Just as the dust is settling after the big rollout of doctor-payment data in the U.S., a new round has made its debut--in Japan. According to The Japan News, the country's top 10 drugmakers shelled out 190 billion yen ($1.66 billion) to doctors in fiscal 2013 in the form of research payments, speaking fees, entertainment, medical seminars and the like.
The numbers aren't as big as those in the U.S., where drugmakers spent $3.5 billion with doctors over a 5-month period. But after a scandal involving prestigious Japanese universities and their research into Novartis ($NVS) drugs, Japan may be particularly sensitive to the suggestion that drugmakers are too cozy with doctors.
The Japan News notes that research payments accounted for 89 billion yen of the 190 billion total. But then it zeroes in on the most controversial aspect of doctor payments: Are speaking fees an important way to get doctors talking to other doctors about the best treatments? Or are those talks sales pitches, pure and simple?
Those speaking fees amounted to 11 billion yen, or about $95 million, from the top 10 drugmakers in the country. Entertainment amounted to 2.5 billion yen. The top 10 companies hosted 70,000 lecture meetings, with 226 doctors paid $17,000 or more, and 11 doctors collected 10 million yen each over the fiscal year. One doctor gave 155 lectures, earning more than 28 million yen, or $244,000. That rivals the amounts paid to some of the top doctor-speakers in the U.S.
Drugmakers defend their Japanese doctor payments as they do Stateside. The informational talks are important for spreading the latest information about treatment strategies. Doctor-speakers themselves told the news organization that their lectures "improve the level of doctors" in their regions and consider "relaying information to doctors" to be "an important part" of their jobs.
But others aren't so sure. Iwao Kuwajima, who chairs the Japanese Organization of Clinical Research Education and Review, told The Japan News that doctors prescribe more high-priced new drugs because of the lecture meetings, pushing up healthcare costs. "Each time new medicines are released, the companies spend a lot of money to hold these meetings, which are actually advertising bids in the guise of study meetings for doctors," he said.
Top universities have been forced to apologize after allegations of data manipulation in studies of the Novartis drug Diovan. Tokyo University also admitted to allowing Novartis sales reps to be involved in research about leukemia drug side effects. Prosecutors are going after Novartis for false-advertising violations related to the suspect data, and one ex-employee was arrested.
Earlier this year, a Japan Times editorial called for broad reforms in clinical trial transparency. But the paper points out that Novartis provided much-needed financial support to the University of Tokyo lab that was involved in the leukemia study: ¥8 million over three years ($1.3 million). To foster neutrality in clinical trials, "the government needs to expand its support for researchers so that they don't have to rely on money from the pharmaceutical industry," the paper contends.
At least one doctors' group in Japan feels similarly about speaking fees. The Kyoto Diabetes Society was started in 2002 to sponsor independent study meetings for doctors. Now, four times a year, the society holds meetings to talk about treatments. Some are jointly sponsored by companies, but the agenda and the lecturers are selected by the society. "[D]octors' own efforts are essential to correctly obtain information for treatments without totally relying on pharmaceutical makers," one of the group's founders said.
- read the Japan News story