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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Shame and blame can create barriers to vaccination
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Understanding the stigma surrounding infectious diseases like HIV and mpox may help community health workers break down barriers that hinder access to care.
Looking back in history can provide valuable lessons to confront stigma in health care today, especially toward Black, Latine, LGBTQ+, and other historically underserved communities disproportionately affected by COVID-19 and HIV.
Public Good News spoke with Sam Brown, HIV prevention and wellness program manager at Civic Heart, a community-based organization in Houston’s historic Third Ward, to understand the effects of stigma around sexual health and vaccine uptake.
Brown shared more about Civic Heart’s efforts to provide free confidential testing for sexually transmitted infections, counseling and referrals, and information about COVID-19, flu, and mpox vaccinations, as well as the lessons they’re learning as they strive for vaccine equity.
Here’s what Brown said.
[Editor’s note: This content has been edited for clarity and length.]
PGN: Some people on social media have spread the myth that vaccines cause AIDS or other immune deficiencies when the opposite is true: Vaccines strengthen our immune systems to help protect against disease. Despite being frequently debunked, how do false claims like these impact the communities you serve?
Sam Brown: Misinformation like that is so hard to combat. And it makes the work and the path to overall community health hard because people will believe it. In the work that we do, 80 percent of it is changing people’s perspective on something they thought they knew.
You know, people don’t even transmit AIDS. People transmit HIV. So, a vaccine causing immunodeficiency doesn’t make sense.
With the communities we serve, we might have a person that will believe the myth, and because they believe it, they won’t get vaccinated. Then later, they may test positive for COVID-19.
And depending on social determinants of health, it can impact them in a whole heap of ways: That person is now missing work, they’re not able to provide for their family—if they have a family. It’s this mindset that can impact a person’s life, their income, their ability to function.
So, to not take advantage of something like a vaccine that’s affordable, or free for the most part, just because of misinformation or a misunderstanding—that’s detrimental, you know.
For example, when we talk to people in the community, many don’t know that they can get mpox from their pet, or that it’s zoonotic—that means that it can be transferred between different species or different beings, from animals to people. I see a lot of surprise and shock [when people learn this].
It’s difficult because we have to fight the misinformation and the stigma that comes with it. And it can be a big barrier.
People misunderstand. [They] think that “this is something that gay people or the LGBTQ+ community get,” which is stigmatizing and comes off as blaming. And blaming is the thing that leads us to be misinformed.
PGN: In the last couple years, your organization’s HIV Wellness program has taken on promoting COVID-19, flu, and mpox vaccines to the communities you serve. How do you navigate conversations between sexual health and infectious diseases? Can you share more about your messaging strategies?
S.B.: As we promoted positive sexual health and HIV prevention, we saw people were tired of hearing about HIV. They were tired of hearing about how PrEP works, or how to prevent HIV.
But, when we had an outbreak of syphilis in Houston just last year, people were more inclined to test because of the severity of the outbreak.
So, what our team learned is that sometimes you have to change the message to get people what they need.
We changed our message to highlight more syphilis information and saw that we were able to get more people tested for HIV because we correlated how syphilis and HIV are connected and how a person can be susceptible to both.
Using messages that the community wants and pairing them with what the community needs has been better for us. And we see that same thing with COVID-19, the flu, and RSV. Sometimes you just can’t be married to a message. We’ve had to be flexible to meet our clients where they are to help them move from unsafe practices to practices that are healthy and good for them and their communities.
PGN: You’ve mentioned how hard it is to combat stigma in your work. How do you effectively address it when talking to people one-on-one?
S.B.: What I understand is that no one wants to feel shame. What I see people respond to is, “Here’s an opportunity to do something different. Maybe there was information that you didn’t know that caused you to make a bad decision. And now here’s an opportunity to gain information so that you can make a better decision.”
People want to do what they want to do; they want to live how they want to live. And we all should be able to do that as long as it’s not hurting anyone, but also being responsible enough to understand that, you know, COVID-19 is here.
So, instead of shaming and blaming, it’s best to make yourself aware and understand what it is and how to treat it. Because the real enemy is the virus—it’s the infection, not the people.
When we do our work, we want to make sure that we come from a strengths-based approach. We always look at what a client can do, what that client has. We want to make sure that we’re empowering them from that point. So, even if they choose not to prioritize our message right now, we can’t take that personally. We’ll just use it as a chance to try a new way of framing it to help people understand what we’re trying to say.
And sometimes that can be difficult, even for organizations. But getting past that difficulty comes with a greater opportunity to impact someone else.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Ham Substitute in Bean Soup
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
I am interested in what I can substitute for ham in bean soup?
Well, that depends on what the ham was like! You can certainly buy ready-made vegan lardons (i.e. small bacon/ham bits, often in tiny cubes or similar) in any reasonably-sized supermarket. Being processed, they’re not amazing for the health, but are still an improvement on pork.
Alternatively, you can make your own seitan! Again, seitan is really not a health food, but again, it’s still relatively less bad than pork (unless you are allergic to gluten, in which case, definitely skip this one).
Alternatively alternatively, in a soup that already contains beans (so the protein element is already covered), you could just skip the ham as an added ingredient, and instead bring the extra flavor by means of a little salt, a little yeast extract (if you don’t like yeast extract, don’t worry, it won’t taste like it if you just use a teaspoon in a big pot, or half a teaspoon in a smaller pot), and a little smoked paprika. If you want to go healthier, you can swap out the salt for MSG, which enhances flavor in a similar fashion while containing less sodium.
Wondering about the health aspects of MSG? Check out our main feature on this, from last month:
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Basic Baked Tofu
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One of the main criticisms of tofu is that it is tasteless. Well, so is flour, but you’re not supposed to eat it plain, and the same goes for tofu. It’s a blank canvas that you get to decide what to do with—not to mention, it’s a canvas that’s very high in protein, and is a complete protein too, containing all essential amino acids. Anyway, here’s a starter recipe that elevates tofu from “nutrition” to “nutritious tasty snack”!
We were going to do a fancier recipe today, but considered that it might be judicious to cover this basic element first, that can be incorporated into a larger recipe later, a bit like we have done with recipes such as our Tasty Versatile Rice, and Plant-Based Healthy Cream Cheese (amongst others).
You will need
- 1 block of extra-firm tofu; these are quite standardized in size; it should be about 12oz; don’t worry if it’s a little more or less.
- 2 tbsp arrowroot powder (or potato starch if you don’t have arrowroot)
- 1½ tbsp extra virgin olive oil
- 1 tbsp nutritional yeast
- 1 tsp black pepper
- ½ tsp MSG or 1 tsp low-sodium salt
- Optional: ½ tsp garlic powder
- Optional: ½ tsp ground turmeric
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 425ºF / 220ºC.
2) Press the tofu for about 15 minutes (to remove excess moisture), using a tofu press if you have one. If you don’t, then here is an example product on Amazon, or alternatively, you can go with the time-honored tradition of cutting the tofu lengthways into slabs, and wrapping it in a lint-free kitchen towel or muslin cloth, and pressing it with heavy books. We don’t recommend pressing for more than about 15 minutes, as you are going to bake the tofu so you don’t want it too dry going in.
3) Cut the tofu into cubes. Size is up to you, but half-inch cubes are very respectable.
4) Combine the tofu cubes in a big bowl with the oil and seasonings, including the nutritional yeast but not the arrowroot powder or potato starch yet. You will need to toss them gently (very gently; they are fragile!) to combine.
5) Add the arrowroot powder or potato starch, and again toss gently to combine. We do this last, because it would stop the other things from sticking properly if we did it earlier.
6) Arrange the tofu on a baking tray lined with baking paper, in a single layer so that the cubes don’t touch. Bake for 15 minutes, turn them over, and bake for a further 15 minutes on the other side. They should now be golden and crisp, but if they’re not, just give them a little more time.
7) Serve as a snack, or set aside for whatever else you’re going to do with them in a larger more complex recipe.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Tofu vs Seitan – Which is Healthier?
- Plant vs Animal Protein: Head to Head
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Strawberries vs Raspberries – Which is Healthier?
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Our Verdict
When comparing strawberries to raspberries, we picked the raspberries.
Why?
They’re both very respectable fruits, of course! But it’s not even close, and there is a clear winner here…
In terms of macros, the biggest difference is that raspberries have moderately more carbs, and more than 3x the fiber. Technically they also have 2x the protein, but that’s a case of “two times almost nothing is still almost nothing”. All in all, and especially for the “more than 3x the fiber” (6.5g/100g to strawberries’ 2g/100g), this one’s an easy win for raspberries.
When it comes to vitamins, strawberries have more vitamin C, while raspberries have more of vitamins A, B1, B2, B3, B5, B6, E, K, and choline. Another clear and easy win for raspberries.
In the category of minerals, guess what, raspberries win this hands-down, too: strawberries are higher in selenium, while raspberries have more calcium, copper, iron, magnesium, manganese, phosphorus, and zinc.
Adding up all the individual wins (all for raspberries), it’s not hard to say that raspberries win the day. Still, of course, enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Tomatoes vs Carrots – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing tomatoes to carrots, we picked the carrots.
Why?
Both known for being vitamin-A heavyweights, there is nevertheless a clear winner:
In terms of macros, carrots have a little over 2x the carbs, and/but also a little over 2x the fiber, so we consider category this a win for carrots.
In the category of vitamins, tomatoes have more vitamin C, while carrots have more of vitamins A, B1, B2, B3, B5, B6, B9, E, K, and choline. And about that vitamin A specifically: carrots have over 20x the vitamin A of tomatoes. An easy win for carrots here!
When it comes to minerals, tomatoes have a little more copper, while carrots have more calcium, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Another clear win for carrots.
Looking at polyphenols, carrots are good but tomatoes have more, including a good healthy dose of quercetin; they also have more lycopene, not technically a polyphenol by virtue of its chemical structure (it’s a carotenoid), but a powerful phytochemical nonetheless (and much more prevalent in sun-dried tomatoes, in any case, which is not what we were looking at today—perhaps another day we’ll do sun-dried tomatoes and carrots head-to-head!).
Still, a) carrots are not short of carotenoids either (including lycopene), and b) we don’t think the moderate win on polyphenols is enough to outdo carrots having won all the other categories.
All in all, carrots win the day, but of course, do enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
Lycopene’s Benefits For The Gut, Heart, Brain, & More
Enjoy!
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Pink Himalayan Salt: Health Facts
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It’s Q&A Day at 10almonds!
Q: Great article about the health risks of salt to organs other than the heart! Is pink Himalayan sea salt, the pink kind, healthier?
Thank you! And, no, sorry. Any salt that is sodium chloride has the exact same effect because it’s chemically the same substance, even if impurities (however pretty) make it look different.
If you want a lower-sodium salt, we recommend the kind that says “low sodium” or “reduced sodium” or similar. Check the ingredients, it’ll probably be sodium chloride cut with potassium chloride. Potassium chloride is not only not a source of sodium, but also, it’s a source of potassium, which (unlike sodium) most of us could stand to get a little more of.
For your convenience: here’s an example on Amazon!
Bonus: you can get a reduced sodium version of pink Himalayan salt too!
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