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.

As we enter a new year armed with resolutions to improve our lives, there’s a good chance we’ll also be carrying something less helpful: extra kilos. At least half a kilogram, to be precise.

“Weight creep” doesn’t have to be inevitable. Here’s what’s behind this sneaky annual occurrence and some practical steps to prevent it.

Small gains add up

Adults tend to gain weight progressively as they age and typically gain an average of 0.5 to 1kg every year.

While this doesn’t seem like much each year, it amounts to 5kg over a decade. The slow-but-steady nature of weight creep is why many of us won’t notice the extra weight gained until we’re in our fifties.

Why do we gain weight?

Subtle, gradual lifestyle shifts as we progress through life and age-related biological changes cause us to gain weight. Our:

• activity levels decline. Longer work hours and family commitments can see us become more sedentary and have less time for exercise, which means we burn fewer calories
• diets worsen. With frenetic work and family schedules, we sometimes turn to pre-packaged and fast foods. These processed and discretionary foods are loaded with hidden sugars, salts and unhealthy fats. A better financial position later in life can also result in more dining out, which is associated with a higher total energy intake
• sleep decreases. Busy lives and screen use can mean we don’t get enough sleep. This disturbs our body’s energy balance, increasing our feelings of hunger, triggering cravings and decreasing our energy

• stress increases. Financial, relationship and work-related stress increases our body’s production of cortisol, triggering food cravings and promoting fat storage
• metabolism slows. Around the age of 40, our muscle mass naturally declines, and our body fat starts increasing. Muscle mass helps determine our metabolic rate, so when our muscle mass decreases, our bodies start to burn fewer calories at rest.

We also tend to gain a small amount of weight during festive periods – times filled with calorie-rich foods and drinks, when exercise and sleep are often overlooked. One study of Australian adults found participants gained 0.5 kilograms on average over the Christmas/New Year period and an average of 0.25 kilograms around Easter.

Why we need to prevent weight creep

It’s important to prevent weight creep for two key reasons:

1. Weight creep resets our body’s set point

Set-point theory suggests we each have a predetermined weight or set point. Our body works to keep our weight around this set point, adjusting our biological systems to regulate how much we eat, how we store fat and expend energy.

When we gain weight, our set point resets to the new, higher weight. Our body adapts to protect this new weight, making it challenging to lose the weight we’ve gained.

But it’s also possible to lower your set point if you lose weight gradually and with an interval weight loss approach. Specifically, losing weight in small manageable chunks you can sustain – periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight.

2. Weight creep can lead to obesity and health issues

Undetected and unmanaged weight creep can result in obesity which can increase our risk of heart disease, strokes, type 2 diabetes, osteoporosis and several types of cancers (including breast, colorectal, oesophageal, kidney, gallbladder, uterine, pancreatic and liver).

A large study examined the link between weight gain from early to middle adulthood and health outcomes later in life, following people for around 15 years. It found those who gained 2.5 to 10kg over this period had an increased incidence of type 2 diabetes, heart disease, strokes, obesity-related cancer and death compared to participants who had maintained a stable weight.

Fortunately, there are steps we can take to build lasting habits that will make weight creep a thing of the past.

7 practical steps to prevent weight creep

1. Eat from big to small

Aim to consume most of your food earlier in the day and taper your meal sizes to ensure dinner is the smallest meal you eat.

A low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day.

We burn the calories from a meal 2.5 times more efficiently in the morning than in the evening. So emphasising breakfast over dinner is also good for weight management.

2. Use chopsticks, a teaspoon or an oyster fork

Sit at the table for dinner and use different utensils to encourage eating more slowly.

This gives your brain time to recognise and adapt to signals from your stomach telling you you’re full.

3. Eat the full rainbow

Fill your plate with vegetables and fruits of different colours first to support eating a high-fibre, nutrient-dense diet that will keep you feeling full and satisfied.

Meals also need to be balanced and include a source of protein, wholegrain carbohydrates and healthy fat to meet our dietary needs – for example, eggs on wholegrain toast with avocado.

4. Reach for nature first

Retrain your brain to rely on nature’s treats – fresh vegetables, fruit, honey, nuts and seeds. In their natural state, these foods release the same pleasure response in the brain as ultra-processed and fast foods, helping you avoid unnecessary calories, sugar, salt and unhealthy fats.

5. Choose to move

Look for ways to incorporate incidental activity into your daily routine – such as taking the stairs instead of the lift – and boost your exercise by challenging yourself to try a new activity.

Just be sure to include variety, as doing the same activities every day often results in boredom and avoidance.

6. Prioritise sleep

Set yourself a goal of getting a minimum of seven hours of uninterrupted sleep each night, and help yourself achieve it by avoiding screens for an hour or two before bed.

7. Weigh yourself regularly

Getting into the habit of weighing yourself weekly is a guaranteed way to help avoid the kilos creeping up on us. Aim to weigh yourself on the same day, at the same time and in the same environment each week and use the best quality scales you can afford.

At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.

Nick Fuller, Clinical Trials Director, Department of Endocrinology, RPA Hospital, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.