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.

If you or a loved one have noticed changes in your memory or thinking as you’ve grown older, this could reflect typical changes that occur with ageing. In some cases though, it might suggest something more, such as the onset of dementia.

The best thing to do if you have concerns is to make an appointment with your GP, who will probably run some tests. Assessment is important because if there is something more going on, early diagnosis can enable prompt access to the right interventions, supports and care.

But current methods of dementia screening have limitations, and testing can be daunting for patients.

Our research suggests virtual reality (VR) could be a useful cognitive screening tool, and mitigate some of the challenges associated with current testing methods, opening up the possibility it may one day play a role in dementia diagnosis.

Where current testing is falling short

If someone is worried about their memory and thinking, their GP might ask them to complete a series of quick tasks that check things like the ability to follow simple instructions, basic arithmetic, memory and orientation.

These sorts of screening tools are really good at confirming cognitive problems that may already be very apparent. But commonly used screening tests are not always so good at detecting early and more subtle difficulties with memory and thinking, meaning such changes could be missed until they get worse.

A clinical neuropsychological assessment is better equipped to detect early changes. This involves a comprehensive review of a patient’s personal and medical history, and detailed assessment of cognitive functions, including attention, language, memory, executive functioning, mood factors and more. However, this can be costly and the testing can take several hours.

Testing is also somewhat removed from everyday experience, not directly tapping into activities of daily living.

Enter virtual reality

VR technology uses computer-generated environments to create immersive experiences that feel like real life. While VR is often used for entertainment, it has increasingly found applications in health care, including in rehabilitation and falls prevention.

Using VR for cognitive screening is still a new area. VR-based cognitive tests generally create a scenario such as shopping at a supermarket or driving around a city to ascertain how a person would perform in these situations.

Notably, they engage various senses and cognitive processes such as sight, sound and spatial awareness in immersive ways. All this may reveal subtle impairments which can be missed by standard methods.

VR assessments are also often more engaging and enjoyable, potentially reducing anxiety for those who may feel uneasy in traditional testing environments, and improving compliance compared to standard assessments.

Most studies of VR-based cognitive tests have explored their capacity to pick up impairments in spatial memory (the ability to remember where something is located and how to get there), and the results have been promising.

Given VR’s potential for assisting with diagnosis of cognitive impairment and dementia remains largely untapped, our team developed an online computerised game (referred to as semi-immersive VR) to see how well a person can remember, recall and complete everyday tasks. In our VR game, which lasts about 20 minutes, the user role plays a waiter in a cafe and receives a score on their performance.

To assess its potential, we enlisted more than 140 people to play the game and provide feedback. The results of this research are published across three recent papers.

Testing our VR tool

In our most recently published study, we wanted to verify the accuracy and sensitivity of our VR game to assess cognitive abilities.

We compared our test to an existing screening tool (called the TICS-M) in more than 130 adults. We found our VR task was able to capture meaningful aspects of cognitive function, including recalling food items and spatial memory.

We also found younger adults performed better in the game than older adults, which echoes the pattern commonly seen in regular memory tests.

In a separate study, we followed ten adults aged over 65 while they completed the game, and interviewed them afterwards. We wanted to understand how this group – who the tool would target – perceived the task.

These seniors told us they found the game user-friendly and believed it was a promising tool for screening memory. They described the game as engaging and immersive, expressing enthusiasm to continue playing. They didn’t find the task created anxiety.

For a third study, we spoke to seven health-care professionals about the tool. Overall they gave positive feedback, and noted its dynamic approach to age-old diagnostic challenges.

However, they did flag some concerns and potential barriers to implementing this sort of tool. These included resource constraints in clinical practice (such as time and space to carry out the assessment) and whether it would be accessible for people with limited technological skills. There was also some scepticism about whether the tool would be an accurate method to assist with dementia diagnosis.

While our initial research suggests this tool could be a promising way to assess cognitive performance, this is not the same as diagnosing dementia. To improve the test’s ability to accurately detect those who likely have dementia, we’ll need to make it more specific for that purpose, and carry out further research to validate its effectiveness.

We’ll be conducting more testing of the game soon. Anyone interested in giving it a go to help with our research can register on our team’s website.

Joyce Siette, Research Theme Fellow in Health and Wellbeing, Western Sydney University and Paul Strutt, Senior Lecturer in Psychology, Western Sydney University

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