The disclosure of payments by pharmaceutical companies to doctors is part of a wider movement to encourage doctors to disclose who pays them, and for what. If you log on to www.whopaysthisdoctor.org you may find out, although to date only a few doctors have jumped at this brave pledge of transparency before being pushed.
The theory goes that you need to know where the money comes from to judge if my doctoring or writing is littered with pharmaceutically sponsored froth and self-serving bias. Am I doing unnecessary internal examinations because I have shares in Latex? Am I commissioning flexible services from my flexible physiotherapist wife? Or maybe I’ve still got a few branded drug company pens and Post-it notes that nudge me down the wrong prescribing path. Most of the GP education I’ve been to has been sponsored by PANG (Pfizer Astra Novartis Glaxo). Most of the local GPs I know were there too, selling their souls for a free sandwich. The question is, should the world and his wife be told so they can judge how ethical and unbiased their doctor is?
I’m a big fan of transparency, especially when it applies to other people, but here’s my go at coming clean(ish). I was paid £367.50 for every column I wrote for PharmaTimes Magazine over 15 years apart from this one, which I gave to them for free because I was feeling kind. I’ve even taken money from the General Medical Council to discuss whether a doctor must always behave ethically, even when off duty.
Hardliners believe doctors must not dabble in comedy if it means lying for laughs, because patients won’t be able to trust them to tell the truth off stage. Doctors must not hide behind pseudonyms in the media (mine’s MD in Private Eye) but must be openly accountable for their opinions. Doctors must not have affairs with their patients, nor with anyone else because it severs the sacred trust society has in them. Doctors must not drink and drive, unless they are wearing a condom. They must never smoke, always wear seatbelts and bicycle helmets, avoid bacon and maintain a healthy body weight. They must at all times demonstrate self-control and resist the temptation of aggressive tax avoidance schemes. I was unable to agree on everything the GMC discussed, much of which I have deliberately misremembered, but still took its money.
Indeed, I have taken money from all sorts of organisations guilty of harbouring appalling criminality, abuse, neglect, incompetence, harm, wilful blindness and cover up. And I continue to do so. I have received money from the NHS (since 1987), the BBC (since 1991), Private Eye (since 1992), a large number of newspapers and magazines as a columnist and many companies, including drug companies, for comedy and conferencing (since 1990). During that time, the NHS has repeatedly failed the most vulnerable patients it was founded to protect (babies, the mentally ill, the frail elderly) and then covered up the harm. The BBC and the NHS blindness to, and silence about, Savile has been particularly horrific and Private Eye did not cover itself with glory over MMR (not my story, and I did write a correction, but not nearly soon enough).
I have occasionally written for newspapers guilty of repeated serious harm, hacking and failures to apologise, and worked for drug companies found guilty of bribery, cooking clinical trial results and other grossly unethical practices. I chair conferences where drugs I will never prescribe are discussed, and I swallow ramapril and amlodipine every day in the vain hope it will stop me having a stroke on stage – the irrational fear of all performers.
I have made many more errors as a doctor, journalist, broadcaster, comedian, parent, husband, dog owner and lover, but continue to take money from myself. These multiple sources of dubious earnings allow me to live well but also to blow the whistle on anything I fancy without losing a sole livelihood, the fate of many who speak up in the NHS.
Whether this affects my fitness to practice and credibility as a writer, you and the GMC can decide. In my opinion (remember these people pay me), the NHS, the BBC and even the drug industry are largely forces for good, but with too much focus on profit and small pockets of appalling practice that need flushing out. If I encounter them, I try to write about them, but my inbox never empties.
Transparency is clearly important, but it does not always make you ethical or accountable. Politicians are forced to be more open in their public declarations than doctors, and around 200 in the Lords and Commons voted through the Health and Social Care Act knowing private health companies that have a declared interest could benefit. They didn’t have the wit or the wisdom to abstain. In these days of mobile phones and social media, no doctor or politician can keep their activities a secret. Every conference I chair or speak at – from NICE to new product launches – is tweeted. And if everyone knows you’re there, they should know if you’re being paid for the pleasure or not.