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GSK to stop paying doctors to make speeches

December 17 2013 at 7:53 PM
Keith 

http://www.bbc.co.uk/news/business-25415485

[linked image]

Chinese authorities are investigating GSK over bribery allegations

GlaxoSmithKline (GSK) is making major changes to its incentive schemes following a damaging corruption scandal in China.

The pharmaceuticals firm will stop paying doctors to promote its products through speaking engagements.

Members of its sales force will also no longer have individual sales targets.

Earlier this year, Chinese police said GSK had transferred 3bn yuan ($489m; £321m) to travel agencies and consultancies to help bribe doctors.

But the company says the latest measures are not related to that continuing investigation. Instead, it says, they are part of a wider effort to improve transparency.

'Greater clarity'
Continue reading the main story

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There is a long way to go if we are truly to extricate medicine from commercial influence

Fiona Godlee
Editor, British Medical Journal
In a statement, Sir Andrew Witty, chief executive of GSK, said: "Today we are outlining a further set of measures to modernise our relationship with healthcare professionals.

"These are designed to bring greater clarity and confidence that whenever we talk to a doctor, nurse or other prescriber, it is patients' interests that always come first."

As well as stopping payments to doctors for making speeches, GSK is also ending payments to healthcare professionals for attending medical conferences.

A spokesperson told the BBC that there were "perceived conflicts of interest with that way of working".

GSK plans a new system under which independent organisations, such as universities, can approach GSK for a grant if they want a particular doctor to attend a medical conference.


Start Quote

There is a long way to go if we are truly to extricate medicine from commercial influence

Fiona Godlee
Editor, British Medical Journal


Doctors 'satisfied'
In a statement, Dr Vivienne Nathanson, head of science and ethics at the British Medical Association (BMA), which represents doctors, said: "Whilst we agree that GSK should not directly sponsor doctors going to meetings, we are satisfied that they will continue to financially support education.

"It is pleasing to see a large pharmaceutical company like GlaxoSmithKline recognise that it can reduce the possibility of undue influence by rewarding employees for providing high-quality information and education for doctors, rather than for their sales figures."

GSK says sales representatives will be rewarded for "technical knowledge" and the "quality of the service they deliver to support improved patient care". Their compensation will also be linked to the overall performance of GSK.

Salespeople in the US have already been working under those conditions since 2011.

A spokesperson from GSK said: "It was always our intent to roll it out globally."

Paying doctors to make speeches and attend conferences is common in the pharmaceuticals industry, but there is growing demand for reform.

"Where GSK leads we must hope that other companies will follow," Fiona Godlee, editor of the British Medical Journal and a campaigner against industry influence in medicine, told the Reuters news agency.

"But there is a long way to go if we are truly to extricate medicine from commercial influence. Doctors and their societies have been too ready to compromise themselves."

'Non-trivial'
Ben Goldacre, author of the book Bad Pharma, is concerned about the quality of advice received by doctors.

He told BBC Radio 4: "Doctors get a lot of their education about which treatment works best from the pharmaceutical industry itself - from doctors who have been paid to give lectures about which drug is best.

"This free education has been shown to be be biased in research and it's non-trivial."

Andrew Powrie-Smith, director at the Association of the British Pharmaceutical Industry, told BBC Radio 4: "A number of companies I think are looking at this area and different models of education are emerging."

He stressed that by 2016 companies would have to disclose how much they pay individual doctors.

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GSK: In or out of China? 05 SEPTEMBER 2013, BUSINESS


 
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The Church of GSKology

December 18 2013, 1:26 PM 

http://davidhealy.org/the-church-of-gskology-2/

The Church of GSKology 2
December 4, 2013 7 Comments

A century ago Freud and Jung made us aware of the biases underpinning what patients say. Not everything should be accepted at face value. In particular claims of abuse may not be based on reality. We needed experts analysts they claimed to tease out what is real from what is not.

The Catholic Church was once intensely hostile to Freud, but when it came to child abuse adopting a Freudian approach was very convenient. But while Freud essentially denied that real abuse was taking place and got away with it in his life-time, the Catholic Church has learnt to its cost that many claims of abuse are real.

This intensely dramatic picture shows a former Pope convening the US cardinals in Rome. They were ostensibly there to put the problem of child abuse in the Church to right but it now seems that the meeting was about managing the consequences for the Church rather than for any of its victims.
Habemus Papam?

There is no pope in medicine. The Presidents of National Associations perhaps once came close. Now someone like Andrew Witty comes closest to fitting the bill.

Whatever about a Pope, there are lots of Cardinals. These usually come with the title professor. Just as with the analysts, these professors have had a training that stresses that you cannot believe everything you are faced with. In this case its more a matter of not believing the evidence of our own eyes as it is doubt about what someone says. We see patients balloon in weight in front of us or voice suicidal thoughts that clear when the treatment is stopped but the Cardinals are the people who on behalf of the Pope tell us this is not happening.

How often eagerness to see a positive response can mislead
The primary training these Cardinals now get is in evidence based medicine (EBM). Psychoanalysis was once a significant advance, as was EBM. Both made us keenly aware of the biases that both doctors and patients bring to therapy how often their eagerness to see a positive response to a treatment can mislead them as to what is going on.

Psychoanalysis made us more aware of the importance of fetishes especially sexual fetishes. A fetish is a part that substitutes for a whole. Adherence to psychoanalysis ultimately itself became a fetish that impaired many doctors abilities to engage with the real complaints of their patients.
EBM has fetished RCTs in a way that endangers our ability to handle many of the real problems our patients have and our ability to tackle the abuse to which they are subject.
If the skepticism that underpins controlled trials were applied primarily to the claimed benefits of treatments the original purpose of these trials there would be little problem. But instead these trials have become a means to deny the harms that drugs cause. Your observation that your patient has been injured by treatment is an anecdote, we are told. There is no evidence here.
Our Cardinals feel sympathetic for your problems but advise you in the interests of the Church at large to keep quiet. You will be doing the Devils work if you speak out about things you know nothing about.
Remaining Quiet for How Long?

We have reached a critical juncture. On the one hand we have evidence from company run trials, up to half of which remain unpublished and over 80% of which are ghostwritten, and close to 100% of which the data are unavailable for independent scrutiny. On the other hand we often have evidence of a problem appearing on a drug, that clears when the drug is stopped and reappears when it is restarted.
This kind of evidence until recently was thought to be the strongest causal evidence there was in clinical practice. In over 80% of cases evidence like this turns out retrospectively to have been right. So which is the more dependable when treatments go wrong, the evidence from company trials or the evidence from doctors and patients own eyes?

When they hear Evidence Based Medicine most people think they are hearing Data Based Medicine. It is an irony that trials are used to drown out good observations from individual case studies when such case studies are often the one group of studies in modern medicine where we actually have the data the person who was injured and their clinical record.
It seems, if only for rhetorical purposes, we need a way to demonstrate how unreasonable it is not to take such reports seriously. If the Church is to survive, we need some Cardinals to take up this cause.


Meanwhile back in the Church of GSKology

In the Church of GSKology, the striking parallels between the way the Catholic Church is handling abuse cases in the Archdiocese of Minneapolis and GSK are handling access to clinical trial data were pointed out.

The legal system in Minneapolis though seems to be sorting the Catholic Church out. Judge van de North has just ordered the Archdiocese of St Paul and Minneapolis and the Diocese of Winona to release the names of 58 priests credibly linked to episodes of child abuse. (Although the story seems to have vanished from the Star Tribune site see

http://www.startribune.com/lifestyle/234042431.html).

The legal system is not getting to grips with the Church of GSKology or with Astra-Zeneca in Minneapolis in anything like the same way.

In the case of Study 329, GSK got patients to sign consent forms saying they would not receive treatment that differed from standard clinical practice, when in fact the plan was to force titrate these children up to imipramine 300 mg per day.

At the end of the study there was a statistically significant increase in the rates of suicidality on Paxil compared to placebo.

Children have been abused. Whose duty is it to inform these now grown children. Pope Andrew?
Or the doctor involved in the trial or their institutions?

Marty Keller, or if not him, Brown University?
Barbara Geller from St Louis?
Rachel Klein from New York?
Neal Ryan from Pittsburgh?
George Papatheodorou or CAMH where he was working then?
Stan Kutcher from Dalhousie?
Gabrielle Carlsson from Stony Brook?
Graham Emslie from Dallas?
Karen Wagner from Dallas?
Michael Strober from UCLA?
Greg Clarke from Portland?
Elizabeth Weller from Columbus?

There were lots of others pulled in to the exercise, pleased perhaps to get their name on a paper. Boris Birmaher for instance.

Rumor has it there are a bunch of bioethicists and lawyers who have got greatly exercised about things going wrong in a St Paul and Minneapolis Astra-Zeneca clinical trial. Perhaps some of them could weigh in on the issue of what should happen next in the case of 329. GSK and A-Z are both British companies perhaps this is a British thing.

What are the duties of companies, doctors, universities and clinical institutions in a situation like this?
- See more at:http://davidhealy.org/the-church-of-gskology-2/#sthash.8WcJN3eO.dpuf

 
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