Intended for healthcare professionals

Analysis

Raising the bar for disclosure of industry payments to doctors

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj-2023-078133 (Published 29 February 2024) Cite this as: BMJ 2024;384:e078133
  1. David B Menkes, academic psychiatrist1,
  2. Barbara Mintzes, professor2,
  3. Nikki Macdonald, journalist3,
  4. Joel Lexchin, professor emeritus4
  1. 1Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
  2. 2University of Sydney, Sydney, Australia
  3. 3Stuff Media, Wellington, New Zealand
  4. 4York University, Toronto, Canada
  1. Correspondence to: D B Menkes david.menkes{at}auckland.ac.nz

David Menkes and colleagues argue that mandatory accessible reporting of drug industry payments to doctors is an important first step to managing harms from conflicts of interest

After a seven year delay, in 2022drug companies operating in New Zealand made their first disclosures of financial relationships with individual health professionals. The information included payments for speaking engagements, consultancies, advisory board memberships, honorariums, travel costs, attendance at conferences, and other sponsored events.1 This welcome development, sponsored by the industry trade association Medicines New Zealand, was intended to promote “transparency” and “public understanding.”2 However, some members of Medicines New Zealand did not participate in the scheme, and several payment types were omitted from disclosure, notably food and drink provided by companies during sponsored events and sales visits.

While health professionals tend to favour transparency in principle, reporting standards for industry payments vary widely across countries. We compare New Zealand’s disclosure policy with that of other countries and consider what is necessary to effectively tackle the potential harms caused by doctors’ financial conflicts of interest.

Problems with industry payments to doctors

Accumulating evidence shows that drug company payments to doctors influence prescribing34 and other aspects of healthcare, including research and teaching (box 1).5 For example, industry influence has been linked to distortion of clinical guidelines and opioid over prescription in the US.6 An analysis of one company’s multifaceted strategy to promote gabapentin, including sponsored research and continuing medical education, sheds additional light on how industry can distort medical knowledge, inflate health expenditure, and cause iatrogenic harm.7

Box 1

Potential harms of industry payments to doctors5

  • Influence on research agendas, practice, and publication

  • Distortion of clinical guidelines

  • Unnecessary or inappropriate prescribing

  • Iatrogenic harm

  • Increased health expenditure

  • Medicalisation of normal life experiences

  • Neglect of lifestyle and other psychosocial interventions

  • Unconscious bias toward sponsor

  • Inappropriate role modelling (colleagues, trainees, students)

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