揭露藥醫利益關係的新招

TWO drug executives walked into a bar. No, this is not the start of a joke. The workers for Roche, a Swiss drugs firm, had been dining with doctors after a Medical conference. At the bar, alleged an anonymous complaint in a recent report by a British industry watchdog, they bought the doctors drinks (“shots of varying colours flowed like hot lava”). One executive danced on stage, prompting bar staff to throw him out. Roche maintains its managers ran into the doctors and did not buy them drinks. But the evening hardly seems like the finest moment in the history of ties between doctors and drug companies.
兩名製藥公司的高管走進一家酒吧。別理解錯了，這可不是在講笑話。瑞士製藥企業羅氏公司（Roche）的員工開完醫學會議後，此時正和醫生們共進晚餐。在一家英國行業監督機構最近發表的報告中，一位匿名人士指控這兩名員工在酒吧請醫生喝酒（“照片上的酒顏色各異，像噴涌而出的火熱岩漿”）。一名高管登臺起舞，結果被酒吧服務人員趕了出去。瑞士公司則堅持認爲，其負責人是偶然碰到幾位醫生的，而且也沒有請他們喝酒。但這個夜晚怎麼看也不像是醫生與製藥企業的關係史上最美好的時刻。

That relationship is a poorly regulated muddle. At one (beneficial) extreme, firms work with doctors to create new treatments. At the other end of the spectrum, firms bribe doctors to prescribe their drugs. America’s justice department has wrung huge settlements from companies over such charges. Between these poles is a lot of activity deemed standard by some, repugnant by others—and which is increasingly subject to new laws.
二者關係疏於監管，可謂一團糟。一個（有益的）極端是，企業爲創造新的治療方案與醫生合作。另一個極端則是企業向醫生行賄，以便讓醫生在開藥時選擇他們廠家的產品。美國司法部門從此類官司涉及的公司中榨取了大量罰金。兩個極端之間可以有種種行事，有些人視之爲標準，有些人則嗤之以鼻，而新法律對這些管得越來越嚴了。

This month American regulators released rules to implement a so-called Sunshine law designed to improve transparency. France passed a similar law in 2011. Firms in Britain are planning voluntary disclosures. By 2015 more than 70% of drug sales will be in countries with such measures, according to Deloitte, a consultancy.
本月，美國監管機構公佈了新規定，旨在貫徹實施一部所謂的“陽光法案”，以提高企業透明度。法國在2011年通過了一部類似的法案。英國的企業正計劃着主動公示信息。據諮詢公司德勤（Deloitte）顯示，在2015年前，70%以上的藥品會在採取此類措施的國家中銷售。

America’s health-care market, the world’s biggest, is particularly busy. In 2012 pharmaceutical companies spent more than $24 billion marketing drugs to doctors, according to Cegedim Strategic Data, a research firm; 35% of doctors accept food, entertainment or travel from the pharmaceutical industry, said a survey by Deloitte last year, while 16% accept consulting or speaking fees. In most states, doctors take regular courses to maintain their licences. In 2011 drug and device companies sponsored nearly a third of the medical training tracked by the Accreditation Council for Continuing Medical Education.
美國擁有世界上最大的醫療市場。如今，該市場相當熱鬧。據調查公司Cegedim Strategic Data 稱，2012年製藥企業爲了向醫生推銷藥品，所花費用超過240億美元；根據德勤去年做的一份調查顯示，35%的醫生接受了製藥行業的宴請或其提供的免費旅遊，而16%的醫生收受了諮詢費，或者說演講費。大部分州的醫生爲維持醫師資格證，需要定期接受培訓。2011年美國繼續醫學教育認證委員會（Accreditation Council for Continuing Medical Education）發現，其追蹤調查的醫學培訓機構中有近1/3是由醫藥和器械公司贊助。

Such chumminess has long raised fears about undue influence. In 2008 two health-industry groups set tighter, voluntary standards for companies. In 2009 America’s Institute of Medicine, an advisory body, urged much stricter regulation to prevent conflicts of interest.
一直以來，人們都擔心醫商之間的這種親密無間會帶來不好的影響。2008年，兩家醫療健康產業集團爲企業制定了更嚴格的自願性質標準。2009年，美國顧問團醫院研究所（America’s Institute of Medicine）敦促要加強監管力度，防止利益糾紛。

Legislative action, though, has been slow, especially at the federal level. The Sunshine law, passed as part of Barack Obama’s health reform, is the first national requirement for transparency. Each year drug and device firms must disclose payments and other “transfers of value” to doctors. They must also report research fees and doctors’ investment interests. The first filing will appear on a public database by September 30th, 2014.
不過美國在立法方面行動一直很慢，尤其是聯邦層級的立法。“陽光法案”是作爲巴拉克??奧巴馬醫療改革項目的一部分通過的，它是第一部爲提高透明度的國家級法案。每年，醫藥和器械公司必須公開支付信息，以及其他用在醫生身上的開銷。他們也必須彙報研究經費、醫生在醫療公司投資股權。第一批申報文案將於2014年9月30日前上傳至公共數據庫中。

The rule’s broader effects are uncertain. It does not limit firms’ interactions with doctors; it merely requires them to be reported. Certain marketing techniques, such as providing free drug samples, are exempt. And in some ways the law is already out of date. It regulates only doctors and some hospitals, not nurses, pharmacists or hospital bureaucrats who have a growing role in patients’ treatment.
這項規定會產生怎樣更大範圍的影響還不得而知。它並沒有限制企業與醫生之間的往來；僅僅只是要求他們上報相關信息。某些營銷方案不在監管之列，比如爲醫生提供免費的藥物樣品。法律在某些方面已經過時了，它所監管的只有醫生和某些醫院，卻不包括護士、藥劑師或者醫院的行政人員，而這些人在病人的治療中發揮的作用越來越大。

Nevertheless, the Sunshine law is likely to lead to at least one change. Firms already have data on each doctor’s prescriptions, points out Chris Wright of ZS Associates, a consultancy. The Sunshine law will also provide them with exhaustive data on how much they and their competitors spend to market drugs to that doctor. This will let firms track which type of marketing spurs the most prescriptions. Companies will not stop wooing doctors. They may simply get better at it.
儘管如此，陽光法案至少可能帶來一個轉變。諮詢公司Chris Wright of ZS Associates指出，製藥企業已經掌握了每個醫生的處方內容。陽光法案還將爲這些企業提供詳細數據，讓他們瞭解自己和競爭對手在向醫生推銷藥品時的花銷情況。這將有利於企業追蹤調查，找出最利於銷售的推銷方案。將來，企業還是會向醫生獻殷勤。但或許他們只是更擅長罷了。