Editorials
Environmental health Ethics
Volume 219 - Issue 6

Pharmaceutical company sponsorship of doctors: is gender equity a concern?

Authors:  Barbara Mintzes and David B Menkes

Med J Aust 2023; 219 (6): 261-262. || doi: 10.5694/mja2.52088
Published online: 18 September 2023
If female doctors receive less pharmaceutical industry funding, gender-based differences in prescribing patterns could result
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Pharmaceutical companies often provide gifts and payments to doctors and other health professionals. Such support is associated with greater prescribing of promoted medicines,1 including more expensive drugs without advantages compared with standard treatment.2

The need for public disclosure of industry funding of clinicians is now recognised internationally. For example, the industry trade association Medicines Australia has required member companies to disclose funding of sponsored events since 20073 and of payments to individual clinicians since 2015.4 In the United States, the 2010 Sunshine Act, requiring public reporting since 2013, was famously announced by Senator Charles Grassley with the comment that it “sheds light on these hidden payments and obscured interests through the best disinfectant of all: sunshine.”5 The European Union, Japan, and South Korea have since also introduced legislated or industry self‐regulatory transparency processes.6,7,8

New Zealand has been slower than most high income countries to require reporting of these payments. Medicines New Zealand, the national trade association, did not release the first payment information until 2022. Although incomplete, this was a welcome first step: of 22 member companies, seventeen are listed as making transparency reports in 2021, eight of which declared payments to doctors (one to non‐medical clinicians only; one posted no report; seven made no payments).9

In this issue of the MJA, Jones reports the first study of industry payments in New Zealand, with a focus on gender differences.10 Of 283 payments, 197 were to men (70%) and 86 to women (30%), although 47% of New Zealand doctors are women. The proportion of payments to women ranged from 38% for conference registration, travel, and accommodation to 25% of speaker and education fees.10 Although the New Zealand numbers are small, these differences mirror the findings of an analysis of 544264 American doctors, 67% of whom received industry payments during 2015–2017: male recipients received a mean US$4164 per year, women US$1650.11 A French analysis similarly found that 76.5% of general practitioners receiving more than €1000 per year were men.12 Jones found differences in the numbers of payments by gender, but not in their median dollar value. She attributes the larger differences in specific payment types to more men having leadership positions in medicine.10 Speaker and consultancy payments are linked in marketing with “key opinion leader” status,13 consistent with the author's interpretation.

New Zealand disclosure data are incomplete, however, raising concerns about the validity of this analysis. Clinicians must provide written consent for their payments to be disclosed by the pharmaceutical companies, and companies are advised to seek consent when providing funding. In the United Kingdom, where consent is also required, an estimated 40% of clinicians receiving payments declined to consent to disclosure.14 No information is available on New Zealand doctors who did not provide consent. Secondly, disclosure of the most frequent type of payment — for food and drink — is not required by Medicines New Zealand, nor research support funding. Thirdly, not all Medicines New Zealand companies have yet reported payments, including major firms such as Pfizer, Takeda, and MSD, and not all pharmaceutical companies active in New Zealand (eg, MundiPharma) are members (nor are any medical device companies).

The available information is therefore limited and inconclusive. But if female doctors in New Zealand do receive less pharmaceutical industry funding, is this a gender equity concern? There are two potentially overlapping reasons for the apparent differences: companies may offer funding to women less often, reflecting inequitable policies or broader societal gender inequities. Alternatively, women may decline payments more frequently than men, possibly reflecting gender differences in professionalism, women opting to avoid financial relationships with industry more often than men. Differences between women and men in prescribing patterns could result, as associations have been reported between receiving payments from pharmaceutical firms and higher cost, higher quantity, and less appropriate prescribing.1

An open question is whether female patients are more affected than men by treatment choices influenced by industry payments. An annual list of “drugs to avoid” with poor safety or efficacy profiles includes many heavily promoted medicines that are primarily prescribed for women.15 Safety scandals — those involving vaginal mesh or textured breast implants, for example16— highlight the potential for financial conflicts in treatment decisions affecting women. If women doctors decline industry payments more often, thereby reducing commercial influence on their clinical decision making, they may be less likely to prescribe inappropriate and unsafe treatments for their patients. Further research and more complete disclosure data are needed to answer this question.


Authors

  • Barbara Mintzes1
  • David B Menkes2
  • 1. Charles Perkins Centre, the University of Sydney, Sydney, NSW
  • 2. The University of Auckland, Hamilton, New Zealand

Correspondence: barbara.mintzes@sydney.edu.au

Competing interests

No relevant disclosures.

Acknowledgements

We thank Joel Lexchin (York University, Toronto, Canada) for reviewing successive drafts of the manuscript.

References

Provenance: Commissioned; not externally peer reviewed.

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