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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Avoiding/Managing Osteoarthritis
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Avoiding/Managing Osteoarthritis
Arthritis is the umbrella term for a cluster of joint diseases involving inflammation of the joints, hence “arthr-” (joint) “-itis” (suffix used to denote inflammation).
Inflammatory vs Non-Inflammatory Arthritis
Arthritis is broadly divided into inflammatory arthritis and non-inflammatory arthritis.
Some forms, such as rheumatoid arthritis, are of the inflammatory kind. We wrote about that previously:
See: Avoiding/Managing Rheumatoid Arthritis
You may be wondering: how does one get non-inflammatory inflammation of the joints?
The answer is, in “non-inflammatory” arthritis, such as osteoarthritis, the damage comes first (by general wear-and-tear) and inflammation generally follows as part of the symptoms, rather than the cause.
So the name can be a little confusing. In the case of osteo- and other “non-inflammatory” forms of arthritis, you definitely still want to keep your inflammation at bay as best you can; it’s just not the prime focus.
So, what should we focus on?
First and foremost: avoiding wear-and-tear if possible. Naturally, we all must live our lives, and sometimes that means taking a few knocks, and definitely it means using our joints. An unused joint would suffer just as much as an abused one. But, we can take care of our joints!
We wrote on that previously, too:
See: How To Really Look After Your Joints
New osteoarthritis medication (hot off the press!)
At 10almonds, we try to keep on top of new developments, and here’s a shiny new one from this month:
- Methotrexate to treat hand osteoarthritis with synovitis (12th Oct, clinical trial)
- New research has found an existing drug could help many people with painful hand osteoarthritis (24th Oct, pop-science article about the above, but still written by one of the study authors!)
Note also that Dr. Flavia Cicuttini there talks about what we talked about above—that calling it non-inflammatory arthritis is a little misleading, as the inflammation still occurs.
And finally…
You might consider other lifestyle adjustments to manage your symptoms. These include:
- Exercise—gently, though!
- Rest—while keeping mobility going.
- Mobility aids—if it helps, it helps.
- Go easy on the use of braces, splints, etc—these can offer short-term relief, but at a long term cost of loss of mobility.
- Only you can decide where to draw the line when it comes to that trade-off.
You can also check out our previous article:
See: Managing Chronic Pain (Realistically!)
Take good care of yourself!
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Sleep wrinkles are real. Here’s how they leave their mark
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You wake up, stagger to the bathroom and gaze into the mirror. No, you’re not imagining it. You’ve developed face wrinkles overnight. They’re sleep wrinkles.
Sleep wrinkles are temporary. But as your skin loses its elasticity as you age, they can set in.
Here’s what you can do to minimise the chance of them forming in the first place.
How side-sleeping affects your face
Your skin wrinkles for a number of reasons, including ageing, sun damage, smoking, poor hydration, habitual facial expressions (such as grinning, pouting, frowning, squinting) and sleeping positions.
When you sleep on your side or stomach, your face skin is squeezed and crushed a lot more than if you sleep on your back. When you sleep on your side or stomach, gravity presses your face against the pillow. Your face skin is distorted as your skin is stretched, compressed and pulled in all directions as you move about in your sleep.
You can reduce these external forces acting on the face by sleeping on your back or changing positions frequently.
Doctors can tell which side you sleep on by looking at your face
In a young face, sleep wrinkles are transient and disappear after waking.
Temporary sleep wrinkles can become persistent with time and repetition. As we age, our skin loses elasticity (recoil) and extensibility (stretch), creating ideal conditions for sleep wrinkles or lines to set in and last longer.
The time spent in each sleeping position, the magnitude of external forces applied to each area of the face, as well as the surface area of contact with the pillow surface, also affects the pattern and rate of sleep wrinkle formation.
Skin specialists can often recognise this. People who favour sleeping on one side of their body tend to have a flatter face on their sleeping side and more visible sleep lines.
Can a night skincare routine avoid sleep wrinkles?
Collagen and elastin are two primary components of the dermis (inner layer) of skin. They form the skin structure and maintain the elasticity of skin.
The dermis is the inner layer of skin. mermaid3/Shutterstock Supplementing collagen through skincare routines to enhance skin elasticity can help reduce wrinkle formation.
Hyaluronic acid is a naturally occurring molecule in human bodies. It holds our skin’s collagen and elastin in a proper configuration, stimulates the production of collagen and adds hydration, which can help slow down wrinkle formation. Hyaluronic acid is one of the most common active ingredients in skincare creams, gels and lotions.
Moisturisers can hydrate the skin in different ways. “Occlusive” substances produce a thin layer of oil on the skin that prevents water loss due to evaporation. “Humectants” attract and hold water in the skin, and they can differ in their capacity to bind with water, which influences the degree of skin hydration.
Do silk pillowcases actually make a difference?
Can they help? New Africa/Shutterstock Silk pillowcases can make a difference in wrinkle formation, if they let your skin glide and move, rather than adding friction and pressure on a single spot. If you can, use silk sheets and silk pillows.
Studies have also shown pillows designed to reduce mechanical stress during sleep can prevent skin deformations. Such a pillow could be useful in slowing down and preventing the formation of certain facial wrinkles.
Sleeping on your back can reduce the risk of sleep lines, as can a nighttime routine of moisturising before sleep.
Otherwise, lifestyle choices and habits, such quitting smoking, drinking plenty of water, a healthy diet (eating enough vegetables, fruits, nuts, seeds, healthy fats, yogurt and other fermented foods) and regular use of sunscreens can help improve the appearance of the skin on our face.
Yousuf Mohammed, Dermatology researcher, The University of Queensland; Khanh Phan, Postdoctoral Research Fellow, Frazer Institute, The University of Queensland, and Vania Rodrigues Leite E. Silva, Honorary Associate Professor, Frazer Institute, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Modern Art and Science of Mobility – by Aurélien Broussal-Derval
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We’ve reviewed mobility books before, so what makes this one stand out?
We’ll be honest: the illustrations are lovely.
The science, the information, the exercises, the routines, the programs… All these things are excellent too, but these can be found in many a book.
What can’t usually be found is very beautiful (yet no less clear) watercolor paintings and charcoal sketches as anatomical illustrations.
There are photos too (also of high quality), but the artistry of the paintings and sketches is what makes the reader want to spend time perusing the books.
At least, that’s what this reviewer found! Because it’s all very well having access to a lot of information (and indeed, I read so much), but making it enjoyable increases the chances of rereading it much more often.
As for the rest of the content, the book’s information is divided in categories:
- Pain (what causes it, what it means, and how to manage it)
- Breathing (yes, a whole section devoted to this, and it is aligned heavily to posture also, as well as psychological state and the effect of stress on tension, inflammation, and more)
- Movement (this is mostly about kinds of movement and ranges of movement)
- Mobility (this is about aggregating movements as a fully mobile human)
So, each builds on from the previous because any pain needs addressing before anything else, breathing (and with it, posture) comes next, then we learn about movement, then we bring it all together for mobility.
Bottom line: this is a beautiful and comprehensive book that will make learning a joy
Click here to check out The Modern Art and Science of Mobility, and learn and thrive!
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The SharpBrains Guide to Brain Fitness – by Alvaro Fernandez et al.
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We say “et al.” in the by-line, because this one has a flock of authors, including Dr. Pascale Michelon, Dr. Sandra Bond Chapman, Dr. Elkehon Goldberg, and various others if we include the foreword, introduction, etc.
This is relevant, because those who contributed to the meat of the book (i.e., those listed above), it makes the work a lot more scientifically reliable; one skilled science writer might make a mistake; it’s much less likely to make it through to publication when there are a bevy of doctors in the mix, each staking their reputation on the book’s content, and thus having a vested interest in checking each other’s work as well as their own.
As for what this multidisciplinary team have to offer? The book covers such things as:
- how the brain works (especially the possibilities of neuroplasticity), and what that means for such things as memory and attention
- being “a coach not a patient”; i.e., being active rather than passive in one’s approach to brain health
- the relevance of physical exercise, how much, and what kind
- the relevance (and limitations) of diet choices for brain health
- the relevance of such things as learning new languages and musical training
- the relevance of social engagement, and how some (but not all) social engagement can boost cognition
- methods for managing stress and building resilience to same (critical for maintaining a healthy brain)
- “cross-fit for your brain”, that is to say, a multi-vector collection of tools to explore, ranging from meditation to CBT to biofeedback and more.
The style is pop-science without being sensationalist, just communicating ideas clearly, with enough padding to feel casual, and not like a dense read. Importantly, it’s also practical and applicable too, which is something we always look for here.
Bottom line: if you’d like to be given a good overview of what things work (and how much they can be expected to work), along with a good framework to put that knowledge into practice, then this is a great book for you.
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The Real Benefit Of Genetic Testing
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Genetic Testing: Health Benefits & Methods
Genetic testing is an oft-derided American pastime, but there’s a lot more to it than finding out about your ancestry!
Note: because there are relatively few companies offering health-related genetic testing services, and we are talking about the benefits of those services, some of this main feature may seem like an advert.
It’s not; none of those companies are sponsoring us, and if any of them become a sponsor at some point, we’ll make it clear and put it in the clearly-marked sponsor segment.
As ever, our only goal here is to provide science-backed information, to enable you to make your own, well-informed, decisions.
Health genomics & genetic testing
The basic goal of health genomics and genetic testing is to learn:
- What genetic conditions you have
- Clearcut genetic conditions, such as Fragile X syndrome, or Huntington’s disease
- What genetic predispositions you have
- Such as an increased/decreased risk for various kinds of cancer, diabetes, heart conditions, and so forth
- What genetic traits you have
- These may range from “blue eyes” to “superathlete muscle type”
- More specifically, pharmacogenomic information
- For example, “fast caffeine metabolizer” or “clopidogrel (Plavix) non-responder” (i.e., that drug simply will not work for you)
Wait, what’s the difference between health genomics and genetic testing?
- Health genomics is the science of how our genes affect our health.
- Genetic testing can be broadly defined as the means of finding out which genes we have.
A quick snippet…
More specifically, a lot of these services look at which single nucleotide polymorphisms (SNPs, pronounced “snips”) we have. While we share almost all of our DNA with each other (and indeed, with most vertebrates), our polymorphisms are the bits that differ, and are the bits that, genetically speaking, make us different.
So, by looking just at the SNPs, it means we “only” need to look at about 3,000,000 DNA positions, and not our entire genome. For perspective, those 3,000,000 DNA positions make up about 0.1% of our whole genome, so without focusing on SNPs, the task would be 1000x harder.
For example, the kind of information that this sort of testing may give you, includes (to look at some “popular” SNPs):
- rs53576 in the oxytocin receptor influences social behavior and personality
- rs7412 and rs429358 can raise the risk of Alzheimer’s disease by more than 10x
- rs6152 can influence baldness
- rs333 resistance to HIV
- rs1800497 in a dopamine receptor may influence the sense of pleasure
- rs1805007 determines red hair and sensitivity to anesthetics
- rs9939609 triggers obesity and type-2 diabetes
- rs662799 prevents weight gain from high fat diets
- rs12255372 linked to type-2 diabetes and breast cancer
- rs1799971 makes alcohol cravings stronger
- rs17822931 determines earwax, sweating and body odor
- rs1333049 coronary heart disease
- rs1051730 and rs3750344 nicotine dependence
- rs4988235 lactose intolerance
(You can learn about these and more than 100,000 other SNPs at SNPedia.com)
I don’t know what SNPs I have, and am disinclined to look them up one by one!
The first step to knowing, is to get your DNA out of your body and into a genetic testing service. This is usually done by saliva or blood sample. This writer got hers done many years ago by 23andMe and was very happy with that service, but there are plenty of other options.
Healthline did an independent review of the most popular companies, so you might like to check out:
Healthline: Best DNA Testing Kits of 2023
Those companies will give you some basic information, such as “6x higher breast cancer risk” or “3x lower age-related macular degeneration risk” etc.
However, to really get bang-for-buck, what you want to do next is:
- Get your raw genetic data (the companies above should provide it); this will probably look like a big text file full of As, Cs, Gs, and Ts, but it make take another form.
- Upload it to Promethease. When this writer got hers done , the cost was $2; that price has now gone up to a whopping $12.
- You will then get a report that will cross-reference your data with everything known about SNPs, and give a supremely comprehensive, readable-to-the-human-eye, explanation of what it all means for you—from much more specific health risk prognostics, to more trivial things like whether you can roll your tongue or smell decomposed asparagus metabolites in urine.
A note on privacy: anything you upload to Promethease will be anonymized, and/but in doing so, you consent to it going into the grand scientific open-source bank of “things we know about the human genome”, and thus contribute to the overall sample size of genetic data.
In our opinion, it means you’re doing your bit for science, without personal risk. But your opinion may differ, and that’s your decision to make.
Lastly, on the pros and cons of pharmacogenetic testing specifically:
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- What genetic conditions you have
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10almonds Tells The Tea…
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Let’s Bust Some Myths!
It’s too late after puberty, hormones won’t change xyz
While yes, many adult trans people dearly wish they’d been able to medically transition before going through the “wrong” puberty, the truth is that a lot of changes will still occur later… even to “unchangeable” things like the skeleton.
The body is remaking itself throughout life, and hormones tell it how to do that. Some parts are just quicker or slower than others. Also: the skeleton is pulled-on constantly by our muscles, and in a battle of muscle vs bone, muscle will always win over time.
Examples of this include:
- trans men building bigger bones to support their bigger muscles
- trans women getting smaller, with wider hips and a pelvic tilt
Trans people have sporting advantages
Assuming at least a year’s cross-sex hormonal treatment, there is no useful advantage to being trans when engaging in a sport. There are small advantages and disadvantages (which goes for any person’s body, really). For example:
- Trans women will tend to be taller than cis women on average…
- …but that larger frame is now being powered by smaller muscles, because they shrink much quicker than the skeleton.
- Trans men taking T are the only athletes allowed to take testosterone…
- …but they will still often be smaller than their fellow male competitors, for example.
Read: Do Trans Women Athletes Have Advantages? (A rather balanced expert overview, which does also cover trans men)
There’s a trans population explosion; it’s a social contagion epidemic!
Source for figures: The Overall Rate Of Left-Handedness (Researchgate)
Left-handed people used to make up around 3% of the population… Until the 1920s, when that figure jumped sharply upwards, before plateauing at around 12% in around 1960, where it’s stayed since. What happened?! Simple, schools stopped forcing children to use their right hand.
Today, people ask for trans healthcare because they know it exists! Decades ago, it wasn’t such common knowledge.
The same explanation can be applied to other “population explosions” such as for autism and ADHD.
Fun fact: Mt. Everest was “discovered” in 1852, but scientists suspect it probably existed long before then! People whose ancestors were living on it long before 1852 also agree. Sometimes something exists for a long time, and only comes to wider public awareness later.
Transgender healthcare is too readily available, especially to children!
To believe some press outlets, you’d think:
- HRT is available from school vending machines,
- kids can get a walk-in top surgery at recess,
- and there’s an after-school sterilization club.
In reality, while availability varies from place to place, trans healthcare is heavily gatekept. Even adults have trouble getting it, often having to wait years and/or pay large sums of money… and get permission from a flock of doctors, psychologists, and the like. For those under the age of 18, it’s almost impossible in many places, even with parental support.
Puberty-blockers shouldn’t be given to teenagers, as the effects are irreversible
Quick question: who do you think should be given puberty-blockers? For whom do you think they were developed? Not adults, for sure! They were not developed for trans teens either, but for cis pre-teens with precocious puberty, to keep puberty at bay, to do it correctly later. Nobody argues they’re unsafe for much younger cis children, and only object when it’s trans teens.
They’re not only safe and reversible, but also self-reversing. Stop taking them, and the normally scheduled puberty promptly ensues by itself. For trans kids, the desired effect is to buy the kid time to make an informed and well-considered decision. After all, the effects of the wrong puberty are really difficult to undo!
A lot of people rush medical transition and regret it!
Trans people wish it could be rushed! It’s a lot harder to get gender-affirming care as a trans person, than it is to get the same (or comparable) care as a cis person. Yes, cis people get gender-affirming care, from hormones to surgeries, and have done for a long time.
As for regret… Medical transition has around a 1% regret rate. For comparison, hip replacement has a 4.8% regret rate and knee replacement has a 17.1% regret rate.
A medical procedure with a 99% success rate would generally be considered a miracle cure!
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