Medicine prices: patients before profits

Why didn’t the dog bark ? It's a curious incident

Frank Portelli 27 June 2010, 12:00am

2 min read

There have been many allegations about pharmaceutical companies giving doctors commissions so that they prescribe certain products instead of others. I am not the only one who is on record stating that pharmaceutical companies give commissions to medical doctors.

Here is what a former member of the Medical Council wrote in a local paper on 4th October 2009. Quote: “Money makes medicines go round... A doctor friend of mine told me that large companies often pay all the expenses doctors incur to take part in conferences abroad. These occasions, he told me, are a flimsy excuse for a first-class all-expenses-paid holiday. The doctors are expected to prescribe the medicines advertised during these conferences, even though other less expensive and equally effective medicines are easily available. And many do just that.” Unquote.

Commissions increase the price of medicines by up to 30%. Putting it another way, if commissions were not being paid, then the patient would pay up to 30% less for certain medicines. The question arises: Does the Medical Council have the power to protect the patient from being exploited?

According to the Health Care Professions Act:- 31. (1) The Medical Council shall have the power, either on the complaint of any person or of its own motion, to investigate any allegation of professional misconduct or breach of ethics by a health care professional falling under its supervision. The Medical Council not only has the power to protect the patient – it has a duty to do so. The primary role of the Medical Council should be to protect the health and safety of the patient by ensuring the highest standards in the practice of medicine.

‘So why didn’t the dog bark? It’s curious’. Proposals: Declare an amnesty under certain conditions; Tax the commissions declared according to law; Pass a Medical Whistleblowers' Act; Review the composition of the Medical Council and increase patient representation.

Notes on the Medical Council 77% of the members of the Medical Council are medical professionals. Attendance in 2008: 1. One Council Member did not attend 80% of Council Meetings 2. One Council Member did not attend 75% of Council Meetings 3. One Council Member did not attend 40% of Council Meetings 4. One Council Member did not attend 37% of Council Meetings 5. One Council Member did not attend 30% of Council Meetings.

More from Frank Portelli

Angelo Cassar •

I don’t normally reply to anonymous contributions – but I will make exceptions when reasonable arguments are made. The medical council has the power and the duty to start an investigation. They know about the situation – in fact some time ago they sent doctors a note reminding them that they cannot accept commissions. Doctors need to prove that we can police ourselves – if we want the public to believe in us. At the moment some doctors are giving the rest of the profession a bad name. Most people then imagine that all doctors are corrupt – whereas if we take action now we can stop this disease from spreading Regards to you too. Dr Frank Portelli

Angelo Cassar •

Your Points 1. The medical council has the power to start an investigation on its own initiative – and I agree that they are not doing their job properly- there's a new council now let's see. 2. There are 13 members in the Medical Council – 5 members appointed by the Government -- 5 elected by Doctors -- 2 Dentists elected by Dentists --- and 1 member nominated by the University. 3. The government of the day has to assume responsibility for the action or lack of action of its representatives. 4. Pity you missed the fact that I wrote and stated this publicly – so no apologies needed. 5. You state “we all know about the unethical commissions given by private clinics. We all know about them. And so do people in government and the health department.” That is why I insist the Medical Council must act regards Frank Portelli

Simon Smith •

When I asked about why some irregularities are not dealt with by the medical council, the answer has always been that they can't investigate unless they have formal complaints......if, as you have quoted, the Maltese medical council has the power to invesitgate on its own initiative....then they are not doing their job well. But seeing as the government nominates many of the medical council members, then the government is partly to blame. (ooops, that must be political bias because I mentioned the government....sorry!) If you have no reason to doubt your former council member friend when he says that there are doctors who take "commissions" for prescribing drugs....WHY on earth did he NOT take any action??? Maybe he is in cahoots with the government, and prefers not to stir up any controversies? There is no logical way in which a doctor can get commissions from serious drug companies. ....but we all know about the unethical commissions given by private clinics. We all know about them. And so do people in government and the health department. If the government is unwilling to do anything, council members nominated by the government will therefore do nothing. Sorry for the "political bias", but you were a PN candidate....and I didn't see you doing anything about this problem back then!!!

Alfred Galea •

Yes it is, but they're not gonna investigate something just coz someone spreads a rumour that docs are getting a kick-back or some other rumour. If someone says that Dr. Spock is getting a kickback from Pfizer THEN they might start an investigation. I doubt if they'll investigate just coz someone who, let's face it, isn't on the best of terms with them, says so. Take Care Joe.

Angelo Cassar •

It is the Medical Councils duty to investigate and see if there is any proof. You cannot say there is no proof unless you start an investigation and see what evidence there is They have not barked That is the curious incident. regards Frank Portelli

Alfred Galea •

If the medical council had to investigate every allegation from every Joe or Frank, without Joe or Frank offering even the slightest proof, it'll take all its time and resources.......only to conclude that they were just allegations. Sorry about the way you feel about my attitude, but I can't stand those who are always alleging this and that without coming right out and naming names and offering some kind of evidence. Take care. Joe.

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Dr Portelli, I fully agree with you. If I had sufficient confidence in generics, I would be a fool not to buy them and save even more (ideally from a maltese pharmacy) but as you say, the medical profession does need to get its act together (Fiducja wise) for a patient to take the word of a professional not fearing hidden impulses. I encourage you on your efforts in this regard. Re agendas, we all have agendas i suppose yet agendas are like cholesterol, good and bad...if an agenda works for good then bully...

Angelo Cassar •

Danny I am not trying to put you off buying on line – just ensure you are purchasing from a reputable source. Incidentally Generic Drugs – i.e. drugs that contain the active ingredient but not being sold under the original trade name must still undergo quality assurance before being sold in the EU. Therefore if you ensure you purchase from a reputable online source the medicine should fall under this quality assurance umbrella. But the point at issue is why should the “ordinary” man in the street not be able to buy Medicine in Malta at prices comparable to those in other countries in the EU. I have already proposed that we should be prescribing Generics. Combine this with my proposals on a clampdown on commissions – and we will be protecting our patients. Regards Frank Portelli PS I may be frank but not naive - I am also aware that generic drug companies have started offering commissions !!

Angelo Cassar •

Mr South The Medical Council has not investigated this question of commissions The Council has the power at law to initiate an investigation any allegation of professional misconduct or breach of ethics by a health care professional falling under its supervision – including the receiving of commissions from pharmaceutical companies, clinics, laboratories, private hospitals etc. It hasn’t done so – that is why I asked why ? "Why didn’t the dog bark?” I am sorry to see that your attitude, in these blogs, seems to be to try and cast doubt – behind a pseudonym. This country cannot move forward if we adopt your attitude. Regards Dr Frank Portelli

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Dr Portelli, Many thanks to you too for comments on the subject. We only buy from the top on-line pharmacy in the UK and all products we buy are branded not generic. We shall of course obtain the opinion of our own GP too on each specific purchase. As in any other sector, money is both a great stimulus for development as it is a great corrupter. We live at a stage when affluence has led to individuality that opened the doors for corruption of mind and soul. History amply shows that when Governments fail in providing a strong regulatory balance, greed will run riot. We are unfortunately at that stage...Jesus retired to the Essens and the dead sea to find ways how to counter the saducee priestly ambition that was eroding the Jewish culture...it is therefore nothing new this that we live, but we can look back through history how, way back, civilizations dealth with these very same implulses

Alfred Galea •

Without names and corraborated evidence it's just hearsay. And hearsay is not admissable in a court of law. Or any other "court".

Angelo Cassar •

It sounds like a doctor speaking here - but unfortunately not well informed and with political bias. Firstly you are wrong to state that “the medical council at the moment has no authority to investigate --unless someone lodges a formal complaint, which cannot be anonymous”. Please check your facts

The Health Care Professions Act:- 31 states

The Medical Council shall have the power, either on the complaint of any person or of its own motion, to investigate any allegation of professional misconduct or breach of ethics by a health care professional falling under its supervision.

The Medical Council not only has the power to protect the patient – it has a duty to do so.

The primary role of the Medical Council should be to protect the health and safety of the patient by ensuring the highest standards in the practice of medicine. It is not doing that. Commissions

Taking commissions is unethical and since the Medical Profession insists on policing itself – it is the responsibility of the profession to police itself well.

I do not need to ask the Medical Council to investigate – it is their duty to do so . I have no doubt that Private Hospitals and Clinics give commissions to Doctors – even you must know this. Some GP’s will only refer patients to Clinics , Laboratories, Private Hospitals – only if they receive a commission. Many Pharmaceutical companies pay commissions to Doctors and this makes the price of medicine locally higher than it should be. Conferences In your haste to attack what I said you did not read the blog properly This quote is from a former member of the medical council which you will find and I have no reason to doubt him Quote: “ Money makes medicines go round... A doctor friend of mine told me that large companies often pay all the expenses doctors incur to take part in conferences abroad. These occasions, he told me, are a flimsy excuse for a first-class all-expenses-paid holiday. The doctors are expected to prescribe the medicines advertised during these conferences, even though other less expensive and equally effective medicines are easily available. And many do just that.” I did not make any comments on this statement. We, Doctors, need to bring our house in order if we wish to regain the public’s trust. I cannot understand anyone trying to defend the indefensible. Dr Frank Portelli

Angelo Cassar •

The Health Care Professions Act:- 31 states

Simon Smith •

1) Taking commissions for prescribing medicines is illegal. So if you know of any cases you should report the doctor to the police or medical council. It is totally useless just recycling hearsay. Why don't you ask the medical council to investigate private hospitals/clinics giving commisions to GPs for referring patients? 2) Conferences are sponsored by the pharmaceutical industry throughout the world. In fact usually it is the parent company and not the local importer which pays for everything. Therefore your claims that this inflates prices when compared to other countries is illogical as even English, French and Italian doctors get sponsored to go on these conferences. Why should it inflate prices by 30% in Malta and not in England, France or Italy?? 3) The medical council at the moment has no authority to investigate unless someone lodges a formal complaint, which cannot be anonymous. The British medical council, on the otherhand can take up things on its own initiative. The nationalists have been in government for over 20 years. You should tell us why it has never been changed.....You should not be the one asking the question....but giving the answers!!

Angelo Cassar •

Hi Danny Kirill is absolutely right – you need to be absolutely certain about purchases of medicine from the internet – it could be a reputable firm – or they could be selling counterfeit medication. With medicine even if contains the correct ingredients – other factors come into play, such as bio availability. Bio Availability -- how much of the drug is available to the tissues ( your body ) within a defined period of time. However the issue is this. Maltese Citizens should be entitled to buy prescribed drugs at prices comparable to those found in the EU. Why should a prescribed medicine cost more in Malta than it does in a pharmacy in central London! I know for a fact that one of the reasons Maltese patients are paying more for their medicine is this unethical question of commissions being paid by pharmaceutical companies to doctors – and yes to other professionals as well. The Medical Council has a duty to safeguard patients. In my view the Medical Council is not doing its duty. The Medical Council as a watch dog should be barking out loud ---but the watch dog is not “barking”. In the thriller Silver Blaze – Sherlock Holmes notes on the night of the break in " it is a curious incident – why didn’t the dog bark ?". The answer is obvious – the dog knew the intruder. 77% of the members on the Medical Council are Medical Professionals. Is this the reason why the dog did not bark ? Why has the Council not been able to control this gross unethical behaviour ? Hence my proposals. Please bring up ideas I will continue to persist on this and other ideas until the Government of the day takes action Thanks Frank Portelli

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Kirill for your eye opening advice. The medicines I buy over the internet are, or appear to be, the same that I would get from local pharmacies. But I will consult my GP pronto on the matter. Thanks once again.

doris cassar •

@ Danny Attard Although the buying of medications over the internet can lead to significant savings, one must be aware of the possible risks. The pharmaceutical and nutritional counterfeit market thrives over the internet and worse still, sometimes a completely different active ingredient from the one ordered will be found in the product. This has been repeatedly documented. In fact, high profile athlete doping cases have implicated the inadvertant use of banned drugs that were present in apparently innocious nutritional supplements. I am not saying do not order from internet, but err on the side of caution and not price. http://www.fda.gov/drugs/resourcesforyou/ucm080588.htm http://www.buysafedrugs.info/

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i use the internet to procure medicines from abroad therefore saving much money. This whole medicine act needs to be addressed and santitised. We must not come to a point where one doubts the need for certain prescribed medication. It is good that you are persistent on this key issue. nd yes, all payents must be visible and relebant taxes paid.