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Panorama.S2014E16.Whos.Paying.Your.Doctor
Transcript
00:00We trust doctors to prescribe the best medicines available.
00:06Tonight, Panorama investigates how far some drug companies will go
00:10to influence your doctor and boost their profits.
00:13If we don't do something soon, it will be all the worse
00:17for patients and for the public. Britain's biggest drug company stands accused of
00:23paying kickbacks to doctors abroad.
00:25Now we reveal new allegations of bribery in Europe.
00:30We pay doctors, they give us prescriptions.
00:34We don't pay doctors, we don't see prescriptions for our drugs.
00:38Some payments are perfectly legal.
00:41We go undercover to see the doctors who are paid to promote medicines.
00:45This is a terrible moment in terms of the drug treatment of any addiction.
00:51With millions of pounds changing hands, many in medicine now want to see total transparency.
00:57If people are being paid, well, please tell us how much you're being paid
00:59because this directly affects your care.
01:03We all want the best health care possible,
01:06so isn't it time you knew who's paying your doctor?
01:27We are all prescribed medicines at some point in our lives
01:31and we trust that what we get is simply what's best for our health.
01:36Across the UK, we were prescribed more than a billion drugs last year
01:40at a cost to the NHS of more than £10 billion.
01:44So that's big business for the pharmaceutical industry.
01:57This is a story of the tactics companies use at home and abroad
02:02to tap into that lucrative market.
02:05Here in the UK, there are strict rules to govern what drug companies can get up to,
02:09but that doesn't stop them spending millions
02:12trying to persuade doctors to prescribe their drugs.
02:16One of the most controversial methods is paying doctors
02:19to promote their drugs to fellow medical staff.
02:23Most patients trust their doctors or want to trust them
02:27and I think they may well be quite shocked
02:30if they knew that their doctor was taking money from an individual drug company
02:36or was committing to speak on that company's behalf
02:40in favour of a particular drug.
02:44Right across medicine, doctors are being paid in this way
02:47and it's perfectly legal.
02:50And where does this subtle persuasion often take place?
02:53The medical conference.
02:56Munich in March and thousands of psychiatrists from across Europe
03:00are here for what's classed as an educational event.
03:05We've come to investigate how conferences like this
03:08are used to market prescription-only medicines to doctors
03:12and there's no shortage of slick sales techniques.
03:17If I want my free Wi-Fi, I have to go up to the Lundbeck stall
03:21and guess what, the username isn't one of their medicines.
03:24Put in Cycrest, capital S.
03:26Oh, Cycrest, OK.
03:28Drug company sponsorship of this four-day event
03:31runs to more than £800,000.
03:37To cut through all the spin, we called in an expert.
03:42Professor Tim Kendall, medical director of an NHS trust
03:46who also helps produce treatment guidelines for doctors across England.
03:52I've never been to a conference like this
03:57apart from just coming to give a talk and then going.
04:01What it feels like is a trade fair.
04:04You know, I mean, that's it.
04:06The first thing Professor Kendall notices
04:08is how many fellow doctors from Britain are here, nearly 300.
04:13How wise are they to some of the more subtle sales techniques?
04:18Throughout the conference, there are sessions like these
04:21that are completely organised and paid for by individual drug companies
04:25because they have a drug that they want to promote.
04:28But the speakers include some of the biggest names in British psychiatry.
04:33We caught a glimpse of Oxford professor
04:35and consultant psychiatrist Guy Goodwin.
04:38He's being paid to speak at a symposium
04:40organised by French drug company Cervier.
04:43It's not part of the main conference programme,
04:45but it's in the same venue.
04:47Professor Kendall went to listen and we tried to follow with a camera.
04:53Oh, no, why not?
04:55They wouldn't let us film the session.
04:57We went in with a hidden camera.
05:03It was a full house with many delegates from the UK.
05:06Thank you to the organisers, it's a pleasure to be here.
05:10An innocent enough opening,
05:12but all speakers are supposed to list any financial links
05:15to drug companies before talking.
05:18Professor Goodwin didn't declare his list.
05:23He later told us this was an honest oversight, which he regrets.
05:28In the symposium, Professor Goodwin talked about
05:31the under-treatment of depression.
05:35Then two other speakers talked favourably
05:38about Cervier's drug, agomelatine.
05:41Agomelatine is a quite recently developed antidepressant...
05:46It's a licensed antidepressant which is not recommended
05:49for use in the UK by our medicines watchdogs.
05:53Doctors can still choose to prescribe it, though.
05:56A lot of UK-based people in the audience,
05:59they will be going back and they will be thinking,
06:02right, agomelatine, that could be the next drug.
06:05I mean, I'm really worried about this.
06:09He was most concerned about the credibility an expert
06:12like Professor Goodwin can give to an industry event,
06:15even though he didn't mention agomelatine directly.
06:19My real worry is that these very eminent, very able people
06:24are walking into industry-sponsored symposia
06:28and in that context, they're just being used.
06:32You know, everybody's... The place is packed.
06:34It was a full house, wasn't it? Absolutely packed.
06:36And I'm sure it's packed because of Galway.
06:39Certainly this delegate from the UK seemed impressed.
06:42When somebody like Guy Goodwin is talking, is that a draw for you?
06:46Oh, definitely. Again, because I'm based in Oxford,
06:49so I know Professor Goodwin from Oxford.
06:52But again, the whole event is really good.
06:56We asked Servier about employing Guy Goodwin
06:59in a statement they told us.
07:01The use of Professor Guy Goodwin is recognition
07:03of the medical expertise we have available in the UK.
07:07Servier is proud to be able to support the transfer of knowledge
07:10around the world and ultimately improve the care of patients.
07:15They also told us they don't promote agomelatine in the UK.
07:21Tim Kendall later approached Guy Goodwin to ask if he's comfortable
07:25being paid to take part in events like this.
07:28His answer, he didn't take a vow of poverty when he became a professor.
07:32His genuine view is that a lot of doctors are involved
07:38in working with the industry and sometimes that does bring
07:42some benefits, financial benefits to them.
07:45He didn't think that that in itself was wrong.
07:48And I think there's probably quite a lot of doctors who think that.
07:52Professor Goodwin didn't want to be interviewed,
07:54but later he told Panorama...
07:57The industry sponsorship of the event was clear.
08:00Payment was at the going rate, no guidelines were knowingly broken
08:04and there was no problem with the content of the talk.
08:07He told us he earns £11,000 a year from such talks,
08:11but that's not all.
08:13He's also paid to advise or consult for these eight drug companies.
08:17Professor Goodwin wouldn't tell us how much he earns from that.
08:26Back in Britain, does this sort of sponsorship really influence
08:30the way the industry is prescribing?
08:32One Glasgow GP thinks it does and for that reason,
08:35Des Spence doesn't go to any industry-sponsored events.
08:40There's a trickle-down effect, so if you have a leading expert or group
08:44that, over the course of time, that trickles down to general practice
08:49and we start changing our clinical care,
08:51you know, whether we prescribe more statins,
08:53whether we prescribe more antidepressants,
08:55you know, this directly affects your care.
08:59What this represents, the industry says,
09:01patients benefit from their work with doctors.
09:04£50 billion a year is spent on research and development
09:07by this industry that has made HIV a liveable condition.
09:11Diabetes, coronary heart disease, asthma,
09:14all these things that have been transformed.
09:16Now, to do that does require a relationship with healthcare professionals,
09:20both in research and also, if you like,
09:22in terms of usage of those medicines with patients.
09:25It's a thin line, though, between education and promotion, isn't it?
09:28It's a very thin line.
09:29What I would also say is that, of course,
09:31what we do is completely and absolutely legitimate.
09:36It's perfectly legal for drug companies to pay doctors to speak.
09:40It happens right across medicine.
09:42And so does sponsorship of doctors' education.
09:47But how objective is the information at industry-funded events?
09:51We went along to one at this Hertfordshire hotel.
09:54It was billed as a clinical lecture
09:56about the treatment of alcohol dependence.
09:59This is it.
10:01The event is invitation only, though,
10:03so we have sent in a hidden camera.
10:06The invitation made clear the event is organised
10:09and sponsored by Danish drug company Lundbeck.
10:12Inside, we found a large turnout, many GPs,
10:15who'd come to hear an eminent addiction expert.
10:18Professor David Nutt was soon singing the praises
10:21of Lundbeck's new drug to treat heavy drinking.
10:24..alcohol use here.
10:25We haven't had any treatments
10:27which could help people more greatly.
10:30That's why this development in nalmofene is very exciting.
10:34This is a seminal moment in terms of the drug treatment of any addiction.
10:40By the end of his 45-minute talk,
10:42there was no mistaking his enthusiasm for the drug nalmofene.
10:46It is quite a revolution.
10:48For the first time in my career,
10:51we have a drug which we can help people control their behaviour
10:55rather than simply say, stop it.
11:01For the first time in my career,
11:03we have a drug which we can help people control their behaviour.
11:08We showed Professor Kendall our undercover footage
11:11of how nalmofene is being promoted directly to GPs.
11:16I think the presentation had very little in the way
11:19of anything critical.
11:21If I was a GP and I didn't have the knowledge that I had,
11:24I would come out and I'd be prescribing that tomorrow.
11:28Nalmofene is only recommended in the UK
11:31if it's prescribed alongside long-term psychological support.
11:35That was in the slides behind him,
11:37but Professor Nutt didn't make it clear in his talk.
11:41When we contacted him later,
11:43Professor Nutt said he was paid the standard industry rate for the talk.
11:47He told Panorama...
12:06Doctors need to earn a certain number of points each year
12:09towards their continuing professional development, or CPD,
12:13by going to training events.
12:15Our undercover reporter asked the chairman
12:18if CPD points could be claimed from this event.
12:21Can he claim this as CPD?
12:23Absolutely, 100%.
12:25Really, it's CPD? 100% he can.
12:27Do you think that sort of event should count as training for doctors?
12:31Not at all, absolutely should not.
12:33I have a real problem with drug companies putting on events
12:39that are apparently for education when they're clearly to sell the drug
12:43and that being declared by GPs or any other doctors
12:47as some sort of contribution to their CPD.
12:50It's a joke.
12:53Lundbeck later told us its event chairman, a consultant psychiatrist,
12:57was not qualified to make such comments and had got it wrong.
13:02The meeting was characterised as a promotional meeting
13:05and for this reason CPD points were not applied for nor awarded.
13:11Yet the chairman was emphatic on the night
13:14that CPD points would be awarded.
13:16100% he can.
13:18All right, OK, well, I don't think he realised that.
13:21100% he can, he'll get two CPD credits for this.
13:24All right.
13:26We later asked the chair if he had been 100% wrong.
13:30As far as he was concerned, it was a scientific lecture that...
13:34..lasted around two hours,
13:36which equates to approximately two points for CPD.
13:41With such a thin line between education and promotion,
13:44is it any wonder there's confusion
13:47over which events qualify for CPD points and which don't?
13:52The editor of the British Medical Journal
13:54thinks drug companies should be kept out of doctors' education.
13:59The drug industry has an irreducible conflict of interest.
14:02They are there to make money for their shareholders,
14:05quite right, legitimate, and in doing that
14:08they also often create good products that we rely on and need.
14:12But they don't have a legitimate role in the education of doctors.
14:19Even with sponsorship that's strictly regulated,
14:22concerns are growing about its influence on doctors' prescribing.
14:28But elsewhere in the world,
14:30some of the biggest names in the pharmaceutical industry
14:33have been accused of breaking the law.
14:36Britain's most profitable drug company, GlaxoSmithKline,
14:39was forced to pay a massive settlement in the US in 2012.
14:43The UK drug store in GlaxoSmithKline
14:45has agreed to plead guilty and pay $3 billion.
14:48The reason Glaxo is paying this fine
14:50is to do with how it promoted some of its drugs.
14:53Today's multibillion-dollar settlement
14:55is unprecedented in both scope and size.
15:01Blair Hamrick started work for GSK
15:03as a sales rep in Colorado back in 1997.
15:07He says he and his colleagues would pay doctors
15:10to promote their drugs to other doctors,
15:12sometimes thousands of dollars for a few hours' work.
15:16It's always under the guise of education.
15:19Doctors have to get so many hours of continuing medical education.
15:23Well, you know, we would have these CME programmes
15:26that would get CME credit for the doctors,
15:29but they were nothing but a commercial.
15:34Doctors were sent on foreign trips and given lavish hospitality.
15:39Kickbacks, essentially, to encourage increased sales.
15:46They would be sent on trips to Jamaica or Bermuda
15:51or Disney World in Orlando, Florida.
15:55They would be taken out to dinner.
15:59Entertainments, Madonna concerts, basketball games,
16:02you know, the tickets that were the hardest to get.
16:05And GSK kept a close eye on whether it was money well spent.
16:10There was what's called an ROI analysis,
16:13and that was return on investment.
16:15So if we spent $5,000 on a speaker
16:19and we spent $20,000 on tickets and food,
16:23that's $25,000 invested,
16:26they would take all those physicians
16:28and they would track their prescription volume
16:31and they would want to see an increase in prescriptions
16:34greater than $25,000 worth of business.
16:37And did you generally see a good return on investment?
16:40Always. Always.
16:42Times were good. Blair Hamrick had a young son,
16:46and that focused his mind when he was asked to market
16:49an antidepressant for children.
16:51The drug was only approved for adults,
16:53and he knew it could cause seizures.
16:55Being a father myself, I started looking at,
16:58well, wait a second, if a kid has a seizure on this medicine,
17:03whose fault is it?
17:05Is it mine? Is it the company's? Is it the doctor's?
17:08And I couldn't have that on my conscience.
17:11When I raised the concern with my manager,
17:13my manager said,
17:15everybody's doing it, so you better do it too.
17:18It's illegal to promote a drug to doctors
17:21outside its licence like this,
17:23but Blair says the bonus system encouraged rule-breaking.
17:27During negotiations to settle the case for $3 billion,
17:31GSK agreed to stop linking bonuses to sales targets in the US.
17:38You want a doctor's prescribing decisions to be independent.
17:42You want them to be objective.
17:44You don't want the relationship between a physician
17:48and his or her patient to be interfered with
17:51by a pharmaceutical company that is driven by profits.
17:56GlaxoSmithKline isn't the only drug company
17:59to fall foul of the law in the US,
18:01but it has the worst track record.
18:03One campaign group has analysed all the payouts by the drug industry
18:07for any kind of rule-breaking in the US over the last two decades.
18:12Glaxo was the number one with $7.6 billion
18:16and the number one company in the world
18:18in terms of total criminal and civil penalties.
18:21Sidney Wolfe says even hefty fines and settlements
18:24haven't stopped Britain's GSK offending again.
18:28The penalties are not large enough to deter these illegal activities
18:33and in one year Glaxo makes more money in terms of profits
18:37than all the penalties they've paid over the 21 years.
18:42GSK's chief executive declined to be interviewed.
18:45In a statement the company said that in the US...
18:48We have made fundamental changes to our business,
18:51including new procedures for compliance, marketing and selling.
18:57With an annual turnover last year of more than £26 billion,
19:02GSK is a massive enterprise.
19:06And it's not just in the US that the company has been accused
19:09of making illegal payments to doctors.
19:13Police in China have today accused the British drug giant GlaxoSmithKline
19:18of using travel agencies as vehicles to bribe officials and doctors...
19:23The Chinese authorities claim that £300 million was paid by GSK
19:28to doctors and government officials in China.
19:31The company is waiting to see if it faces prosecution there
19:34and says it's co-operating fully with the investigation.
19:38GSK could face prosecution in Britain.
19:41It's against the law to bribe government officials abroad.
19:45The company has told the serious broad office here
19:48about the allegations in China and clearly wants to draw a line
19:52under the whole issue of illegal payments.
19:56In the last fortnight, though,
19:58new allegations have emerged about the company's behaviour in Iraq.
20:02And now Panorama can reveal more allegations of corruption.
20:07We've uncovered evidence that GSK reps have recently been paying
20:11doctors to boost prescriptions much closer to home in Europe.
20:37Jarek Wyszynewski once had a good life with his family in Poland.
20:41He worked as a sales rep for GlaxoSmithKline until 2012
20:45and at first the future looked bright.
20:48I was in some programme for future managers.
20:53Really, really, they invest in me.
20:55I was a talent, they said. I was a talent for them.
20:59But things started to change for him in 2010.
21:03GSK launched a major marketing programme across Poland
21:07to push its asthma drug Serotide.
21:12The budget of this programme is more than 5 million Polish money.
21:18It's about £1 million.
21:20It's a really huge marketing programme.
21:25It was just extra money for increased sales
21:28because we need to sell more.
21:32Always more, more, more.
21:35For the first time, Jarek is speaking publicly
21:38about exactly how he and his colleagues boosted sales.
21:42He says that on paper, the budget was to educate patients about asthma.
21:47The reality, he says, was they paid doctors to prescribe more Serotide.
21:54I pay for education and in the same meeting I said
21:59that I need more prescription for Serotide.
22:03So they knew exactly for what I pay.
22:08So this was a deal that everybody understood?
22:12Yes, yes.
22:17Another former GSK drug rep who doesn't want to be identified
22:21confirms that they routinely paid doctors for lectures that never happened.
22:27Do you find that this tactic worked?
22:31That if you paid doctors, they tended to prescribe more?
22:35Yes, of course.
22:37The doctor feels obliged and he tries to a greater or lesser extent
22:41to fulfil that obligation.
22:43How did you feel about that?
22:45I think that, like many people, my feelings are very negative and unpleasant
22:49but that was the work culture.
22:52Just like in the US, years before,
22:55the more prescriptions they could secure, the bigger their bonus.
22:59And they say their manager also expected them to secure a return on investment.
23:05We prepare an agreement for a speech, we pay £100
23:09but we expect more than 100 prescriptions for this drug.
23:14So although the deal verbally between you and the doctor was clear,
23:19it was not written down like that anywhere?
23:21No.
23:23With doctors in Poland earning around £700 a month,
23:27even small cash incentives could be lucrative.
23:31What you are essentially describing is a bribe?
23:34Yes, it's a bribe.
23:37Two years ago, he told GSK he was unhappy.
23:40The result? He says he was sidelined at work and eventually sacked.
23:45Now there's a criminal investigation.
23:4711 doctors and a GSK regional manager have been charged.
23:51One of the doctors, who didn't want to be interviewed,
23:54told Panorama he did take money from GSK.
23:58He told us he took 500 zlotys, about £100,
24:01for a single lecture that he never gave.
24:04He said, I blame those pharmaceutical representatives for that
24:07because it's hard to refuse when they keep putting pressure on you.
24:11They kept tempting, he said, and I'm just a man.
24:15The regional public prosecutor has examined the contracts
24:18that doctors like him were given by GSK.
24:22They've found evidence to support claims of corrupt payments.
24:29In more than a dozen cases, these contracts were fictitious.
24:35So these payments were, in effect, bribes?
24:38Yes. We have evidence to claim that in more than a dozen cases,
24:42it was a camouflaged form of a bribe.
24:44And was the deal, actually, that the doctors were to prescribe
24:48more drugs in return for this money?
24:51That was the point, that in return for the financial gains,
24:54the doctors would favour the product proposed
24:56by the pharmaceutical company and they prescribed that medicine.
25:01What we've uncovered in Poland is significant
25:04because it could eventually lead to an investigation
25:07by the authorities, both in the UK and abroad.
25:11Both in the UK and the US.
25:15GlaxoSmithKline told us it's cooperating with the investigation
25:19and has carried out one of its own.
25:22The investigation found evidence of inappropriate communication
25:25in contravention of GSK policy by a single employee.
25:29The employee concerned was reprimanded and disciplined as a result.
25:36In the UK, the drug industry spent nearly £40 million
25:40on healthcare professionals last year.
25:42Payments that are strictly regulated.
25:45But how easy is it to find out if your doctor has been paid?
25:50All NHS medical staff are expected to register
25:53any financial conflicts of interest.
25:55We asked more than 200 NHS trusts and health boards across the UK
26:00if their register is publicly accessible.
26:04Only 6% said it was available online.
26:07The overwhelming majority say you have to ask to see it.
26:11If people are being paid, please tell us how much you're being paid
26:14because that will influence the message that you give.
26:17And perhaps doctors and experts are in denial about that.
26:21But I think, again, anybody with any common sense can see
26:24that if you pay people, they tend to give you the message that you want.
26:30Things in the US couldn't be more different.
26:33Since the end of last month,
26:35drug companies have been legally obliged to detail all payments to doctors.
26:40One research group has even created a single searchable database.
26:45So if you want to know if your doctor is on a drug company's payroll,
26:48you just type in a name...
26:51..and the computer does the rest.
26:55Yep, here's somebody. $145,000.
26:59And the effect of this transparency has been startling.
27:03Payments to doctors in the US overall have plummeted.
27:07The fact that payments have gone down is interesting
27:09because it may be both the company itself changing its behaviour
27:12but also the doctors not wanting to be on a register
27:15with those payments made public.
27:18Will transparency here have the same effect?
27:21The drug industry says it will publish all payments
27:24to doctors in the UK by 2016.
27:28We should never fool ourselves that doctors will be overly swayed
27:32by some of this commercial activity
27:34given they're receiving a lot of other information.
27:36Why on earth would these drug companies spend all this money on doctors
27:41if it didn't sway their prescribing?
27:43Well, that's always an interesting question.
27:45But why would they?
27:46Well, my view is it should sway their prescribing
27:49and I will absolutely categorically say that
27:51because it's absolutely appropriate for doctors to prescribe medicines
27:55for patients that need them within the right guidance.
27:58It is up to the doctor to decide what is right
28:01on all the information they receive from all the sources,
28:05what is right for that patient.
28:08But is transparency on its own enough?
28:11GlaxoSmithKline recently announced it will no longer pay doctors
28:15anywhere in the world to promote its drugs
28:17or sponsor them to go to conferences.
28:21The GSK announcement seems to me actually to represent
28:25the beginning of the unpicking of decades of behaviour
28:29that has been acceptable and now we're beginning to say
28:32actually that was never OK.
28:34Why did we ever think it was OK?
28:37If doctors are to maintain their trust with patients,
28:40a growing number in medicine now think it's time for a fundamental change
28:45in the relationship with the drug industry.
28:49.
28:52Coming up, violence spreads in eastern Ukraine
28:55with Russia and the West blaming each other.
28:57Oscar Pistorius is accused of concocting his evidence in court
29:00and New Zealand bowled over by the royal visitors.
29:03That's all next.
29:05Well, forget mosquitoes, you'll need some bear spray next
29:08as the search for a million melting pound chest with the treasure hunters.