Doctors Oppose Bill Forcing Them to Disclose Donations From Drug Firms

Israel Medical Association takes preemptive measure by publishing information on money received from pharmaceutical companies in '09

The Israel Medical Association has voluntarily disclosed the amount of money it received from drug companies in 2009. It decided on this step in the hope of thwarting legislation that would require doctors to report how much money they receive from such companies.

The IMA's ethics bureau said that in 2009, the association received NIS 599,000 from commercial bodies. Half went for promotional campaigns on various medical issues.

For instance, the association said, it received NIS 80,000 from companies that market swine flu vaccines when it was holding a campaign to encourage doctors and the general public to be inoculated.

The information was released against the background of a Finance Ministry proposal to require money given by drug companies to health-care organizations or research physicians to be reported, beginning next year. The proposal was included in the Economic Arrangements Bill accompanying the 2011-12 budget, and the Health Ministry has come out in support of it. The IMA decided to make the figures public six months ago, before the treasury's proposal was finalized, in an effort to keep it from being enacted into law.

The head of the IMA's ethics bureau, Prof. Avinoam Reches, said that eventually, individual physicians would also voluntarily report their income from drug companies. So far, the drug companies are not cooperating with the IMA initiative.

Two weeks ago, IMA chairman Dr. Leonid Eidelman also asked approximately 100 specialist associations to join the initiative. But so far, only 39 have agreed.

Sources in the association said they pushed the issue after a similar law was passed in the United States, as they feared such a law would be passed in Israel. Reches said that the law would discriminate against doctors, since other sectors are not required to make such disclosures. Moreover, he warned, "a law could encounter opposition or a conspiracy of silence," while voluntary disclosure would be "much more reliable and transparent."

In 2003, when then-MK Ophir Pines-Paz sponsored a bill limiting the transfer of funds and gifts from drug companies to physicians, the IMA and the drug companies quickly signed an agreement, approved by the Health Ministry, in an effort to prevent legislation.

Out of the NIS 599,000 the IMA received from commercial bodies, NIS 275,000 came from drug companies. Of this latter figure, NIS 245,000 was to support campaigns the association was sponsoring, and NIS 30,000 was in exchange for the right to place a booth at IMA conventions.

The association received NIS 40,000 from Neopharm, which marketed a swine flu vaccine manufactured by Novartis, and the same from GlaxoSmithKline, which marketed its own swine flu vaccine in Israel. It also received NIS 40,000 each from MSD, Pfizer, Roche and Teva; NIS 15,000 from Eli Lilly and Dexxon; and NIS 5,000 from Novo Nordisk.

"The Israel Medical Association held a day-long conference on swine flu inoculations, and the companies marketing the inoculations exhibited information," Reches said. "But the association deliberately did not take money from those companies in exchange for the conference."

Reches said it was accepted practice worldwide for pharmaceutical companies to support medical associations, "but when there was concern over the appearance of a conflict of interests, the medical association did not accept money."

Indeed, he said, there is no reason why a physician or medical organization should not accept money from a drug company. "If I sit on a drug company's committee of experts and advise them on a certain medical issue ... it is legitimate for me to receive financial remuneration."

But there must be transparency, he added, so that a doctor won't later appear before the committee that determines the list of state-subsidized medical treatments and recommend a drug he helped promote.

The IMA said it also received NIS 20,000 each from the Clalit and Maccabi health maintenance organizations and from insurance companies, to fund conferences on health-care economics.

So far, the association has been unable to persuade Pharma Israel, the organization representing proprietary drug manufacturers, to join the initiative. Pharma Israel's director, Guy Gorecki, said his organization, "welcomed any move that promotes transparency and contributes to the improvement of the health-care system." However, he added, "transparency should be implemented not only by the private side of the health-care system, but by the entire public health-care system."