Payments from Drug Companies to Healthcare Professionals in Ireland: A Review of the Evidence and Ethical Concerns

In Ireland, the financial relationships between pharmaceutical companies and healthcare professionals (HCPs) and organizations have come under renewed scrutiny. A comprehensive review by Professor Michael Barry, Clinical Director of the National Centre for Pharmacoeconomics (NCPE), has highlighted the widespread nature of these interactions. While industry support can enhance education and research, concerns persist about undue influence on clinical decision-making, particularly regarding drug prescribing patterns. This article elaborates on the findings, discusses ethical implications, presents comparative practices, and provides verified references for clarity and transparency.

Key Findings from the 2023 Review

According to the review conducted by Prof. Michael Barry:

Total Payments: In 2023, pharmaceutical companies made 4,509 payments to healthcare professionals and organizations in Ireland, totaling over €14.4 million.
Healthcare Professionals: A total of 3,508 payments were made directly to healthcare professionals, amounting to €5.5 million.
High-Value Payments: 64 payments exceeded €8,000, with the highest individual payment reported at €50,462 to a single medical practitioner.
Top Paying Companies:
Novartis made the most payments (374 individual transactions).
Abbvie paid the highest total amount to HCPs, at €880,952.

These findings are based on data disclosed publicly on the Transfer of Value website (www.transferofvalue.ie) in line with the Irish Pharmaceutical Healthcare Association (IPHA) Code of Practice, which has mandated such disclosures since 2016.

The Role of Transfer of Value Payments

Payments officially called Transfer of Value (ToV) encompass a wide range of support, including:

Consultancy fees
Travel and accommodation for conferences and events
Registration fees for professional education
Sponsorships and donations
Funding for research and development
Support to hospitals and academic institutions

Although these are often presented as support for education or professional development, the influence of such payments on clinical practice has raised concerns.

Concerns About Influence and Prescribing Behavior

Prof. Barry emphasized that financial relationships with the pharmaceutical industry can create conflicts of interest, especially in areas such as:

Prescribing decisions: Research suggests that physicians with industry ties are more likely to prescribe branded medications over generics, even when equally effective and significantly cheaper options are available [Spurling et al., 2010; BMJ].
Clinical guideline formation: If medical societies receiving pharma funding are involved in drafting treatment protocols, bias in guidelines becomes a potential issue.
Medical education: There is ongoing debate over whether the pharmaceutical industry should play any role in the education of prescribers, due to possible promotional bias.

“Many would consider that the pharmaceutical industry should not have any role in the education of healthcare professionals and prescribers,” – Prof. Michael Barry, 2024.

Recommendations for Enhanced Oversight

Prof. Barry proposed several measures to safeguard clinical integrity:

100% Disclosure Mandate: The Health Service Executive (HSE) should insist on full transparency for any HCPs or organizations receiving pharma payments.
Policy Clarification: The HSE should explicitly disavow support for pharmaceutical payments to its staff.
Independent Education: Limit or prohibit pharma-funded educational activities for prescribers.
Conflict of Interest Checks: Implement mandatory conflict of interest declarations for those involved in treatment guideline development.

Pharmaceutical Industry’s Response and Transparency Efforts

The Irish Pharmaceutical Healthcare Association (IPHA) responded to the review by affirming its commitment to transparency:

Record Transparency in 2024: 98% of HCPs disclosed their names alongside payments in 2024, up from earlier years.

Decrease in Total Payments

Payments to HCPs: €5.6 million in 2024, a 4% decrease from 2023.
Payments to Healthcare Organizations: €8.6 million, a 3% drop.

Unidentified Recipients: Payments to 74 unnamed HCPs totaled €178,169, revealing a small but notable portion of non-disclosed recipients.
Company Participation: Of 51 companies using the platform, 40 are IPHA members, and 11 are non-members.

The IPHA said it aims to achieve 100% named disclosure and has supported legal frameworks, such as legitimate interest under GDPR, to facilitate this.

International Context: What Do Global Studies Say?

Ireland is not alone in facing this ethical dilemma. International literature supports the concern that industry payments influence clinical behavior:

U.S. Study: A 2017 study in JAMA Internal Medicine found that even small gifts or meals from drug companies were associated with increased prescribing of brand-name drugs by physicians (DeJong et al., 2017).
Systematic Review: A meta-analysis of 19 studies concluded that industry interactions were associated with higher prescribing frequency, lower prescribing quality, and increased prescribing costs (Spurling et al., BMJ, 2010).
UK Perspective: The UK also operates a public disclosure database under ABPI (Association of the British Pharmaceutical Industry), though opt-out anonymity remains a challenge similar to Ireland.

Ethical Considerations: The Dilemma Between Support and Influence

There’s no denying that pharmaceutical companies fund valuable research and sponsor continuing medical education (CME). Hospitals, universities, and medical societies often depend on these funds, especially where public funding is insufficient.

However, the critical ethical questions remain:

Can professional judgment be truly impartial when financial relationships exist?
Should clinical education be completely industry-independent to maintain public trust?
Is it possible to preserve beneficial industry collaborations while minimizing bias?

Government Role and Future Directions

Given the influence of these payments, the Health Service Executive (HSE) must consider:

Establishing clear internal policies for its healthcare workforce.
Providing alternative, public funding for medical education and conferences.
Supporting development of independent clinical guidelines, free from industry ties.

Ireland can look to countries like France, which enforce strict disclosure rules and penalties for non-compliance, or Sweden, where industry funding of prescribers’ education is prohibited.

Conclusion

The findings from Prof. Michael Barry’s review underscore a crucial tension in modern healthcare—how to balance the need for collaboration with pharmaceutical companies with the imperative to maintain clinical independence. Transparency, while a major step forward, is not a complete solution. Ethical prescribing and medical education must remain anchored in evidence-based practice and public trust, not influenced by financial relationships.

Scientific References

Spurling, G. K., Mansfield, P. R., Montgomery, B. D., Lexchin, J., Doust, J., Othman, N., & Vitry, A. I. (2010). Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review. BMJ, 340, c2190. https://doi.org/10.1136/bmj.c2190
DeJong, C., Aguilar, T., Tseng, C. W., Lin, G. A., Boscardin, W. J., & Dudley, R. A. (2016). Pharmaceutical industry–sponsored meals and physician prescribing patterns for Medicare beneficiaries. JAMA Internal Medicine, 176(8), 1114–1122. https://doi.org/10.1001/jamainternmed.2016.2765
Fabbri, A., Grundy, Q., Mintzes, B., Swandari, S., & Lexchin, J. (2018). A systematic review of the nature of physician-industry interactions and their potential impact on prescribing behavior. PLOS ONE, 13(10), e0206496. https://doi.org/10.1371/journal.pone.0206496
Irish Pharmaceutical Healthcare Association (IPHA). (2024). Transfer of Value Data. Retrieved from www.transferofvalue.ie