn more from Dr. Epel?
We reviewed one of her books, The Telomere Effect, previously. It’s about what we can do to lengthen our telomeres (a key factor in health aging; effectively, being biologically younger). You also might enjoy her newer book, The Stress Prescription, as well as her blog.
Enjoy!
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ADHD medication – can you take it long term? What are the risks and do benefits continue?
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Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.
But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.
What are ADHD medications?
The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).
There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.
How stimulants work
Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.
Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.
For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.
One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.
What about side effects?
The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.
These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.
This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.
Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.
Will medication be needed long term?
Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.
People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.
In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.
Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.
Medication is usually prescribed by a specialist but rules differ around Australia.
Ground Picture/ShutterstockToo many prescriptions?
ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.
In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.
There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).
Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.
Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Gut Health 2.0
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Gene Expression & Gut Health
This is Dr. Tim Spector. After training in medicine and becoming a consultant rheumatologist, he’s turned his attention to medical research, and is these days a specialist in twin studies, genetics, epigenetics, microbiome, and diet.
What does he want us to know?
For one thing: epigenetics are for more than just getting your grandparents’ trauma.
More usefully: there are things we can do to improve epigenetic factors in our body
DNA is often seen as the script by which our body does whatever it’s going to do, but it’s only part of the story. Thinking of DNA as some kind of “magical immutable law of reality” overlooks (to labor the metaphor) script revisions, notes made in the margins, directorial choices, and ad-lib improvizations, as well as the quality of the audience’s hearing and comprehension.
Hence the premise of one of Dr. Spector’s older books, “Identically Different: Why We Can Change Our Genes”
(*in fact, it was his first, from all the way back in 2013, when he’d only been a doctor for 34 years)
Gene expression will trump genes every time, and gene expression is something that can often be changed without getting in there with CRISPR / a big pair of scissors and some craft glue.
How this happens on the micro level is beyond the scope of today’s article; part of it has to do with enzymes that get involved in the DNA transcription process, and those enzymes in turn are despatched or not depending on hormonal messaging—in the broadest sense of “hormonal”; all the body’s hormonal chemical messengers, not just the ones people think of as hormones.
However, hormonal messaging (of many kinds) is strongly influenced by something we can control relatively easily with a little good (science-based) knowledge: the gut.
The gut, the SAD, and the easy
In broad strokes: we know what is good for the gut. We’ve written about it before at 10almonds:
Making Friends With Your Gut (You Can Thank Us Later)
This is very much in contrast with what in scientific literature is often abbreviated “SAD”, the Standard American Diet, which is very bad for the gut.
However, Dr. Spector (while fully encouraging everyone to enjoy an evidence-based gut-healthy diet) wanted to do one better than just a sweeping one-size-fits-all advice, so he set up a big study with 15,000 identical twins; you can read about it here: TwinsUK
The information that came out of that was about a lot more than just gene expression and gut health, but it did provide the foundation for Dr. Spector’s next project, ZOE.
ZOE crowdsources huge amounts of data including individual metabolic responses to standardized meals in order to predict personalized food responses based on individual biology and unique microbiome profile.
In other words, it takes the guesswork out of a) knowing what your genes mean for your food responses b) tailoring your food choices with your genetic expression in mind, and c) ultimately creating a positive feedback loop to much better health on all levels.
Now, this is not an ad for ZOE, but if you so wish, you can…
- Get the free ZOE gut health guide (this is good, but generic, gut health information)
- Take the ZOE home gut health test (quiz followed by offers of lab tests)
- Browse the ZOE Health Academy, its education wing
Want to know more?
Dr. Spector has a bunch of books out, including some that we’ve reviewed previously:
- Spoon-Fed: Why Almost Everything We’ve Been Told About Food Is Wrong
- The Diet Myth: The Real Science Behind What We Eat
- Food for Life: The New Science of Eating Well
You can also check out our own previous main feature, which wasn’t about Dr. Spector’s work but was very adjacent:
The Brain-Gut Highway: A Two-Way Street
Enjoy!
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