Seeking to recover from sensational marketing scandals, GlaxoSmithKline did something unexpected five years ago — the company promised it would no longer pay doctors to promote its medicines, which had been a long-standing industry practice.
The move came not long after Glaxo paid $3 billion in fines in the U.S. for illegal marketing and kickbacks, among other things, and also followed reports the company showered doctors and government officials in China with bribes. With its announcement, Glaxo won praise for setting a new tone and raised hopes other drug makers would follow suit.
They did not.
And, now, Glaxo says it will largely reverse course — and patients, doctors, and the entire pharmaceutical industry are the losers.
Here’s why: For years, drug makers tried to goose sales by enticing doctors to write prescriptions. In many instances, this involved juicy incentives, such as fees for speaking or consulting. There were also freebies: meals, event tickets, or paid travel to conferences at luxurious destinations.
This generosity rightfully prompted scrutiny over who really benefited — the patient or the doctor and drug company? The answer was never hard to figure out. And despite indignant protests from some doctors who argued they are not swayed by largesse, studies have shown otherwise.
An analysis in the Journal of the American Medical Association back in 2000 found that interactions between doctors and drug companies appeared to affect prescribing and physician behavior. More recently, a 2016 study in JAMA Internal Medicine found an association between meals and an increased rate of prescribing for medicines that were being promoted.
“The problem has been well-documented over many years,” said Eric Campbell, the director of research at the Center for Bioethics and Humanities at the University of Colorado, who has studied the financial relationships between physicians and pharmaceutical companies.
Over concerns that financial ties were unduly influencing medical research and practice, the federal government created a database of payments to doctors. Drug makers are required to report these payments, and the data are publicly available. The feds also pursued many companies for paying kickbacks. Mindful of the horrible optics, the pharmaceutical industry trade group issued a tougher voluntary code for interactions with doctors.
But Glaxo was the only company to halt payments.
The move was part of an effort by former Glaxo chief executive Andrew Witty to remove a growing stain on his tenure. He also changed the system for sales rep compensation to put less emphasis on physician prescribing. And Glaxo committed to disclosing clinical trial data, since the company had also been fined for hiding important information.
But Witty is gone now and his successor, former consumer products chief Emma Walmsley, is trying to remake the drug maker. So far, she has replaced 50 top executives and is reworking pharma R&D. And as she sees it, resuming payments to doctors can only help the bottom line.
In explaining the decision, Glaxo noted it was the only drug maker that halted payments when the policy was put into effect in 2016, and it placed the company at a competitive disadvantage. “We believe this has led to a reduced understanding of our products and is, ultimately, restricting patient access to truly innovative medicines and vaccines,” according to a statement.
Glaxo would not make any executives available to discuss this in detail, but a spokesman told us the new policy pertains to only about a dozen products launched in the last two years, although it could also apply to other new drugs going forward. For now, payments will be permitted for only two years for new medicines or vaccines, and one year following the release of “significant new data.”
Putting aside any skepticism, Glaxo deserves some credit for trying to nudge an industry known for egregious marketing in a better direction. The fact that its effort failed to catch on says more about other drug makers than Glaxo.
But that shouldn’t mask the real significance of Glaxo’s about-face. The job of any doctor is to provide health care for patients or to do research; the point of payments from Glaxo and other drug makers is to help companies get a foothold in the market.
“If a doctor is being paid to market under the cover of professional or academic standing, it looks like an abuse of entrusted power for private gain,” said Roy Poses, a Brown University professor, who is also president of the Foundation for Integrity and Responsibility in Medicine.
In fact, financial ties between industry and doctors fell over the past 15 years, but a majority of doctors still reported them in 2017, according to a new survey in the Journal of General Internal Medicine.
For all concerned, Glaxo’s decision takes us back to the future. And it will only cement the value of paying doctors to promote drugs.