By Dr. Lode Wigersma

While there is understandable concern in the medical profession that financial disclosure will fuel media sensation, the Dutch experience indicates that showing exactly how much was paid to who, for what, neutralises speculation, says Lode Wigersma, former director of the Royal Dutch Medical Association

Wtbv KNMGUtrecht 20/05/2009 dhr. Nieuwenhuizen Kruseman, Rijksen en Wigersmahen the medical profession and the pharma industry in the Netherlands responded to a suggestion from the government in 2009 that they establish a voluntary system for financial disclosure, there was a long heritage on which to build.

“Industry and doctors had set up a self-regulatory body more than a decade before, in support of a code of conduct governing their relationship. Although it did not cover financial transparency, the collaboration has been fruitful,” says Dr Lode Wigersma. This provided the foundations for discussions between pharma and healthcare professionals on how to structure and run a register, leading on to the first publication of financial transparency data in April 2013.

“Of course, some physicians questioned the value of disclosure, asking ‘why is it necessary?’ ‘for whom is it useful?’, but they are a minority,” Dr Wigersma says.

The preparation for the first publication of data was painstaking, and it definitely helped not only that physicians and the industry had a pre-existing cooperation, but also that “they started from the same place” in the discussions on setting up a register.

This is different from the situation now facing healthcare professionals elsewhere in Europe, who must come to terms with the industry unilaterally moving to introduce the EFPIA code on transfers of value.

While Dr Wigersma acknowledges this difference, he emphasises the advantages of working in collaboration with industry in putting a system for financial disclosure in place.

One example is that in the Netherlands the register is hosted by the Royal Dutch Medical Association, rather than by individual companies or an industry association. “Patients can look up a doctor and see all the payments received, for what, and from whom, in a single place. We could have chosen from several different systems. The advantage of this approach is that it works best for the public,” says Dr Wigersma.

There is a limitation, in that there is no record of what each company paid in aggregate. However, Dr Wigersma believes this must be set against having a single record for each physician. “The most important thing is that patients are able to look and see ‘is my doctor to be trusted’,” he says.

Defusing sensation

The collaboration between the medical profession and the industry – and the support of the Ministry of Health – also enabled financial transparency to be presented in a positive light from all sides, defusing any potential for media sensation.

“There was some negative press, but really it has been quite moderate,” Dr Wigersma says. In addition to the communications work preparing the ground for publication, that is because the data showed there were no grounds for bad press. “If you look at the details, there are hardly any large payments; disclosure removes the possibility for sensationalism because payments are modest, and the register says exactly what the payments are for,” Dr Wigersma noted.

At the same time, financial transparency improves the relationship between healthcare professionals and the industry, for the good of patients, believes Dr Wigersma. “There’s always a tension in the relationship; it’s necessary to work together, but there’s always a point for physicians where they need to be careful, because the industry wants to sell something. Being able to see the reason for any payments, that they are for specific services, reduces this tension,” he says.

There is inevitably some nervousness and disquiet in the medical profession about financial disclosure. However, Dr Wigersma advises taking a collaborative approach to implementation. “This is going to happen; as doctors it is better to collaborate. You just have to be transparent about what you do – it is all for the good of the patients.”