ObjectivesTo analyse patterns and characteristics of pharmaceutical industry sponsorship of events for Australian health professionals and to understand the implications of recent changes in transparency provisions that no longer require reporting of payments for food and beverages.DesignCross-sectional analysis.Participants and setting301 publicly available company transparency reports downloaded from the website of Medicines Australia, the pharmaceutical industry trade association, covering the period from October 2011 to September 2015.ResultsForty-two companies sponsored 116 845 events for health professionals, on average 608 per week with 30 attendees per event. Events typically included a broad range of health professionals: 82.0% included medical doctors, including specialists and primary care doctors, and 38.3% trainees. Oncology, surgery and endocrinology were the most frequent clinical areas of focus. Most events (64.2%) were held in a clinical setting. The median cost per event was $A263 (IQR $A153–1195) and over 90% included food and beverages.ConclusionsOver this 4-year period, industry-sponsored events were widespread and pharmaceutical companies maintained a high frequency of contact with health professionals. Most events were held in clinical settings, suggesting a pervasive commercial presence in everyday clinical practice. Food and beverages, known to be associated with changes to prescribing practice, were almost always provided. New Australian transparency provisions explicitly exclude meals from the reporting requirements; thus, a large proportion of potentially influential payments from pharmaceutical companies to health professionals will disappear from public view.

Relationships between consumer organizations and pharmaceutical manufacturers are the focus of transparency efforts in some jurisdictions, including Australia. This study describes the frequency and nature of industry sponsorship of Australian health consumer organizations and examines the link between sponsorship of the most highly funded organizations and manufacturers’ requests for public reimbursement of products for related health conditions. We downloaded 130 transparency reports covering the period January 2013 to December 2016 from the website of Medicines Australia and carried out a descriptive analysis. For the most heavily funded organizations and their sponsors, we examined Public Summary Documents of the Pharmaceutical Benefits Advisory Committee to identify relevant products under consideration for public reimbursement over the study period. Thirty-four pharmaceutical companies provided 1,482 sponsorships to 230 organizations, spending a total of AU$34,507,810. The top clinical areas in terms of amount of funding received were cancer, eye health, and nervous system disorders. The sponsors of the most highly funded groups were companies that in most cases had drugs under review for public reimbursement for conditions covered by these organizations. Interactions between the pharmaceutical industry and consumer organizations are common and require careful management to prevent biases that may favor sponsors’ interests above those of patients and the public.

ObjectivesTo investigate patterns of industry-sponsored educational events that focus on specific health conditions for which there are concerns about overdiagnosis and overtreatment.Design and settingThis retrospective cohort study examines publicly reported industry-sponsored events in Australia from October 2011 to September 2015 for three conditions potentially subject to overdiagnosis and overtreatment: depression, osteoporosis and overactive bladder. We used a database of transparency reports to identify events with a focus on depression, osteoporosis and overactive bladder and compared these with other sponsored events. We hypothesised that companies marketing treatments for each condition would sponsor related events and that target audiences would mainly work in primary care, reflecting a broad patient population.Main outcome measuresEvent and attendee characteristics, sponsoring companies, related marketed treatments, cost-effectiveness ratings and dispensing rates.ResultsOver the study period, we identified 1567 events focusing on depression, 1375 on osteoporosis and 190 on overactive bladder (total n=3132, with 96 660 attendees). These events were attended by primary care doctors more often than sponsored events without a focus on these three conditions: relative risk (RR)=3.06 (95% CI 2.81 to 3.32) for depression, RR=1.48 (95% CI 1.41 to 1.55) for osteoporosis and RR=2.59 (95% CI 2.09 to 3.21) for overactive bladder. Servier, which markets agomelatine and AstraZeneca (quetiapine) sponsored 51.2% and 23.0% of depression events, respectively. Amgen and GlaxoSmithKline, which co-market denosumab, sponsored 49.5% of osteoporosis events and Astellas and Commonwealth Serum Laboratories (CSL) (mirabegron and solifenacin) sponsored 80.5% of overactive bladder events.ConclusionsThis 4-year overview of industry-sponsored events on three overdiagnosed and overtreated conditions found that primary care clinicians were often targeted, dinner was often provided and that a few companies sponsored most events. In most cases, sponsors’ products are not cost-effective choices for the specified condition. This pattern highlights the need for professional education to be free of commercial sponsorship.

disease has remained relatively stable from 2009 through 2014, although the prevalence of individuals reporting adherence to a gluten-free diet has more than tripled (0.52% in 2009-2010 to 1.69% in 2013-2014).Part of what may be driving this gluten-free diet trend is simply a belief, fueled by marketing and media, that these foods are healthier. However, surveys suggest that many individuals who adhere to a gluten-free diet believe that the exclusion of gluten has resulted in subjective health benefits from weight loss to reduced symptoms of inflammation and gastrointestinal distress. 3,4 Because a gluten-free diet may have negative social, financial, and health repercussions, it is important for clinicians to understand whether, in most cases, it is the elimination of the protein gluten that is responsible for symptom improvement or whether following a gluten-free diet is simply a marker of other dietary choices that are creating positive effects. 5 Not all research has found that individuals who adhered to a gluten-free diet resulted in subjective health benefits. A recent 2-year prospective study 6 from Italy suggests that something other than gluten itself is resulting in self-reported health benefits. Researchers enrolled all consecutive patients with gluten-related symptoms, and after those with celiac disease or wheat allergy were eliminated, only 7.5% experienced any change of symptoms with a gluten-free diet. Studies such as this raise the question of what other than gluten might explain the symptomatic improvement experienced among those following a gluten-free diet.One explanation is that it is not the gluten but the grain itself. Researchers in Australia found that that the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) and insoluble fiber that are found in glutencontaining foods may be responsible. FODMAPS and insoluble fiber increase the osmotic pressure in the large intestine and promote bacterial fermentation, which results in gas production and abdominal bloat. In a controlled, crossover study 7 of patients with irritable bowel syndrome, a diet low in FODMAPs effectively reduced these symptoms; in a related study, 8 patients who improved while following a low-FODMAP diet experienced no exacerbation of symptoms when gluten was introduced.Another explanation is that gluten elimination may accompany other dietary trends that are associated with improved symptoms. For example, adherents to the popular Paleolithic and autoimmune protocol diets might also report being on a gluten-free diet. 9 There is a debate about whether these diets, which promote eating unprocessed foods that were available in preagricultural times while avoiding grains, oils, and legumes, offer any health advantage over other whole food diets (such as the Mediterranean diet). Nonetheless, some have argued that simply eliminating highly processed foods (including highly processed gluten-containing foods) might result in an improved sense of well-being.Following a gluten-free diet likely means d...

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