Health workers have accepted more than $300,000 worth of drug company-sponsored travel and gifts, as global concerns grow about the influence of freebies on treatment decisions.

While the rest of the world is increasing disclosure of such payments, in New Zealand they have become more opaque.

However, Medicines New Zealand plans could see all freebies publicly declared from next year.

District Health Board gift registers obtained under the Official Information Act show doctors, nurses and other health workers last year declared 149 medical company gifts, worth $334,979*.

The figure is just the tip of the iceberg. Despite a Health Ministry letter to DHBs in January advocating gift registers, six DHBs still do not have them.

That includes the second largest - Canterbury DHB. Others recorded no drug company gifts, despite employing more than 2000 doctors and nurses.

The biggest gift declared was Astra Zeneca-sponsored travel, accommodation and registration for a Counties Manukau doctor to attend the European Respiratory Society congress in Barcelona, worth $15,000-$20,000.

Other big tickets included Merck Sharp and Dohme funding $16,000 worth of travel and accommodation each to a research nurse and clinical research co-ordinator to attend an investigator's meeting in the United States. Pfizer funded a Counties Manukau rheumatologist's $15,000 trip to attend the Paris meeting of the European League Against Rheumatism.

Pfizer also paid $8000 to send a Wellington specialist nurse to Barcelona for a global haemophilia summit it organised, which included one Pfizer staff member for every four health workers.

Drug and medical companies also paid for meals, All Black test tickets, honoraria for attending workshops and fees for talks and advice.

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Research has showed that drug company freebies influence treatment decisions. Christchurch oncologist Mark Jeffery has refused freebies for nine years (see sidebar) and said there was no excuse for accepting free travel, as senior doctors received $16,000 a year specifically for medical education. Nurses get a professional development allowance of up to $4500 annually, depending on seniority.

In the past 18 months, Britain, the United States and Australia have increased transparency of drug company payments to health workers, in recognition of the risk they influence patient care.

The United States introduced the Physician Payments Sunshine Act, requiring drug and device makers to declare all payments to individual doctors. Medicines Australia's new code of conduct also demands disclosure of payments to named health workers.

In New Zealand, however, several health boards have become less transparent. Southern DHB now refuses to describe gifts and name their donors. Auckland DHB last year named recipients but this year did not.

Auckland University professor Cindy Farquhar co-wrote a New Zealand Medical Journal editorial in March calling for greater transparency. She said patients deserved to know where health professionals were receiving gifts from, especially if they were making recommendations about medications and medical devices.

"It is a big concern. A lot of people use their doctors for advice."

Drug company industry body Medicines New Zealand has been investigating disclosure methods over the past three months. General manager Graeme Jarvis expected to have a system in place next year. He said New Zealand's health system was unique and it was not just a matter of following another country's lead.

Medical Association chairman Stephen Child said doctors welcomed transparency, in the interests of patients. "The important thing is to make sure that it is done in a fair, equitable and robust manner, so that it's not bad data." However, gifts by medical device makers were arguably a bigger risk and would not be covered by any Medicines New Zealand disclosures, Dr Child said.

THE REFORMED DOCTOR

As a medical student, Mark Jeffery was so wary of the potential influence of drug companies he would cut the drug ads out of the New Zealand Medical Journal before reading it.

Some 20 years later the Christchurch oncologist found himself playing a drug company-sponsored $500 round of golf at California's swanky Pebble Beach. At that same conference, the company held a party on an old decommissioned aircraft carrier in San Francisco harbour. The deck was jammed with buffets and bars and there was a dance to follow. The band was The Temptations.

From his initial hard-line stance, Jeffery had gradually rationalised accepting drug company sponsorship. He would accept funding for a conference he already planned to go to and then use his annual education grant to attend an event he couldn't get sponsorship for, such as a Cochrane Collaboration meeting. Over the years, drug reps got to know him and his interests. A tee-off time at Pebble Beach just happened to open up.

"I was becoming increasingly uncomfortable with the lavishness of the sponsorship. Business class airfares, great hotels - goodness knows what the whole thing cost. If, at the start of my career, someone had said in 15 or 20 years' time you will be accepting gifts of hundreds of dollars for non-conference-related things I would have said they were crazy. But this is the insidious nature of the relationships that develop. I decided, I guess, enough was enough."

That was nine years ago, at the height of revelations about dodgy drug company practices and multimillion dollar fines for fraud. Jeffery no longer sees drug company reps or accepts pharmaceutical sponsorship. He has convinced colleagues to do the same. Given New Zealand doctors get $16,000 a year specifically for continuing education he does not believe there is any excuse for accepting sponsored travel.

The Medicines New Zealand code of practice now prohibits "the provision of hospitality in the absence of medical/scientific education". The code also says relationships with health care professionals must "withstand public scrutiny".

Jeffery called for a Sunshine Act with the "threat" of publicity and greater leadership from health boards - in his 23 years working for two DHBs he had never been asked to declare a gift. "It just is not happening".

DRUG COMPANY AND MEDICAL DEVICE MAKER GIFTS, BY DISTRICT HEALTH BOARD

AUCKLAND - its 4292 doctors and nurses declared 7 gifts, worth $67,684. The largest were two $16,000 trips, sponsored by Merck Sharp and Dohme, for a nurse and clinical research co-ordinator to attend an investigator meeting in the United States.

BAY OF PLENTY - 1318 doctors and nurses, 9 gifts declared, but 0 from drug companies.

CANTERBURY - 3770 nurses and doctors. Says it does not keep a central gift register, despite instructing its staff to send their Conflict of Interest/Hospitality Declaration Forms to "Disclosure Register, Corporate Office"

CAPITAL AND COAST - 2313 doctors and nurses, 18 gifts disclosed, worth $28,546. Largest gift was $8000 Pfizer sponsorship for specialist haemophilia nurse to attend a Pfizer-organised Global Haemophilia Summit in Barcelona. Two thirds of the declared gifts went to nurses.

COUNTIES MANUKAU - 2937 doctors and nurses, 44 gifts disclosed, worth $80,436. The largest was sponsorship from Astra Zeneca for travel, accommodation and registration to attend a European Respiratory Society congress in Barcelona, valued at $15,000-$20,000. Non-drug-company-related declarations included $25,000 in business class flights, accommodation and a speaker's fee for a primary care representative to speak at the Qatar Annual Health Forum. One gift - $10,800 worth of conference travel - was declined.

HAWKE'S BAY - 987 nurses and doctors. Still developing a gifts register.

HUTT VALLEY - 871 nurses and doctors, 2 gifts declared, worth $2600. Both were for nurses, to attend overseas conferences.

LAKES - 571 nurses and doctors, 5 gifts declared, worth more than $11,000 (one conference sponsorship, with flights and accommodation, was not given a value). The largest was $5000 in flights, transport and accommodation to attend a surgery meeting in Italy. The DHB refused to disclose who funded the freebies*.

MID CENTRAL - 1157 doctors and nurses, 0 gifts declared. Only recently established a gift register.

NELSON MARLBOROUGH - 753 doctors and nurses. Do not keep gift register "due to the practicalities involved".

NORTHLAND - 1056 doctors and nurses, 2 gifts declared, but 0 from drug or device companies.

SOUTHERN - 1934 doctors and nurses, 135 gifts declared, of which an estimated 72, worth $144,963, were from drug or device companies*. The largest gift was $10,660 in unspecified sponsored travel. Despite being last year's most transparent health board, Southern this year refused to disclose the description of gifts or their donors, after initially pretending the information did not exist.

TAIRAWHITI - 317 doctors and nurses. Submitted internal gifts rather than ones from external organisations and failed to respond to further questions.

TARANAKI - 645 doctors and nurses, 9 gifts declared, ranging from rugby test match tickets to four $55 rounds of golf. Donors were not named, rendering it meaningless for assessing potential conflicts of interest.

WAIKATO - 2747 doctors and nurses, 0 gifts of more than $200 declared from any source

WAIRARAPA - 241 doctors and nurses, 0 gifts declared from any source

WAITEMATA - 2798 doctors and nurses, 1 gifts declared - including flights and accommodation for three senior managers to attend a Sydney leadership forum, funded by Johnson and Johnson. No value declared - the DHB says it does not record that information.

WEST COAST - Still does not hold a central gift register for its 313 doctors and nurses, despite saying 18 months ago that it was implementing one.

WHANGANUI - 405 doctors and nurses. Do not keep gift register because "we do not see any need for one".

*For those health boards who refused to specify donors, we have assumed that all conference and travel sponsorship declared was provided by drug or device companies, which is consistent with the disclosures of other DHBs.

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