By: Michael O’Farrell and Craig Hughes

HUNDREDS of doctors and hospital consultants continue to secretly pocket millions in payments from pharmaceutical firms while refusing to allow their names to be made public.

The payments raise vital questions about the potential for conflicts of interest when these doctors are prescribing medications to patients or purchasing drugs for publicly funded hospitals.

This weekend, one mother whose son killed himself and another person weeks after he’d been prescribed anti-depressants spoke of her concerns.

Leonie Fennell said: ‘If the companies are paying money, they’re getting something for it.’ Now a campaigner in medical ethics, Ms Fennell said: ‘They’re not doing it out of the goodness of their hearts. The fact that somebody is taking money from a drug company without declaring it and then maybe promoting that firm’s drugs is a huge cause for concern.’

Industry figures say that the process is necessary to advance research and education in the development of drug treatments.

And doctors who do declare the payments they receive – as advised by the Irish Medical Organisation (IMO), the Irish College of General Practitioners (ICGP) and the Irish Hospital Consultants Association (IHCA) – say it’s not fair they are singled out while those who refuse to be transparent remain nameless.

An MoS examination of data made public by the Irish Pharmaceutical Healthcare Association (IPHA) reveals that more than 1,852 doctors and consultants chose to be secretly paid by drug firms in 2015.

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That figure improved slightly last year but it is still the case that some 50% of those who receive drug firm payments remain secret.

The largest funder of payments secretly accepted by physicians is Novartis which paid out €1,070,568 to doctors who chose to remain anonymous in the past two years.

In the same period, AbbVie Ltd – a spin-off of Abbot Laboratories – also made transfers worth €751,742 to doctors and consultants who declined to have their identities revealed – the second highest figure among all pharmaceutical firms in Ireland.

The IPHA – which represents the pharmaceutical firms – says this level of secrecy is unacceptable. So too do some drug firms, patient advocates and many doctors.

But it remains the case that patients have no way of judging whether their GP or specialist has a conflict of interest when prescribing treatment and medication. In all, pharmaceutical companies in Ireland have made payments worth €7.3m to thousands of doctors and hospital consultants in the past two years. Further millions are paid to healthcare organisations, hospitals and other groups.

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Doctors in receipt of almost €4.2m of this sum refused to allow their identities to be made public.

The payments – known, in the healthcare field, as transfers of value – cover fees and the travel and accommodation expenses of medical practitioners who attend conferences sponsored by pharmaceutical firms throughout the world.

Some doctors identified by an MoS investigation travel to more than half a dozen such conferences annually with all expenses paid.

The top twenty-earning doctors who agreed to be named in the past two years all received more than €20,000.

Some, such as prominent mental health expert Dr Harry Barry, received almost €70,000 in travel expenses and fees for services provided to drug firm Lundbeck – the manufacturer of one of a commonly prescribed antidepressants.

The highest recipient of declared drug firm payments in the past two years is Professor Seán Gaine, a respiratory consultant in Dublin’s Mater Hospital.

In 2015 and 2016 Prof. Gaine received transfers of value worth €71,223 from a variety of firms such as A Menarini Pharmaceuticals, Actelion UK Ltd, GLAXOSMITHKLINE Ireland, MSD and Bayer Pharmaceuticals.

Prof. Gaine told the MoS much of this related to his expertise and interest in a rare and incurable lung disease called pulmonary arterial hypertension (PAH) for which he has helped develop a number of drugs in association with pharmaceutical firms.

‘I am proud as an Irish physician to play a leadership role in advancing our understanding and awareness about this rare disease,’ he said.

Prof. Gaine said it was unfair that his ethical decision to be transparent had resulted in him being the focus of inquiry while those who remain secret go unnoticed.

However, he noted: ‘Doctors generally say that they are not influenced by the pharmaceutical industry but it is naive to discount the influence that it may have.’

The third highest recipient of disclosed payments was Dr Gregory Pastores, a consultant at the Mater Hospital who specialised in metabolic disorders.

He received €51,751 from Irish-based drug firms in the past two years – the majority of it from Shire Pharmaceuticals. Dr Pastores said he featured among the highest paid by drug firms because as an expert in his field he is high up in the pay scale.

‘I have worked with them through the years as a clinical expert with international standing in the field,’ he said. ‘The rarer the disease the fewer the number of experts in that field and those few experts will probably also have also been involved in the drugs under development and subsequently marketed. It kind of goes around in circles.’

Dr Pastores said any potential conflict of interest is ‘probably neutralised in a way given I work with different competing companies’.

When asked why he did not declare his relationship with Shire in a recent paper in the American Journal of Genetics, as other co-authors did, Dr Pastores said: ‘That may have been an oversight… I appreciate you calling it to my attention.’

Asked how potential conflicts involving drug firm payments might be avoided, Dr Pastores said he previously channelled them through a departmental fund when working in the US and indicated he may now do the same here.

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Philip Cannon, the Public Affairs Manager at the IPHA, said the pharmaceutical industry itself was driving new levels of transparency.

But he acknowledged that the high level of doctors who opt out of being named was an issue where his organisation’s ‘hands are tied’.

‘The opt-out… that’s an issue where our hands are tied. All medical representatives – the IMO, ICGP, the Irish Hospital Consultants Association – they’re all for transparency and we know that they have encouraged their members to grant consent but because of data protection it is a matter for individual doctors,’ he said.

‘We want to see 100%. It certainly would be desirable to see that level of disclosure for individual doctors to be higher. As an association we’ll continue to push for that.

‘The only lasting solution could possibly be a change in the data protection regulations. We’d be happy enough to work with the Data Protection Commissioner on that.’

Such a change has already happened in Spain where the Data Protection Commissioner has ruled that the common good is best served if all doctors who receive payments are named.

Virtually all of the firms spoken to by the MoS also said they were in favour of transparency. Just one – GSK – has made it obligatory for doctors to agree to be named if they receive funding. In contrast many firms have poor transparency rates with less than 30% of doctors being identified in some cases.

Asked about their low rates of doctors choosing to be identified, Novartis’s head of government and external affairs, Susanne O’Reilly, said: ‘Collaborations between healthcare professionals and pharmaceutical companies had long been a driver for advancements in patient care and innovative medicine’.

‘Our expectation is that consent to disclose transfers of value will continue to increase as full transparency builds a better understanding of this important collaboration,’ she said.

Similarly a spokesperson for AbbVie said the firm was ‘fully committed to introducing greater transparency in our collaborations and interactions with healthcare professionals’.

The spokesperson went on: ‘We communicate this ambition with them on an ongoing basis. We also educate healthcare professionals on the increasing importance that society is placing on transparency.’

‘GPs are actually independent minded’ says doctor given €70k over two years

DR Harry Barry is a familiar face to many. As well as authoring several best-selling books on anxiety and depression, he’s a contributor to national newspapers, speaks frequently on drivetime radio and has been a guest on the Late Late Show.

But few will be aware that in the past two years Dr Barry has received almost €70,000 in payments from Lundbeck, one of the largest manufacturers of antidepressants.

Does that mean that he – or any other doctor who receives payments – is compromised in any way? Dr Barry thinks not.

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‘I think GPs are being regarded here as almost eejits, do you know what I mean? In fact we’re actually quite independently minded,’ he said this week.

‘I can understand the concern over a linkage between pharmaceutical companies and doctors and I would be in agreement with that. I don’t have an issue with that,’ he continues.

‘But I think what bothers me a little bit is that everybody is jumping on antidepressants but, for example, a much bigger problem is things like statins, which are prescribed unbelievably often and in my opinion very unhealthily, and yet nobody does a big thing on statins.’ Dr Barry says it is important that he is being transparent rather than hiding his drug firm payments, as many do.

‘I could have chosen not to have my name out there and just hidden away in the undergrowth… Why should I be hiding something when I’m not actually bothered about it? I’m sure I’ll be pilloried for doing so, but maybe it’s more honest.’ The money Dr Barry receives from Lundbeck is related to travel and fees for his participation in a Lundbeck initiative called the THINC Task Force – a group of experts who have developed a diagnostic tool to measure cognition among those suffering from depression.

The initiative is not, Dr Barry says, in any way related to the promotion or marketing of any Lundbeck drug.

‘If this was something to do with marketing a drug then I would be very uncomfortable about it. It was not to do with that,’ he says.

‘I would have walked away if it was associated with a product.’ However, many will view Lundbeck’s sponsorship of the THINC initiative, which is accompanied by heavy branding online and at each event, as a marketing opportunity.

‘If Lundbeck use this as a marketing opportunity that’s not our affair,’ Dr Barry responds.

In 2013 and 2014 – before Irishbased firms began disclosing payments to doctors – Dr Barry spoke at Lundbeck-sponsored THINC events in Berlin, Mexico, Dublin and Shanghai.

In 2015 – the first year payments were made public – he travelled to Brazil and Seoul for these events.

That year Dr Barry received fees of €20,000 from Lundbeck for this work and the firm paid travel, accommodation and other expenses of €15,000 on his behalf.

By the end of 2016, Dr Barry had received transfers of value from Lundbeck worth €67,536.

Dr Barry says the declared payments cannot constitute a conflict because he has not worked as a GP since 2013 and does not prescribe much any more. He does not want to say how much, if anything, he may have received prior to 2015 and before 2013 when he was still actively working as a GP.

‘That’s going back quite a few years. I’m really not sure,’ he told the Irish Mail on Sunday before later declining to respond to additional email questions about the matter.

‘I have pulled out of full-time general practice so I’m actually only seeing people purely on a consultancy basis and I do very little prescribing,’ he says, adding that he now refers patients he treats with psychotherapy back to their own GPs if they need medication.

In response to queries from the MoS, Lundbeck’s Ireland manager Patrick Campion said the firm ‘adheres to the highest ethical standards and complies with all legal, transparency and disclosure requirements’.

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