The unhealthy relationship between big pharmaceuticals and small doctors

Czech law is structured in such a way that non-prescription drugs can be freely advertised, while prescription drugs cannot. This has led to a totally unregulated culture of lobbying by pharmaceutical companies, desperate to get doctors to take notice of their prescription drugs. Sometimes, these lobbying efforts take the form of free pens or magazines and leaflets, but other times, they include far more expensive free gifts and even exotic holidays under the guise of inviting doctors to so called “conferences.”

A recent undercover investigation for Czech Television showed how Czech doctors had been whisked off to a luxury hotel in the Egyptian town of Sharm El Sheik – all courtesy of the Icelandic pharmaceutical company Actavis. Another scandal a year before pointed to the Canadian pharmaceutical company Apolex, which had offered doctors a free safari in Kenya in exchange for the doctors prescribing their urology drug. Apolex later conceded that its local dealer may have crossed the line. Meanwhile, the Health Ministry has promised to act and act soon, but as discussions continue, little real change seems to be forthcoming.

Luboš Olejár is the head of the Czech Patients’ Association, an organization which tries to protect the rights of patients throughout the Czech Republic. I asked him to explain just why this practice exists:

“The pharmaceutical company, because it cannot influence its sales through marketing, tries to compensate by saying to doctors ‘If you write a lot of prescriptions for my drug, then I will make it worth your while.’”

And how exactly do they make it worth their while? Luboš Olejár again:

Luboš Olejár

“We are finding out that all kinds of congresses, conferences and seminars are being held about new drugs – and they are being held in Greece and they are being held in the summer and by the beach! And then of course, we find out that these are essentially a reward for the doctor for being so dutiful and writing prescriptions for a particular company’s drugs and they decided to reward them for that.”

Václav Šmatlák is the head of the Czech General Practitioners Association - and it should be noted that this organization’s own website carries advertising from private pharmaceutical companies. I asked him how serious he believes the problem is:

“I don’t believe that there are that many doctors who are going on these ‘congress holidays’ but there are some. And it isn’t right so we are trying to communicate or negotiate with these pharmaceutical companies to change this. And I think that we can say that this whole problem represents the corruption of doctors.”

I asked Václav Šmatlák if there were clear ethical guidelines in place to stop discourage these kinds of activities:

“There are some ethical guidelines, but, you know, it is not a crime. So everybody can choose to respect such guidelines, but they are not obliged to do so. These practices are not just in the Czech Republic, but they are everywhere, and more often in the so-called ‘developing countries.’”

Yet Luboš Olejár believes that this system of unregulated bribery is corrupting the Czech healthcare system:

“All these events, often outside the Czech Republic are creating a sort of dependence among doctors on what are essentially bribes from the pharmaceutical companies. And in order to maintain their relationships with these companies, doctors are trying to prescribe more and more of their drugs.”

And could such undue influences directly cause harm to patients? Luboš Olejár again:

“The active chemical in a drug from this or that company is often the same. And a doctor cannot dare to prescribe something that they know will not work, but what can harm the patient far more is the fact that different drugs cost different prices and I would recommend that patients do some research to find out which drugs are not only more effective but also cheaper for them.”

So what are the solutions, especially when it appears that a system of lobbying that may or may not have reached even Czech politicians, has nevertheless created a comfortable reliance on an amoral and unethical mode of operations? Václav Šmatlák, the head of the more than 4000 member Czech General Practitioners Association believes that Pharmaceutical budgets can be used for good, rather than this covert lobbying, and points to the education seminars his association organises as a way out.

“The only solution is that the company in question gives its money to a professional association, like mine is, for example, and we organize the educational seminars for the doctors.”

Patients’ rights advocate Luboš Olejár agrees:

“The Czech Patients’ Association looked into this issue and came up with a recommendation that an independent system for educating doctors about new drugs be put in place. That way, a forum is created where the drug companies could be allowed to make their case alongside various experts. This would basically do away with the suspicion that a doctor is unhealthily attached or dependant on a particular pharmaceutical company.”

And if that doesn’t work? At present, the Czech anti-corruption police are investigating cases of bribery by pharmaceutical companies – though no charges have yet been brought, and the corruption watchdog Transparency International has expressed its concerns about the lack of progress. Meanwhile, the lines between those who produce, those who oversee and those who provide care continue to be blurred in the Czech Republic – even an organisation headed by the Czech health minister is alleged to receive more than a million crowns from pharmaceutical companies. So what will motivate the government to act to protect its citizens? Luboš Olejár:

“If it becomes evident that the self-regulating system that we have is starting to cost taxpayers and health insurance payers far too much, then obviously there will be pressure on the government to make legislative changes, for example to ban pharmaceutical companies from visiting doctor’s surgeries – so if a company is caught essentially acting as a dealer inside these places, then they should be subject to some kind of sanctions.”