【英语中国】探源GSK中国丑闻

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2013-12-25 08:58

小艾摘要: Unshaven and dressed in a blue and grey striped T-shirt, Liang Hong looked nondescript on screen. But his words, broadcast on Chinese television last July, were explosive. He told two policemen how, a ...
Unshaven and dressed in a blue and grey striped T-shirt, Liang Hong looked nondescript on screen. But his words, broadcast on Chinese television last July, were explosive. He told two policemen how, as a vice-president of GlaxoSmithKline, he had channelled concealed payments via a local travel agency.

On the same day, Gao Feng, a leading fraud investigator, held a highly unusual briefing for foreign journalists at which he likened the British-based pharmaceutical company to the “big boss” in a “criminal partnership”, paying up to Rmb3bn ($500m) to officials and doctors. He claimed it used 700 travel agencies, some in turn offering money and “sex bribery” to GSK executives to win their favour.

This week Sir Andrew Witty, GSK’s chief executive, unveiled worldwide measures aimed at removing incentives to sales staff that encouraged excessive marketing, strengthening transparency and cutting funding to doctors. The moves follow both the China scandal and a record $3bn fine from US regulators last year.

While the changes build on reforms Sir Andrew launched in the US to tackle the legacy of his predecessors, the revelations in China were personally embarrassing for him. Most had happened since he took over GSK in 2008, winning the job partly on the basis of his knowledge of Asia acquired during a senior posting in Singapore.

Since the accusations, which depressed GSK’s sales in China by 61 per cent and spread concern to its multinational rivals, Sir Andrew has scrambled to find a resolution. He stepped up his efforts this month with a first visit to the country since the scandal, accompanying David Cameron, the British prime minister, on a delegation but spending much of his time in meetings of his own.

Ethical concerns Industry practices under scrutiny

The case has sparked broader concerns about the difficulties of operating in emerging markets and about the pharmaceutical industry’s ethical practices. It raises narrower ones about GSK’s own conduct and the responsibility of senior management.

In so far as Chinese investigators are probing for the facts – rather than responding to broader political or cost-cutting pressures, as some observers suggest – they need to determine how far the company was complicit, suffered from poor compliance or was a victim of sophisticated undetectable fraud.

While the GSK probe is yet to lead to charges or convictions, it has echoed broader concerns about drug company practices around the world. Only last month, Johnson & Johnson agreed a $2.2bn fine in the US after officials targeted practices including incentives paid to pharmacies to boost prescriptions, fees to sympathetic doctors to give favourable talks on its drugs, and kits of medicines mixed with lollipops to encourage use by children.

In the US alone, in the past three years cumulative fines from government prosecutions exceeded $13bn. Elsewhere, from Western Europe to Central Asia and Latin America, local regulators have been stepping up scrutiny of similar practices, mirrored by probes from the US and the UK.

In China, the authorities have detained four of GSK’s top Chinese executives and, according to local media, questioned another 40 inside and outside the company. Its British finance chief in Shanghai was banned from leaving the country, while Mark Reilly, who ran the national operation and left shortly before the accusations, has since returned and remains under similar restrictions.

Sir Andrew has described the alleged corruption as “shameful”, launched internal inquiries, and despatched senior officials to Shanghai, including a replacement for Mr Reilly.

The ripples have spread more widely. Whistleblower allegations against several other foreign drug companies, including Sanofi, Novartis, Eli Lilly, and Bayer, were reported by the Chinese media after the GSK investigation. Industry insiders say local drug companies have also been investigated, and staff detained, though no charges have been announced publicly.

Homegrown corruption: Local company ‘commissions’

Yet the steady stream of allegations in the Chinese press has ceased in recent months, and the crisis atmosphere seems to have calmed. Bruno Gensburger, head of the pharmaceutical working group at the EU Chamber of Commerce in China, says things are “going back to normal”.

“My feeling is that it had a big psychological impact?.?.?.?and after the GSK case many companies reinforced their compliance regulations, but we already had tight compliance regulations so I don’t really know what more we could do,” he says.

That might appear a defensive industry posture. But across the healthcare spectrum, from doctors to hospital officials to sales representatives for rival local companies, there is agreement that foreign pharmaceutical groups are not the main culprits of corruption in the Chinese healthcare industry.

Local companies are far more profligate with so-called “commissions” to doctors because they are not subject to the kind of scrutiny that foreign companies face under global anti-bribery laws.

A medical student in a leading Shanghai hospital says: “The supervising doctor in my department sees as many as 80 patients in a morning, and prescribes as much as Rmb100,000 worth of drugs. She definitely takes commissions from drug companies, but that only affects what she prescribes when there are two similar drugs.”

That situation normally arises when both are local generic businesses, industry analysts say. “In China, foreign drug companies are the best boys, but the parents beat them first,” says one industry insider, echoing a sentiment heard frequently from Chinese doctors who say foreign drug companies pay for educational activities that no one else will pay for in China.

“Financial flows – both legal and illegal – tied to drug and device sales are funding perhaps 60-80 per cent of total hospital costs,” says George Baeder, an independent drug industry adviser. “Without this funding, the current system would collapse.”

Many drug analysts see kickbacks as structural, and therefore hard to eradicate: central and provincial Chinese governments cannot afford to pay doctors a living wage, and many patients cannot afford to pay the true cost of care. Up to now, Beijing has turned a blind eye as pharma companies find ways to subsidise doctor salaries and underwrite their medical education.

Because corruption is core to the system, it cannot be eradicated by government fiat – though industry analysts say that fining GSK and imprisoning some of its employees would send an important signal.

At a time when the new government of Xi Jinping has launched an anti-corruption campaign across Chinese society, some habits have already begun to change. One Chinese consultant says she is often invited by drug companies to give lectures in public hospitals.

“There used to be a group of people escorting me everywhere and taking me to big meals, but since the GSK thing happened foreign companies have cancelled their invitations and there are very few invitations from local companies either,” she says. “Now I fly on my own and only one person meets me at the airport”.

Price pressures Crackdown on costs will continue

Despite these changes, most foreign drug companies have experienced only a modest impact on sales. Chinese doctors say they often have little alternative to using foreign drugs, which command a significant price premium, despite being mostly off-patent medicines. Local companies make generic alternatives for many, but doctors and patients do not trust their quality.

Beijing is determined to bring down the cost of such medicines, with consolidation of drug distribution, new quality controls on domestic producers and a revamping of the hospital financing system. “This is just year five in the government’s 12-year healthcare reform plan” to bring quality affordable care to 1.3bn people by 2020, says Franck Le Deu, author of a recent McKinsey report on pharmaceuticals in China. “It’s early days yet.”

By 2020, the drug market in China could top $310bn in retail sales value, the McKinsey report says, making it the world’s largest market after the US. But up to now, it accounts for only 3.8 per cent of the global revenues of the top 10 foreign drug companies. Sales have been rising fast, but now they are coming under increasing price pressure, creating commercial uncertainties alongside the concerns sparked by the unresolved probe against GSK.

There is no shortage of rumours in China about what the outcome of the specific GSK probe might be. The company is widely expected to escape corporate charges, with its four senior Chinese executives likely to go to jail but no punishment for foreign executives. GSK could face financial penalties. Industry insiders caution that, given the opaque nature of China’s judicial system and the almost total silence of GSK on the issue, reading the tea leaves on the eventual outcome is more of an art than a science.

If the facts are as the Chinese authorities claim, investigators and investors alike must question whether the company’s systems were adequate or it turned a blind eye as sales rose.

Whatever the truth, it and other pharmaceuticals companies are bracing for price cuts ahead and the need to be ever more cautious on their practices in emerging markets as well as more industrialised ones.

Additional reporting by Yan Zhang

屏幕上的梁宏满脸胡渣,穿着蓝灰条纹T恤衫,看上去并没有什么特别,但今年7月他所做的供述却是爆炸性的。中国电视台播出了这段内容。梁宏是葛兰素史克(GlaxoSmithKline,简称GSK)中国副总裁,他向两名警察讲述了自己是如何通过一家国内旅行社行贿的。

同一天,在一次罕见的面向外国记者召开的新闻发布会上,中国经济犯罪侦查部门的警官高峰将这家英国制药公司比作“犯罪组织”的“老大”,向官员、医生行贿高达30亿元人民币(合5亿美元)。他说,GSK通过700余家旅行社行贿,而其中一些旅行社向GSK高管提供现金和“性贿赂”以获得业务。

GSK首席执行官安伟杰爵士(Sir Andrew Witty)最近公布了该公司在全球范围内的改革措施,旨在废除一些鼓励过度营销的销售激励措施、增加透明度,并削减为医生提供的经费。在这些举措出台之前,GSK不仅在中国丑闻曝光,去年还被美国监管机构处以30亿美元的创纪录罚款。

尽管安伟杰在美国发起改革以解决前任遗留问题,并在全球范围推行新措施,但中国曝出的丑闻让他处境尴尬,因为它们大多发生在2008年安伟杰出任GSK首席执行官之后。他之所以能够坐上这个位置,一定程度上归因于他曾在新加坡担任高管,对亚洲市场颇为了解。

贿赂指控导致GSK在中国市场销售额下降61%,同时也引起了其他跨国药企的不安。安伟杰匆忙寻找解决办法。本月他进一步采取行动,自丑闻爆发以来首次访问中国。安伟杰跟随英国首相戴维?卡梅伦(David Cameron)的代表团访问中国,但大部分时间都在进行自己的私人会晤。

道德层面的担忧:行业惯例引起关注

从宏观层面来说,该案件引发了人们对企业在新兴市场运营所面临的困难以及制药行业道德规范的担忧。从微观层面来说,它还导致人们不信任GSK产品以及该公司高级管理层的责任心。

如果中国相关部门一心要把事情查个水落石出,而不是像一些观察人士认为的那样,主要是迫于政治压力或医药行业成本削减压力而采取调查行动的,它们就必须裁定,该公司串通行为的严重程度,以及该公司是否合规政策存在缺陷,还是该公司本身就是某种不明的复杂欺诈活动的受害者。

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尽管GSK案迄今还没有做出任何指控或定罪,但这起风波发生时,世界各地都在担忧医药公司开展业务的手段。就在上月,强生(Johnson & Johnson)在美国同意支付22亿美元罚款以了结如下指控:为药店提供激励,让它们多开强生的药,付费给医生让他们说强生药品的好话,以及将棒棒糖与药品打包在一起以鼓励儿童使用。

仅仅在美国一个国家,医药公司在过去三年里因遭到公诉而接受的罚款总额就超过130亿美元。在从西欧到中亚和拉美等其他地区,当地监管机构一直在加大对类似行为的审查,这些审查类似于美国和英国进行的调查。

据当地媒体报道,中国有关部门拘留了GSK的4位中国高管,并对另外40人(不仅仅是该公司内部人士)进行了讯问。该公司驻上海的英籍财务总监被禁止离境,中国总裁马克锐(Mark Reilly)在指控前曾经离境,但返回后同样被禁止离境。

安伟杰表示相关腐败指控“令人羞耻”,他在公司内部展开了调查,派遣高管去上海,并找人接替马克锐。

GSK案件在整个行业产生了广泛影响。在GSK遭到调查之后,中国媒体报道称,赛诺菲(Sanofi)、诺华(Novartis)、礼来(Eli Lilly)和拜耳(Bayer)等多家外国制药公司也被举报存在贿赂行为。业内人士称,中国本土制药公司也遭到调查,而且也有员工被拘,不过没有公开宣布指控。

土生土长的腐败:中国药企的“回扣”

近几个月来,中国媒体不再集中火力抨击制药公司,危机氛围似乎有所缓和。中国欧盟商会(EU Chamber of Commerce in China)医药工作组负责人布鲁诺?根斯布格尔(Bruno Gensburger)表示,情况正在“恢复正常”。

他说:“我的感觉是,这件事产生了很大的心理冲击……在GSK案件之后,许多公司加强了合规措施,但我们已经有了严格的合规措施,因此我真的不知道我们还能做什么。”

看来医药行业好像是处于守势,但在整个医疗界,从医生到医院管理人员,再到本土药企的销售代表,业界普遍认为,外国制药集团并非是中国医疗行业腐败的罪魁祸首。

本土药企在向医生支付所谓的“回扣”上要肆无忌惮得多,因为它们不像外国公司那样受到全球反贿赂法的规范。

上海一家大医院的一名医学生表示:“我们科室的主任医师一个上午要看80个病人,开出10万元的药。她肯定从药企拿回扣了,但这只影响她在两种类似药物中选择开哪一种。”

行业分析师表示,当两家公司都是本土普药公司的时候,通常就会出现这种情况。一位业内人士表示:“在中国,外国制药公司是最乖的孩子,但父母首先打得就是他们。”这和中国医生们通常的感受一致。中国医生们说,外国医药公司为教育活动支付费用,而中国其他公司不会这么做。

医药行业独立咨询顾问乔治?巴德(George Baeder)表示:“与药品和医疗设备有关的资金流动(无论合法与否)或许为医院60%-80%的成本提供了融资。如果没有这种资金,当前的体系将会崩溃。”

许多医药分析师认为回扣是结构性现象,很难根除:中央和省级政府无法为医生支付合理工资,许多病人负担不起实际的治疗成本。迄今为止,北京方面对医药公司想方设法为医生薪资提供补贴和承担医学教育费用视而不见。

腐败是中国医疗体系中存在的核心问题,政府行政命令不可能根除腐败,但行业分析师们表示,对GSK罚款并将其部分员工判刑将会传递出重要信号。

在中国新一届政府在全社会发起反腐运动之际,医药行业的一些惯例已经开始改变。一位中国顾问表示,医药公司经常邀请她去公立医院演讲。

她说:“过去我走到哪里都有一群人陪同,宴请不断。自从GSK事件发生以来,外国公司取消了邀请,来自本土公司的邀请也非常少。现在我自己乘坐飞机,到机场后,也只有一个人来接我。”

价格压力:中国将继续限制成本

尽管发生了上述变化,但大多数外国制药公司的销售情况只受到了很小的影响。中国医生们表示,他们经常别无选择,只能使用外国药品。进口药价格贵很多,尽管大多是非专利药。本土公司生产许多种普药,但医生和病人并不信任它们的质量。

北京方面决心压低此类药品的成本,整合药品分销渠道,对国内生产商出台新的质量控制措施,并改革医院融资体制。乐诚铎(Franck Le Deu)表示:“中国政府提出了为期十二年的医疗改革计划,即到2020年向全国13亿人提供民众负担得起的优质医疗服务,而现在才第5个年头。目前仍然是初期阶段。”乐诚铎是麦肯锡(McKinsey)最近发表的一份关于中国医药公司的报告的作者。

麦肯锡报告称,到2020年,中国医药市场零售总额可能突破3100亿美元,这将让它成为仅次于美国的全球第二大市场。但目前在十大外国制药公司的全球营收中,中国市场的贡献只有3.8%。销售一直在迅速增长,但现在它们正承受着日益增长的价格压力,这导致了商业上的不确定性,同时人们也对GSK案件久拖不决感到担忧。

有关GSK具体调查的结果,中国国内风声四起。人们普遍认为,该公司将不会遭到起诉,但4名中国高管很可能会被判刑,而外国高管则不会受到任何惩罚。GSK可能面临经济上的处罚。行业人士警告称,鉴于中国司法体系内在的不透明性,以及GSK在该问题上几乎完全保持缄默,要判断案件最终结果与其说是一种科学,还不如说是一门艺术。

如果事情真相确实如中国当局所言,调查机构和投资者必须要问,GSK内部制度是否完善,或者说,该公司在销售增长时故意睁一只眼闭一只眼。

无论真相如何,GSK和其他制药公司都得面对药价下降,而且有必要在新兴市场和更为工业化的市场多加谨慎行事。

张嫣补充报道

译者/邹策

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