By Dr. Zbigniew Gaciong

Implementing EFPIA’s code on transfers of value involves an inequitable level of disclosure by individual doctors and will leave members of the medical profession in Poland open to media sensation, says Zbigniew Gaciong, Chairman of the Department of Internal Medicine, Hypertension and Vascular Diseases at the Medical University of Warsaw

Gaciong photoIn common with other healthcare professionals, Zbigniew Gaciong has no problem with the mandatory requirement to disclose any potential conflicts of interest, or of declaring the value of any contracts with pharma companies to the tax authorities.

However, he believes publishing details of individual transfers of value from the industry to physicians is a move too far. People have a right to keep personal financial affairs private: putting information about payments from pharma companies online is equivalent to requiring people to make their tax returns public.

“In Poland, if you provide a service for pharma, such as leading a clinical trial, providing advice, or lecturing, everything is paid on the basis of a contract – it’s not money going under the table,” Dr Gaciong noted. “I have to submit to the inland revenue service and I pay tax, it’s not something that is not known to the authorities.”

The medical profession is definitely not prepared for this kind of regulation, Dr Gaciong believes. “It’s not generally accepted [physicians] should have to provide this kind of information about their income,” he says. It is also inequitable to require this level of disclosure. “Remember, we are not elected, we are nominated,” Dr Gaciong said.

Dr Gaciong’s views are reflected in a survey carried out by the Polish industry association Infarma in February 2014, to assess the attitudes of physicians who regularly cooperate with industry to the financial disclosure code. Respondents said cooperation between companies and healthcare organisations is mutually beneficial. However, they were also aware that the public view of the relationship is negative and said there was little public understanding of why they receive payments from pharma.

Media Sensation

While existing reporting requirements provide suitable safeguards, publishing individual transfers of value online will leave physicians exposed to media sensation, Dr Gaciong says.

“I’m not concerned that disclosure will have an impact on the doctor/patient relationship; for me the issue is that there’s no way to defend yourself if you become a point of interest for a journalist,” says Dr Gaciong. “If you want a correction, the only way is to go to court – if you are lucky you will get a small apology, in small type, on an inside page.”

Justifying this concern, Dr Gaciong points to media reports that a clinician was receiving personal payments worth millions of euros. In fact the money was for a screening programme – and the funding covered the cost of the entire project.

Nor is Dr Gaciong reassured by the fact that mandatory disclosure elsewhere in Europe, for example, the Netherlands, has gone smoothly. “It’s a question of different social attitudes: in Poland it definitely will be a problem,” he said.

The concern is that as a consequence of the code on disclosure of transfers of value, healthcare professionals in Poland will limit their interactions with pharma. “My colleagues say they are no longer interested in involvement in clinical trials; this will sever cooperation between physicians and pharma,” said Dr Gaciong.

Professor Zbigniew Gaciong, M.D. Ph.D. graduated from the Medical University of Warsaw. He spent three years as a fellow of American Heart Association in University of Southern California. Since 1998 he has been the chairman of the Department of Internal Medicine, Hypertension and Vascular Diseases (Medical University of Warsaw). Prof Gaciong served as Dean for Postgraduate Education and he developed and introduced courses on the methodology of clinical trials in the university curriculum. He also was a member of the International Advisory Board in JAMA and the Union of European Medical Specialists.