Although there are some grey areas regarding whether companies have to disclose payments for "medical writing support" or "editorial services," which may mean "ghostwriting," it is clear that drug and medical device companies are required to disclose payments to physicians who participate in speakers' bureaus.
Johns Hopkins School of Medicine defines speakers' bureaus and promotional talks as when pharmaceutical or medical device companies:
a) have the contractual right to dictate or control the content of speakers' presentations or talks,
b) create the slides/presentation materials and have final approval of the content/edits,
c) expect speakers to act as agents/spokespersons for the sponsoring company, for the purpose of disseminating company for product information.
The Continuing Medical Education Advisory board at Johns Hopkins School of Medicine believes that engaging in speakers' bureaus, as above, is unprofessional and is not permitted by its faculty, including physicians.
An inquiry by ProPublica has found that, with the approaching deadline for increased transparency of payment transfers, "...drug companies have dramatically scaled back payments to doctors for promotional talks." ProPublica says that while this marked decrease in disclosed spending on speakers' fees can be partially attributed to the increased attention and scrutiny by regulators, academic institutions, and the public regarding misleading marketing practices by pharmaceutical and medical device companies, this scaling back of payments has occurred also in the face of blockbuster drugs losing their patent protection.
For example, in 2011, Eli Lilly lost patent protection for two of its top-selling drugs and, therefore, began facing market competition from generic manufacturers that could now manufacture bioequivalents. Pfizer and Novartis also lost patent protection for one of its top-selling medications. The resources that would have otherwise been spent on promoting their previously patented medications have been reallocated "to support potential future product launches" (see ProPublica). Pfizer's disclosed spending on consultants decreased by 9% (2011-2012), while its expenditures on research remained the same.
Here are some figures, provided by ProPublica, which illustrate the dramatic declines in disclosed payments between companies and physicians for engagement in promotional talks for drugs and medical devices:
- Eli Lilly & Co.: US$47.9 million (2011) to US$21.6 million (2012) [decline of 55%]
- Pfizer: US$22 million (2011) to US$8.3 million (2012) [decline of 62%]
- Novartis: US$24.8 million (2010) to US$14.8 million (2011) [decline of 40%]
- GlaxoSmithKline: US$24 million (2011) to US$9.3 million [decline of 61%]
However, not all companies have decreased their payments to physicians for speakers' bureaus and promotional talks. For example, Johnson & Johnson increased their payments to physicians by 17% (2011-2012), and AstraZeneca's payments to doctors remained approximately the same, compared with the previous year, when AstraZeneca decreased payments to physicians.
As Full Disclosure Nears, Doctors’ Pay for Drug Talks Plummets
GlaxoSmithKline to Quit Paying Doctors for Promotional Talks
Johns Hopkins Speakers' Bureau Policy
Drug makers spending less on MD speakers
How much to do companies pay for ghostwritten articles?: Drug companies against disclosure for payments for ghostwriting under US Sunshine Act