UK 'needs more transparency on pharma-doctor payments'

The UK's voluntary system for disclosing payments from pharma companies to healthcare professionals (HCPs) has "critical gaps" that hide potential conflicts of interest and could put patients at risk, claims a new study.

According to the paper by researchers at the University of Bath in the UK and Lund University in Sweden, the self-regulated Disclosure UK system operated by the Association of the British Pharmaceutical Industry (ABPI) is not adequate to monitor payments effectively and should be replaced by "strong legislation" to ensure transparency.

The same research team was also involved in an earlier study that claimed patient advocacy groups and charities are at risk of aligning their interests with their corporate funders, even when that does not benefit the people they represent.

Published in the journal BMJ Evidence-Based Medicine, the new study concludes that billions of pounds in payments to HCPs – billed as research payments – are listed in Disclosure UK without naming recipients, which the researchers say makes it impossible to assess where the money goes or how it might influence patient care.

Around £3.3 billion ($4.1 billion) in research payments were made by companies in the ABPI between 2015 and 2022, according to the study, with some drugmakers – including AstraZeneca, Allergan, and Bristol Myers Squibb – classifying more than 90% of their HCP payments as being research-related.

There were also payments of around £1.1 billion over that period classed as non-research, but - while recipients are supposed to be disclosed under the ABPI code of practice - that is sometimes not the case. In the case of Allergan, for example, the researchers claim that as little as 15% of payments indicate who received the money.

They also point to a number of cases in which companies have been taken to task by the ABPI for breaching the code, including a recent case involving Novo Nordisk in which it failed to report approximately £7.8 million in payments to over 150 UK healthcare professionals and organisations.

Call for UK version of the US Sunshine Act

"Our analysis reveals that the public sees only the tip of the iceberg when it comes to drug company payments to healthcare professionals and organisations," according to Dr Piotr Ozieranski, the lead author of the research paper.

"Without strong legislation, conflicts of interest will remain hidden, undermining healthcare integrity and potentially putting patients at risk," he added. "Sunlight is the best disinfectant, which is why we're calling for a UK version of the USA's Sunshine Act to ensure transparency in pharmaceutical spending."

The 2010 Physician Payments Sunshine Act requires manufacturers of drugs and medical devices to collect and track all financial relationships with doctors and hospitals – including full recipient details and amounts – and to report them to the Centers for Medicare and Medicaid Services (CMS).

The authors of the paper have welcomed the UK government's recent consultation on payment transparency, calling it a "step in the right direction," and point to its recommendation that refinements or expansion of the Disclosure UK programme will not be enough.

"Only legislation backed by enforcement mechanisms can bring the clarity and accountability needed to protect public trust in healthcare," they claim.

pharmaphorum reached out to the ABPI for its take on the paper, which provided the following statement from Dr Amit Aggarwal, the trade organisation's executive director of medical affairs: 

"We believe that Disclosure UK has played an important role in improving transparency in the relationships between industry and healthcare professionals and organisations, and we will continue to evolve it to make it more accessible and comprehensive, as we have done since it started. Transparency reporting is part of a much broader landscape of regulation and accountability for both healthcare professionals and the industry. 
 
"As one of the most highly regulated industries in the world, we welcome a continuing, evidence-based and constructive discussion on how to continue to create the best conditions for industry and healthcare stakeholders to work appropriately together in the interests of patients."
 

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