Who's Paying Your Doctor? Panorama

Panorama investigates how far some drug companies will go

Panorama investigates how far some If we don't do something soon it

will be all the worse If we don't do something soon it

of paying kickbacks to doctors abroad. Now we

of paying kickbacks to doctors pay doctors, they give us

prescription. We don't pay doctors, we

prescription. We don't pay doctors, legal. We go undercover to see the

doctors who legal. We go undercover to see the

in terms of the drug treatment of any addiction. With

in terms of the drug treatment of transparency. If people are being

paid, transparency. If people are being

We are all prescribed medicines at best

We are all prescribed medicines at some point in our lives. And we

trust that what we get is simply what's best for our health. Across

the UK, we were prescribed more than a billion drugs last year at a cost

to the NHS of more than ?10 billion. So that's big business for the

pharmaceutical industry. This is the story of the tactics

companies use at home and abroad to tap into that lucrative market. Here

in the UK there are strict rules to govern what drug companies can get

up to. But that doesn't stop them spending millions trying to persuade

doctors to prescribe their drugs. One of the most controversial

methods is paying doctors to promote their drugs to fellow medical staff.

Most patients trust their doctors or want to trust them. And I think they

may well be quite shocked if they knew that their doctor was taking

money from an individual drug company or was committing to speak

on that company's behalf in favour of a particular drug. Right across

medicine doctors are being paid in this way and it's perfectly legal.

And where does this subtle persuasion often take place? The

Medical Conference. Munich in March and thousands of psychiatrists from

across Europe are here for what is classed as an educational event.

We've come to investigate how conferences like this are used to

market prescription-only medicines to doctors. And there's no shortage

of slick sales techniques. If I want my free wifi, I have to go up to the

Lundbeck stall and guess what? The user name is one of their medicines.

Sycrest. Oh sorry. Sycrest. OK? Drug company sponsorship of this four-day

event runs to more than ?800,000. To cut through all the spin we called

in an expert. Professor Tim Kendall. Medical director of an NHS Trust,

who also helps produce treatment guidelines for doctors across

England. I've never been to a conference like this apart from

coming to give a talk and then going. What it feels like is a trade

fair. The first thing Professor Kendall notices is just how many

fellow doctors from Britain are here. Nearly 300. How wise are they

to some of the more subtle sales techniques? Throughout the

conference there are sessions like these. They are completely organised

and paid for by individual drug companies because they've got a drug

they want to promote. But speakers include some of the biggest names in

British psychiatry. We caught a glimpse of Oxford Professor and

consultant psychiatrist Guy Goodwin. He's being paid to speak at a

symposium organised by French drug company Servier. It's not part of

the main conference programme but it's in the same venue. Professor

Kendall went to listen and we tried to follow with a camera. Oh no, why

not? I don't know. They wouldn't let us film the session. We went in with

a hidden camera. It was a full house, with many delegates from the

UK. Thank you to the organisers. It's a pleasure to be here at this

EPA. An innocent enough opening. But all speakers are supposed to list

any financial links to drug companies before talking. Professor

Goodwin didn't declare his list. He later told us this was an honest

oversight, which he regrets. In the symposium, Professor Goodwin talked

about the under-treatment of depression. Then two other speakers

talked favourably about Servier's drug, agomelatine.

It's a licensed antidepressant which is not recommended for use in the UK

by our medicines' watchdogs. Doctors can still choose to prescribe it

though. A lot of UK based people in the audience they will be going back

and they will be thinking, right, agomelatine, that could be the next

drug. I'm really worried about this. His biggest concern was reserved for

the credibility experts like Professor Goodwin can give to an

industry event, even though he didn't mention agomelatine directly.

My real worry is that these very eminent and very able people are

walking into industry sponsored symposia and in that context they

are just being used. The place is packed. It was a full house, wasn't

it? Absolutely packed and I'm sure it was packed because of Guy.

Certainly this delegate from the UK seemed impressed. When somebody like

Guy Goodwin is talking, is that a draw for you? Oh definitely again

because I'm based in Oxford. I know Professor Goodwin from Oxford. The

whole event is really good. We asked Servier about employing Guy Goodwin.

In a statement they told us: They also told us they don't promote

agomelatine in the UK. Tim Kendall later approached Professor Goodwin

to ask if he's comfortable being paid to take part in events like

this. His answer? He didn't take a vow of poverty when he became a

professor. His genuine view is that a lot of doctors are involved in

working with the industry and sometimes that does bring some

benefits, financial benefits to them. He didn't think that in itself

was wrong and I think there's probably quite a lot of doctors who

think that. Professor Goodwin didn't want to be interviewed. But later he

told Panorama: He told us he earns ?11,000 a year

from such talks. But that's not all. He's also paid to advise or consult

for these eight drug companies. Professor Goodwin wouldn't tell us

how much he earns from that. Back in Britain, does this sort of

sponsorship really influence prescribing? One Glasgow GP thinks

it does and for that reason Des Spence doesn't go to any

industry-sponsored events. There's a trickle-down effect. So if you have

a leading expert or group that, you know, over the course of time that

trickles down to general practice and we start changing our clinical

care, you know. Whether we prescribe more statins, whether we prescribe

more antidepressants. This directly affects your care. The body that

represents the industry says patients benefit from their work

with doctors. ?50 billion a year is spent on research and development by

this industry. That has made HIV a liveable condition, diabetes,

coronary heart disease, asthma, all these things that have been

transformed. Now, to do that does require a relationship with health

care professionals, both in research and also in, if you like, in terms

of usage of those medicines with patients. It's a thin line though

between education and promotion, isn't it? It's a very thin line,

absolutely. But I would also say is that, of course, what we do is

completely and absolutely legitimate. It's perfectly legal for

drug companies to pay doctors to speak. It happens right across

medicine. And so does sponsorship of doctors' education. But how

objective is the information at industry-funded events? We went

along to one at this Hertfordshire hotel. It was billed as a clinical

lecture about the treatment of alcohol dependence. This is it. The

event is invitation-only though, so we've sent in a hidden camera. The

invitation made clear the event is organised and sponsored by Danish

drug company, Lundbeck. Inside, we found a large turnout, many GPs, who

had come to hear an eminent addictions expert. Professor David

Nutt was soon singing the praises of Lundbeck's new drug to treat heavy

drinking. By the end of his 45-minute talk,

there was no mistaking his enthusiasm for the drug, nalmefene.

We showed Professor Kendall our undercover footage of how nalmefene

is being promoted directly to GPs. I think the presentation had very

little in the way of anything critical. If I was a GP and I didn't

have the knowledge that I had, I would come out and I would be

prescribing that tomorrow. Nalmefene is only recommended in the UK if

it's prescribed alongside long-term psychological support. That was in

the slides behind him but Professor Nutt didn't make it clear in his

talk. When we contacted him later, Professor Nutt said was paid the

standard industry rate for the talk. He told Panorama:

Doctors need to earn a certain number of points each year towards

their Continuing Professional Development, or CPD, by going to

training events. Our undercover reporter asked the Chairman if CPD

points could be claimed from this event. Can he claim this as CPD

points? Absolutely 100%. Really? It's CPD. 100% he can. Do you think

that sort of event should count as training for doctors? Not at all.

Absolutely should not. I have a real problem with drug companies putting

on an event called education that's clearly to sell the drug and that

being declared as some sort of contribution to their CPD. It's a

joke. Lundbeck later told us its event chairman, a consultant

psychiatrist, was not qualified to make such comments and had got it

wrong. Yet the Chairman was emphatic on the

night that CPD points would be awarded. 100% he can. All right, OK.

I don't think he realised that. 100% he can. You get two CPD credits for

this. We later asked the chair if he had

been 100% wrong. As far as he was concerned it was a scientific

lecture that: With such a thin line between

education and promotion is it any wonder there's confusion over which

events qualify for CPD points and which don't?

The editor of the British Medical Journal thinks drug companies should

be kept out of doctors' education. The drug industry has a conflict of

interest. They are there to make money for their shareholders, white

right, legitimate, and in doing so, they often create good products

which we rely on and need. But they do not have a legitimate role in the

education of doctors. Even with sponsorship that is strictly

regulated, concerns are growing about its influence on the

prescribing of doctors. But elsewhere in the world, some of the

biggest names in the pharmaceutical industry have been accused of

breaking the law. Britain's most profitable drug company,

GlaxoSmithKline, was forced to pay a massive settlement in the US in

2012. GlaxoSmithKline has agreed to pay $3 billion... It is to do with

how it promoted some of it strikes... This is unprecedented in

scope and size... Blair Hamrick started work for GSK as a sales rep

in Colorado back in 1997. He says he and his colleagues would pay doctors

to promote their drugs to other doctors, sometimes thousands of

dollars for a few hours work. It is always under the guise of education.

Doctors have to get so many hours of continuing medical education. Well,

we would have these programmes which would get credit for the doctors.

They were nothing but a commercial. Doctors were sent on foreign trips

and given lavish hospitality, kickbacks, essentially, to encourage

increased sales. They would be sent on trips to Jamaica or Bermuda, or

Disney World in Orlando, Florida. They would be taken out to dinner.

Entertainments, Madonna concerts, basketball games, the tickets which

were the hardest to get. And GSK kept a close eye on whether it was

money well spent. There was what is called an ROI analysis analysis,

return on investment. So, if we spent $5,000 on a speaker and we

spend $20,000 on tickets and food, that is $25,000 invested. They would

take all of those physicians and they would track their prescription

volume, and they would want to see an increase in prescription is

greater than $25,000. It is business. Did you generally see a

good return on investments? Always. Times were good. Blair Hamrick had a

young son, which focused his mind when he was asked to market an

antidepressant for children. The drug was only approved for adults,

and he knew it could cause seizures. Being a father myself, I

said, wait a second, if a kid has a seizure on this medicine, whose

fault is it? Is it mine, is it the company, is it the doctor? And I

could not have that on my conscience. When I raised the

concern with my manager, my manager said, everybody is doing it, so you

had better do it as well. It is illegal to promote drugs to doctors

outside of the license, like this. But it is claimed that the bonus

system encouraged breaking the rules. During the court case, GSK

agreed to stop linking bonuses to sales targets in the US. You want a

doctor prescribing decisions to be independent. You want them to be

objective. You do not want the relationship between a physician and

his or her patient to be interfered with by a pharmaceutical company,

which is driven by profits. Back so Smith Klein is not the only drug

company to fall foul of the law in the US, but it has the worst track

record. One campaign group has analysed all of the pay-outs by the

drug industry for any kind of rule breaking in the US over the last two

decades. -- GlaxoSmithKline. Glaxo was the number one, with $7.6

billion, in terms of criminal penalties. Even hefty fines and

settlements have not stopped Britain's GSK offending again. The

penalties are not large enough to deter these illegal activities. In

one year, Glaxo makes more money in terms of profits and all of the

penalties they have paid over 21 years. GSK's chief executive

declined to be interviewed. In a statement, the company said that in

the US... With an annual turnover last year of

more than ?26 billion, GSK is a massive enterprise. And it is not

just in the US that the company has been accused of making illegal

payments to doctors. Police in China have today accused the British drug

giant GlaxoSmithKline of using travel agencies as vehicles to bribe

officials and doctors... The Chinese authorities claimed that 300 minimum

pounds was paid by GSK to government officials and doctors in China. The

company is waiting to see if it faces prosecution there, and says it

is cooperating fully with the investigation. GSK could face

prosecution in Britain - it is against the law to bribe the company

has told the Serious Fraud Office here about the allegations in

China, and clearly it wants to draw a line under the issue of illegal

payments. In the last fortnight, though, new allegations have emerged

about the companies behaviour in Iraq. And now, Panorama can reveal

more allegations of corruption. We have uncovered evidence that GSK

sales reps have recently been paying doctors to boost prescriptions much

closer to home, in Europe. There is a simple equation - we pay doctors,

they give us prescription. We don't pay doctors, we do not see

prescription for our drugs. . Jarek Wisniewski once had a good life with

his family in Poland. He worked as a sales rep for GlaxoSmithKline until

2012, and at first, the future looked bright. I was in a programme

for future managers. Really, they invest in me. I was a talent, they

said. I was a talent for them. But things started to change for him in

2010. GSK launched a major marketing programme across Poland to push its

asthma drug Seretide. The budget of this programme was more than 5

million Polish money, about ?1 million. It is a really huge

marketing programme, extra money, for increased sales, because we need

to sell more. Always more, more, more. For the first time, Jarek is

speaking publicly about exactly how he and his colleagues hosted sales.

He says that on paper, the budget was to educate patients about

asthma, but the reality, he says, was that they paid doctors to

prescribe more Seretide. I said, I need more prescription for Seretide.

So they knew exactly for what I was paying. So this was a deal that

everybody understood? Yes. Another former GSK drug sales rep, who does

not want to be identified, confirms that they routinely paid doctors for

lectures that never happened. Do you find that this tactic worked, that

if you paid doctors, they tended to prescribe more? Yes, of course. The

Dr feels obliged. How did you feel about that? TRANSLATION: Like many

people, my feelings were very negative and unpleasant, but that

was the work. Just like in the US years before, the more prescriptions

they could secure, and they say their manager also expected them to

secure a return on investment. On the first pitch, we pay ?100. But

we expect more than 100 perceptions. So, although the deal verbally

between you and the doctor was clear, it was not written down like

that anywhere? No. With doctors in Poland earning around ?700 a month,

even small cash incentives could be lucrative. What you are essentially

describing is a bribe. Yes, it is a bribe. Two years ago, he told GSK he

the result - he says he was sidelined at work and eventually

sacked. Now, there is a criminal investigation. 11 doctors and one

GSK regional manager have been charged. One of the doctors, who did

not want to be interviewed, told Panorama you did take money from

GSK. He told us he took 500 zlotys, about ?100, for a single lecture

which he never gave. He said he blamed the pharmaceutical

representatives, because it is hard to refuse when they keep putting

pressure on you. They kept tempting, you said, and I am just a man. The

regional public prosecutor has examined the contracts which doctors

like him were given by GSK. They found evidence to support claims of

corrupt payments. TRANSLATION: In more than a dozen

cases, these contracts were fictitious. So, these payments were

in effect bribes? Yes. We have evidence to claim that in more than

a dozen cases, it was a camouflaged form of bribe. And was the deal

actually that the doctors were to prescribe more drugs in return for

this money? That was the point. In return for the financial gains, the

doctors would favour the product proposed by the pharmaceutical

company and they would prescribe that medicine. What we have

uncovered in Poland is significant, because it could eventually lead to

an investigation by the authorities both in the GlaxoSmithKline told us

it is cooperating with the investigation and has carried out

one of its own. In the UK, the drug industry spent

nearly ?40 million on health professionals last year. Payments

are strictly regulator, but how easy is it to find out if your doctor has

been paid? All NHS medical staff are expected to register any financial

conflict-of-interest. We asked more than 200 NHS trusts and health

boards across the UK if their register is publicly accessible.

Only 6% said it was available online. The overwhelming majority

say have to ask to see it. People who are being paid, please tell us

how much you are being paid, because that will influence the message that

you give. Perhaps doctors and experts are in a state of denial

about that, but anybody with any common sense can see that you can

pay people to give the message that you want. Things in the United

States could not be more different. Since the end of last month, drug

companies have been legally obliged to detail all payments to doctors.

One research group has even created a single searchable database. So, if

you want to know if your doctor is on the payroll of a drug company,

just type in a name, and the computer does the rest. Yes, here is

somebody. $145,000. The effect of this transparency has been

startling. Payments to doctors in the US overall have plummeted. It is

interesting, because it might be the company itself changing its

behaviour, but also the doctors not wanting to be on the register, with

those payments made public. Will transparency here have the same

effect? The drug industry says it will publish all payments to doctors

in the UK by 2016. We should never fool ourselves that doctors will be

overly swayed by some of this commercial activity, given that they

receive a lot of other information. Why on earth would the struck

companies spend all of this money on doctors if it did not sway their

prescribing? That is always interesting. But why would they?! My

view is that it should sway their prescribing, I would say that

categorically, because it is appropriate for doctors to prescribe

medicines for patients that need them, within the right guidance. It

is up to the doctor to decide what is right on all of the information

that they receive, from all sources. But his transparency on its own

enough? Back so SmithKline recently announced it will no longer pay

doctors anywhere in the world to promote its drugs or sponsor them to

go to conferences. -- back so SmithKline. This announcement from

GSK seems to represent the beginning of the unpicking of decades of

behaviour which has been regarded as acceptable, now, we are beginning to

say, it was never OK, why did we ever think it was OK? A growing

number of doctors macro now think it is time for a fundamental change in

the relationship with the drug industry.

Probably not seen as the most popular job.

When I say I hate them, I mean I hate them.

Who put that on it? Where's he gone?

If there's one thing that drives us all crazy... This is wrong!