On August 27, 2021, Tansa and the nonprofit Medical Governance Research Institute released the 2018 data for our Money for Docs Database, which allows anyone to look up the additional income that doctors receive from pharmaceutical companies. The database now includes information from fiscal years 2016 to 2018.

Looking at data from all three years, we found that 66 doctors have consistently received at least 10 million yen (about $​​91,000) per year in additional income from pharmaceutical companies in the form of lecture fees and other remuneration.

Of these 66 doctors, 19 had received a total of more than 50 million yen (about $454,000) over the same period.

Pharma-sponsored lectures for doctors

The vast majority — about 80% — of additional income paid to doctors by pharmaceutical companies takes the form of remuneration for lectures. The remaining 20% consists of payments for consulting and manuscript writing for things like company brochures.

These lecture events are organized by pharmaceutical companies for doctors, nominally for the purpose of further educating them about diseases and drugs.

However, according to pharmaceutical company employees and those familiar with sales, sometimes the real purpose of these lectures is to emphasize the advantages of the host company’s drugs. Prescription drugs comprise about 90% of pharmaceutical companies’ sales. It follows that they would want the doctors attending their lectures, which are often held in luxury hotels, to prescribe their drugs to patients.

The lecturers are often influential members of the medical community, referred to as “key opinion leaders (KOLs).”

KOLs include medical schools professors, medical association leadership, and members of the committees that prepare treatment guidelines.

Of the 66 physicians who received over 10 million yen from pharmaceutical companies for three consecutive years, the following number have served in leadership positions at medical associations, as university professors, and/or participated in writing treatment guidelines.

・Medical society leadership: 52
・University professor: 49
・Treatment guidelines committee member: 42

Payments concentrated around “lucrative” diseases

The 66 doctors who received more than 10 million yen for three consecutive years specialized in the following fields.

・Diabetes: 20
・Cardiovascular: 13
・Rheumatism: 5
・Digestive: 5
・High blood pressure: 4
・Hepatitis: 3
・Hematology: 2
・Dermatology: 2
・Respiratory: 2

And the following fields contained one doctor each: dementia, psychiatry, infectious diseases, oriental medicine, breast cancer, pharmacology, Parkinson’s disease, dialysis, prostate cancer, and stroke.

An experienced salesperson in the pharmaceutical industry explained why the number of doctors receiving significant amounts of addition income includes so many diabetes and cardiovascular disease specialists.

“Pharmaceutical companies spend a lot of money holding many lectures for fields with large and competitive markets,” they said. “Conversely, companies don’t sponsor lectures as often for fields with smaller markets, such as rare, chronic diseases.”

Another individual with experience in pharmaceutical sales elaborated on which areas are chosen for lecture events.

“If there is a clear difference in effectiveness, such as for anti-cancer drugs, doctors will use the one that is more effective, so sales initiatives won’t make much of an impact.

“However, when there are many types of drugs with comparable effectiveness, such as diabetes drugs, we sales representatives often make sure that the doctors speaking at lecture events don’t speak about our company’s drug in a way that sounds like a blatant advertisement.”

Government takes measures against high additional income

The government is taking measures to address the issue of doctors earning significant amounts of additional income from pharmaceutical companies.

For example, the Ministry of Health, Labour and Welfare has established the following regulations for doctors who serve on the government committee that reviews new drugs.

1. A doctor cannot vote or participate in the deliberation if they have received over 5 million yen (about $45,500) in a year within the past three years from the pharmaceutical company whose drug is being reviewed.

2. A doctor cannot vote if they have received over 500,000 yen (about $4,500) in any year from the pharma company whose drug is being reviewed.

The top-earning physicians take home much more than what the health ministry considers to be a conflict of interest.

In November 2019, Japan’s House of Representatives’ Committee on Health, Labour and Welfare discussed the results of an inquiry — which used our Money for Docs database — into additional income received by medical school professors.

The committee found that 29 practicing medial school professors had each received over 15 million yen (about $137,000) in remuneration from pharmaceutical companies in fiscal year 2016, drawing criticism of the practice from a Constitutional Democratic Party lawmaker. The ministry of education’s parliamentary secretary noted the importance of gaining public trust and stated that universities would be required to improve their regulations.

In response, the Association of Japan Medical Colleges issued “Recommendations regarding the receipt of gratuities from pharmaceutical companies” on Nov. 27, 2020. Its main points are as follows.

1. Each institution must stipulate the appropriate handling of cases where faculty members receive remuneration from pharmaceutical companies.

2. “Appropriate handling” must take into account the individual circumstances of each member institution. It is difficult for the association to set specific, uniform conditions, and therefore it is appropriate for each institution to set its own.

3. Since the content of requests from pharmaceutical companies differs, it is recommended that each institution’s conflict of interest committee should manage them as appropriate. Institutions that do not have a conflict of interest committee should establish one.

4. It is necessary to manage the receipt of remuneration from pharmaceutical companies in a transparent manner to ensure accountability to society.

5. The following methods may be considered for determining appropriate handling. Each institution should undertake this consideration, taking into account that the above four points are satisfied.

・Based on each faculty member’s regular salary
・Manage conflict of interest in accordance with a conflict of interest committee
・Set a maximum amount of annual additional income
・Set a maximum number of times or hours per year
・An appropriate method other than the above

“Decrease number of lectures and amount of additional income”

Tansa sent, via the universities and hospitals where they work, the following four questions to the 19 doctors who earned more than 50 million yen in three years.

1. Why have you received so much additional income from pharmaceutical companies?

2. Is it possible that additional income from pharmaceutical companies could influence your drug prescriptions or medical research?

3. Do activities that generate additional income, such as lecturing, disrupt your main work (treatment, research, etc.)?

4. Do you think it is necessary to reduce additional income from pharmaceutical companies going forward?

Out of the 19 physicians, five responded. Here are their answers in full.

Masanori Abe, professor at Nihon University; specializes in dialysis, etc.

1. Most of my additional income is from lectures.

 

2. Lectures planned by pharmaceutical companies are strictly regulated by prior screening. They don’t contain any content that would either advantage or disadvantage certain products. Lectures are intended mainly to raise awareness of a given disease among non-specialists, and the content is based on evidence regarding patient background, risk factors, diagnosis, and treatment. I can only introduce content that has been published. I sometimes also receive lecture requests from pharmaceutical companies for drugs not used at our hospital, so there is no possibility of a favorable outcome for the company concerned. We do this with the hope that it will contribute to improving the treatment and prognosis of our patients.

 

3. In general, this work is done after hours, so it does not interfere with my main work, such as treatment and research.

 

4. There is a need to reduce physicians’ additional income. As you pointed out, this matter has been discussed in the Diet, and it could be seen as “affecting physicians’ impartial execution of their duties” in the eyes of society. For this reason, I have already received a warning from my university regarding this matter, and from this year, I will reduce my involvement and also refuse to take remuneration.

Hiroshi Ito, professor at Okayama University; specializes in heart failure, etc.

1. In most cases, the lecture requests come from medical associations and are for educational purposes.

 

2. The additional income payments are not limited to any specific pharmaceutical company. In most cases, I have responded to lecture requests sent via a medical association from multiple companies, so my participation in these activities does not result in favorable treatment for any specific company.

 

3. I am able to attend all lectures, treatment, administrative tasks (attending meetings, etc.), and research; there is no impact, such as cancelled classes, on my work.

 

4. In order to promote medical research through industry-academia collaboration, we believe it is necessary to gain the understanding and cooperation of society, under certain requirements disclose economic interests with companies, and ensure fairness and transparency of research in order to be accountable to society. On the other hand, in many cases lectures were requested by medical associations, which provide opportunities for family physicians or hospital doctors, who have few opportunities to attend conferences, to obtain the latest information on diseases.

 

My lectures focus on disease pathology, and then I identify some treatment options, which I believe helps in the treatment of cardiovascular diseases. Considering the duties of university professors, although lectures for the general public are also important, I think lectures like these to educate doctors are very important for raising the quality of medical care. In addition, the current regulations for concurrent employment at Okayama University do not stipulate precise approval criteria for the amount of remuneration.

 

Okayama University will also consider any content that should be reviewed in terms of conflicts of interest and responsibility. However, I also believe that it is necessary to make careful decisions regarding setting approval standards to ensure that excessive restrictions do not lead to excessive interference in one’s private life, as concurrent work is only supposed to be done outside of working hours. In addition, if there is a review of the regulations on concurrent work, I will naturally follow any updated standards.

Tsutomu Takeuchi, Keio University professor emeritus; specializes in rheumatism

1. I believe my additional income is a fair compensation for labor done to properly educate others about the efficacy and side effects of new drugs.

 

2. My activities are fair, transparent, and based on scientific evidence, without being influenced by income. I strive to benefit society as a whole, including local doctors, patients, and their families who have little access to information, rather than only the pharmaceutical companies concerned.

 

3. Most of the work I am asked to do takes place on weekends or weekdays evenings, so it has not affected my main work.

 

4. If there are activities that need to be done for the benefit of society as a whole, I will continue to do my best to accommodate them, if I have time.

Yoshiya Tanaka, professor at the University of Occupational and Environmental Health; specializes in rheumatism

1. I am often asked to give lectures or to facilitate seminars implemented by medical associations, etc.

 

2. I evaluate products solely on scientific evidence, regardless of manufacturer and completely free from the influence of any additional income. In the first place, these activities are not intended to benefit any particular company but are for the proper provision of medical care to patients and the advancement of medicine.

 

3. In all cases I submitted [to my university] a notification of side business and basically participate in these activities outside of working hours; they do not interfere with my main job.

 

4. I believe I spent a reasonable amount of time preparing outside of work hours, and I consider this to be fair compensation for my labor.

Koutaro Yokote, professor at Chiba University; specializes in diabetes, etc.

1. I assume that I have been asked to give or facilitate many lectures because of the wide range of areas in which I specializes, such as dyslipidemia, diabetes, atherosclerosis, medical care for the elderly, and general internal medicine.

 

2. I disclose all funding from companies and other sources to ensure the fairness and transparency of my research and be accountable to society, and I don’t believe it possible that certain companies can gain an advantage.

 

3. Activities such as speaking and moderating at lecture events were basically conducted outside of working hours (weekends, holidays, or weekday evenings), so there was no impact on my main duties (education, research, and medical treatment) such as cancelled classes.

 

4. I believe that cooperation between the medical community and pharmaceutical industry is one of the necessary elements for the development of medicine and medical care, in order to promote medical research through industry-academia collaboration with the understanding and cooperation of society.

None of the other top-earning physicians responded to our request for comment.

However, in the case of Saga University professor Koichi Node, we received the following response from the university.

“Our university has informed our faculty of discussions in the Diet, notices from the ministry of education, and recommendations from the Association of Japan Medical Colleges.”

Additional reporting by Mariko Tsuji, Rinsho Saito, Tomohiro Arakawa, Makoto Sano, and Nanami Nakagawa.

(Originally published in Japanese on Aug. 27, 2021. Translation by Annelise Giseburt.)

Money for Docs: All articles