Dr Trevor Mudge, AMA Vice President - ABC Radio 2BL, with James Valentine
VALENTINE: We spoke yesterday with a journalist from The Financial Review, Ray Moynihan, who'd written on the relationship between doctors and pharmaceutical companies. What seems to be something of a growing concern to medical practitioners, to their patients, to the community at large, is that the pharmaceutical companies will attempt to enlist the doctors in the marketing and promotion of their particular products. They might do this by having the doctors on the advisory board for particular treatments, they might have a quite direct relationship with the medical practitioner.
The actual way this should work, whether there should be disclosure, whether there should be in some cases not allowed at all, is really yet to be decided. It is an ethical dilemma that is really only starting to emerge in recent times. We thought we'd try and find out today what the Australian Medical Association makes of all this and we're joined by Dr Trevor Mudge who is Federal Vice President, Chair of the Ethics, Science and Social Issues Committee with the Australian Medical Association. Dr Trevor Mudge, good afternoon.
MUDGE: Good afternoon.
VALENTINE: What's the AMA's position on this?
MUDGE: We recognise that the relationship between the profession and the pharmaceutical industry is one fraught with potential ethical conflict. Nonetheless, it's a very important one. Doctors and their patients rely on the global pharmaceutical industry very heavily. Without the pharmaceutical industry, we don't have new drugs, and one of the major advantages of the late 20th and early 21st centuries has been a multiplicity of new and very effective, powerful drugs with much fewer side effects than in the past. They cost a lot of money to produce and therefore the pharmaceutical industry is large and powerful, and both the profession and governments have difficulty dealing with it. Witness the recent publicity about the independence of the Pharmaceutical Benefits Advisory Committee. It's terribly important that there be no conflict of interest and that there be independence, both of individual doctors and of government advisers such as the PBAC.
VALENTINE: Isn't it automatically a conflict of interest if a doctor stands up to launch a particular product?
MUDGE: It can be if that conflict of interest isn't disclosed. The AMA has a series of ethical statements on what ought to be the relationship between the profession and the pharmaceutical industry, and anybody interested can view those on our website. Basically, our view is that all steps should be taken to avoid conflict of interest and where conflict of interest occurs it needs to be declared.
VALENTINE: Do you insist on full disclosure? Do you insist that doctors say 'Yes, this is how much I'm being paid, this has been my involvement in the development of this product'?
MUDGE: Absolutely. I think there's no question there needs to be full disclosure but bear in mind that we now live in a brave, new world of advertising. One of the unintended consequences of the ACCC's application of trade practices law to the health profession is that the profession no longer has the ability to regulate and limit advertising by doctors. Now, not all of that advertising is going to be scientifically accurate and some of it has the potential to mislead. That's one of the problems with open advertising, in our view.
VALENTINE: We expect a high standard from doctors, though, don't we and we don't expect to suddenly find that really senior surgeons, senior medical academics, people that are heads of departments, are suddenly out there spruiking for the drug company.
MUDGE: No, we expect a high level of scientific accuracy and clinical independence. Clinical independence is critical to the medical profession. That's why we've been fighting such evils as managed care because it is vitally important that any of us who visit any professional, and perhaps especially doctors, rely on the fact that the advice we get from that doctor is totally unbiased and totally free of influence from a third party.
VALENTINE: Do you think that your ethical standards are more honoured in the breach?
MUDGE: No, not at all. They're more honoured in the observance but look, we've got 50,000 practising doctors in Australia, 27,000 of those are our members. Our members know what the ethical standards are and, by and large, they abide by them and I'm sure most of our non-members do too but…
VALENTINE: …are the doctors…
MUDGE: There's going to be a conflict from time to time.
VALENTINE: Do you think that the doctors are actually aware of what happens at the marketing and media end of some of these products? They might be on the advisory board. They may be putting their name to…up for interview and this sort of thing…but they're not aware that there isn't the full disclosure of their involvement going on?
MUDGE: I think doctors, by and large, it's probably fair to say, are fairly na ve in terms of marketing and business practice. It's not the sort of thing that we have much experience of and in this increasingly difficult research environment it's very hard to find funding for research from any source and I'm sure that researchers are very tempted to look at funding and not be as concerned about the strings that may be attached to that funding. That's why we have guidelines. Those guidelines are by and large observed but there will be exceptions to it.
VALENTINE: But you're saying, beyond the guidelines there's not much that you, the peak medical body, can do. It's what, an ACCC issue?
MUDGE: I think the history of legislation to determine human behaviour has not been very good. Human behaviour has to be demonstrated by example and by leadership and by ethical sets of guidelines. That's why the professions have a valued place in society, that they are trusted to, by and large, conform to standards of behaviour that is not expected of most people in the community, especially in relation to their profession.
VALENTINE: But we also put…
MUDGE: They do a good job but no job's going to be perfect. That doesn't mean we shouldn't be vigilant about the exceptions.
VALENTINE: So are you saying that you do have the power to rein this in or it does get sheeted home elsewhere, it's an ACCC issue?
MUDGE: It is an ACCC issue. It's an issue for medical boards. It's an issue for the medical community at large, I think, and it's an issue that the community in medicine is aware of and polices, I think, by and large, very well. But look, I take the point of the recent publicity and I think Ray's right, that there are more and more, I think, episodes of advertising by press release, if you like, of a so-called new discovery, and maybe the journalism profession needs to look at its responsibilities as well.
VALENTINE: This also happened. There are attempts made to educate us as to what these press releases might mean and to try and deal with that sort of thing but they often present as here is a doctor talking about a new discovery, not here is a doctor talking about a new drug.
MUDGE: I think we all need to question what the doctor's position is in terms of making those statements. Doctors should be making public statements on behalf of organisations. Nobody really cares what Dr Trevor Mudge thinks of an issue but, quite rightly, the community cares about what the Ethics Committee of the AMA thinks of that issue and I think we all need to look. Those of us who make public statements, need to look at who we are making them on behalf of and what the scientific veracity and the independence of those statements is, and probably so should journalists.
VALENTINE: Dr Trevor Mudge, thanks for talking with us. Dr Trevor Mudge is the Federal Vice President, the Chair of Ethics, Science and Social Issues, with the Australian Medical Association.