Fertility clinics reap rich payments from pharmaceutical companies

How much sponsorship is given to fertility clinics by pharmaceutical companies in Australia? Millions, according to a new analysis, suggesting transparency of sponsorship is essential to protect vulnerable patients.

In a new paper, published in BMJ Open, researchers accessed publicly available databases that detailed the payments from pharmaceutical companies Merck Serano and Merck, Sharp and Dohme (MSD) given to Australian fertility clinics or personnel to support the running of, or travel to, professional development events. They found that around $4.5 million was spent on 970 fertility-related events between 2011 and 2018.

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The financial breakdown of the sponsorships was accessed through Medicines Australia, which is a voluntary open-access registry of pharmaceutical payments to fertility clinics, use of which is heavily encouraged in Australia. However, this level of transparency is not available in Aotearoa New Zealand, which likely means that patients have less information to assess whether the clinical advice they receive is objective.

Report shows most sponsorship was for professional development events

From the reports of Australian sponsorship, 61.8% was for events held at clinics and 31.5% for events run by professional medical associations. Overall, 74% of the events were classified as education or clinical meetings, while a further 20% were conferences.

The major contributions were for healthcare professionals to attend educational events, or for food at the events.

Of the professionals who attended sponsored events, most were medical practitioners – particularly obstetricians and gynaecologists – followed by nurses and general practitioners.

Authors suggest caution about sponsorship

The analysis shows that pharmaceutical companies provide significant funding for fertility professionals to attend events considered to be educational, but it does not establish a causative relationship between the funding and treatments given to patients.

Regardless, the authors suggest that care is needed when assessing education events, especially if they indirectly affect patients.

“There are concerns about this because it may be contributing to the overuse of fertility services or causing the use of one type of fertility treatment over another type, influencing the behaviour of people who receive more than clinic services,” says study author Cindy Farquhar, Professor of Obstetrics and Gynaecology at the University of Auckland and clinical director at Auckland hospital.

“The payments are used in a way that some of it can be described as marketing, as opposed to educational. And I think that is a worry for people who have got limited resources.”

Money doesn’t go into the pockets of doctors

However, Dr Alex Polyakov, fertility specialist and a senior lecturer at the University of Melbourne, says that the lump sum of total payments doesn’t represent doctors getting individual payments to peddle medications.

“[If you’re] talking like fertility specialists are getting money in their bank account, then that’s not quite what it is,” he says.

“We’re talking about sponsoring. For example, [if] a fertility society, let’s say, decides to organise a conference, that costs money. You need a place to hold it, you need to have logistics support, you need to have catering, it’s an expensive exercise.

“So these drug companies get approached by the representatives of that particular society, [who] say: ‘Would you sponsor us? Would you chip in to run the conference?’

“The drug company has no input into what is actually discussed at the conference. They have their banner at the front saying, ‘we’re the sponsors’, but they almost never have direct influence on what the presentations are, or what the topics are at the conference.”

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Additionally, Polyakov says that the individual amounts of money are quite small, even though the annual total for all clinics seems high. He also iterates that there are very few fertility drugs used in Australian clinics, and clinics don’t participate in arrangements where a company requires them to sell a specific drug to receive sponsorship.

“They don’t come to you and say ‘we want you to talk about this drug and we’re going to pay you for your presentation’,” he says.

“There’s a lot of regulations about these payments that are rigidly controlled for.”

Relationship between pharmaceutical companies and clinics may be subtle

But there may be a more subtle, blurred relationship between companies and fertility clinics, says Farquhar, especially as the study only analysed data on pharmaceutical companies that participated in the voluntary reporting. Companies that fell outside of Australia’s jurisdiction did not have to report to Medicines Australia.

“What I am critical about is that this a wealthy area of health provision and there’s no reason why fertility clinics can’t fund their own research and education, or can’t fund the nurses and scientists and doctors to get to important meetings and to access those educational services,” says Farquhar. “They don’t really need that provisional sponsorship.

“But why wouldn’t they take the money that they’re offered? I think that the companies, throughout the symbiotic relationship, can sell their drugs to that clinic. They’re more likely to have some sort of arrangement about pricing and that sort of thing, and that’s a bit of a worry.

“I don’t think most patients appreciate how much money comes through this way.”

Transparency and regulation of sponsorship information is crucial to ethical practice

Put simply, transparency of payments is absolutely crucial, because it leaves a paper trail that clearly shows whether sponsorship adhered to the appropriate regulations to prevent conflicts of interest.

“I think the main message that I would like to put out there is that doctors are not being paid,” says Polyakov. “I have never had money coming into my account from a drug company.

“There are very stringent rules, in actual fact, as to what is considered appropriate sponsorship and what is considered inappropriate sponsorship.”

This may be especially important in contrast to Aotearoa New Zealand, which doesn’t have the same transparency about funding sources as Australian clinics and companies, and so vulnerable patients don’t have access all the information they need to make informed decisions.

“One of the good things about the study is that it highlights the fact that, in Australia, there is some transparency about payments,” explains Farquhar.

“In New Zealand, there is no transparency. We don’t have the regulations. In Australia, they have agreed with the companies that they will release this information.

“I did have a challenge a few years ago – if [clinics] are happy to be transparent, would they like to put a sign on the wall of the clinic and say that they were sponsored by different companies, and how much money was it?

“So that would be another way of being totally transparent to patients.”

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