There ain’t such a thing as a free lunch: Pharmaceutical company payments to Australian psychiatrists

Dear Editor,

The marketing of products to psychiatrists by pharmaceutical companies includes offers of money for consulting services and for conference registration, travel and accommodation. Since 2019, under changes in the Medicines Australia (MA) Code of Conduct, the names of all doctors receiving payments from MA member pharmaceutical companies have been published online at www.disclosureaustralia.com.au/.

Here, we present an analysis of the first 3 years of data from this repository. We recorded the names of psychiatrists who received any payment between November 2019 and October 2022 and cross-checked this information against their AHPRA public listing, with doctors matched by name and practice address. Matching was undertaken in R (version 4.3) using an efficient approximate entity matching algorithm. We used a Jaro-Winkler threshold of ≥0.8, with accuracy manually assessed by two authors using a 10% random sample. The total number of psychiatrists in Australia in 2020/21 was 4409 (Callie Kalimniou, personal communication, 26/04/2023).

In total, 103 psychiatrists received at least one payment, with a total of AUD$515,437 transferred. The range of payments was between AUD$100 and AUD$30,598 (median AUD$2984). The 10 highest paid psychiatrists were all prominent individuals, including university professors and past RANZCP office bearers.

There were substantial errors within the MA database, with misclassification of psychiatrists as other health professionals and some psychiatrists listed under several different names. There is a clear need for greater transparency given the poor quality of MA data.

In our sample, 2.3% of Australian psychiatrists received a payment from a pharmaceutical company. This relatively low number may reflect that MA, an industry body, do not include meal expenses in their database. In the USA, which has more robust legislative instruments to capture pharmaceutical payments, over half of practising psychiatrists receive some form of pharmaceutical payment, with most payments made to influential psychiatrists. ¹ Additionally, this 2.3% figure is likely an underestimate given Servier (makers of Valdoxan and Latuda, who have made payments to psychiatrists in the past) are not a MA member company.

There is evidence that pharmaceutical payments influence prescribing patterns, including off-label prescribing. ² This remains the case even when payments are indirect and of nominal value. ³ Pharmaceutical industry payments may be partly contributing to rising stimulant prescription rates. ⁴ In our study, over 80% of payments to psychiatrists were from Janssen-Cilag and Takeda, the makers of Concerta (methylphenidate) and Vyvanse (lisdexamfetamine), respectively.

Psychiatrists receiving payment or gratuity from pharmaceutical companies should consider whether they are free from real or perceived undue influence and whether their involvement with pharmaceutical companies is in keeping with public expectations and consistent with ethical practice.