A Cochrane review found that pharmaceutical company payments and gifts to prescribers were associated with more prescriptions being written. But are these findings applicable to Australia?
A global Cochrane review, published Friday, found that money and meals provided to doctors by pharmaceutical companies was associated with the increased prescribing of drugs that were more expensive, offered fewer benefits or were not clinically necessary.
The review analysed millions of doctors’ prescribing practices across 93 studies – 82 of which were conducted in the United States, with the remainder from the European Union or the United Kingdom. Most studies examined payments and gifts, and seven examined free drug samples.
Although Australian researchers conducted the review, none of the studies were conducted in Australia due to a lack of granular data.
A spokesperson from Medicines Australia told The Medical Republic, “We would not advise making any conclusions about Australia in the absence of studies here”.
“Suggestions of inappropriate prescribing in Australia go far beyond the data provided and cannot be substantiated,” the spokesperson said.
The researchers examined how four types of exposure affected prescribing: advertising and education, gifts and payments, free samples, and conflict-of-interest policies.
The evidence on exposure to pharmaceutical company advertising or education was less certain. Compared with no or less exposure, researchers found it could reduce prescribing appropriateness and likely increase prescribing costs.
Ultimately, there was no definitive evidence that free samples affected prescribing appropriateness, quantity, or costs.
Researchers found that conflict-of-interest policies that restrict or manage these interactions were associated with improved prescribing appropriateness and could decrease prescription volume.
AMA vice-president Associate Professor Julian Rait said Australia’s rules governing interactions between pharmaceutical companies and doctors were far stricter than those in the United States.
The Medical Board of Australia’s guidelines require doctors to recognise marketing influences, understand their potential impact on practice, and reject gifts or hospitality of more than trivial value that could affect patient prescribing, treatment, or referrals.
Practitioners who fail to appropriately manage conflicts of interest are otherwise subject to regulatory action.
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Medicines Australia’s disclosure log also provides a searchable database of significant payments and transfers to healthcare professionals made by its pharmaceutical company members.
“The overriding principle guiding doctors’ relationships with industry is the primacy of patient care. Patients and the wider community expect doctors to uphold this duty and put patients’ interests above their own personal interests or the interests of industry,” Professor Rait said.
Under Medicines Australia’s 20th edition code of conduct, hospitality is limited to $140 per person per meal, excluding gratuities and GST, with the cap reserved for events of significant duration and educational value.
While meals can be provided in connection with legitimate activity, including an educational event, unlike in the US, doctors cannot be taken out to dinner as a gift, nor can guests or spouses receive hospitality.
Gifts are also prohibited under the Medicines Australia Code of Conduct.
RACGP president Dr Michael Wright said while the Cochrane review raised “legitimate concerns”, he cautioned against applying the findings directly to Australia, as none of the studies examined involved Australian prescribers.
“However, no prescriber is immune to bias, and the evidence reinforces why strong safeguards matter. As prescribing rights expand to other professions like pharmacists, conflict-of-interest rules, transparency, and oversight need to keep pace with those changes,” he said.
Dr Wright said further scrutiny and transparent management were necessary for businesses that both prescribe and dispense, a sentiment that has grown as pharmacy prescribing powers expand.
The RACGP also urged the production and availability of “broader unbiased information” about the Quality Use of Medicines for all prescribers, as the college said pharmaceutical companies often focus on the latest and most profitable medicine classes.
“Patients should be able to trust that every medicine is recommended because it is the safest and most appropriate choice for them – not because anyone stands to profit benefit from supplying it,” Dr Wright said.
An Australian-based report published in Nature Briefing analysed publicly disclosed payments from Medicines Australia member companies to healthcare professionals between 1 October 2015 and 31 October 2024.
In total, researchers found that 104,663 payments, worth a combined $164.4 million, were made to 23,528 individuals – predominantly funding for travel, fees for service, and educational meetings.
Payments ranged from $1 to $114,400, with the top 1% of recipients accounting for 25% of total payments.
Researchers theorised that these recipients were most likely key opinion leaders holding leadership positions within medical associations.
Haematology, oncology and rheumatology specialists made up the largest share of clinicians among the 12.2% of doctors in Australia who received at least one payment, a trend researchers attributed to pharmaceutical companies’ sponsorship of clinical trials and conferences.
Read the Cochrane study here.
