BMJ  2006;333:1121-1122 (25 November), doi:10.1136/bmj.39037.695069.3A

Letters

Doctors as lapdogs to drug firms

Independence may be most cost effective way to improve health care

I hope Fugh-Berman's talk is effective in prompting drug companies to cease their involvement in medical education.¹ If so, stopping such talks could be the most cost effective way to improve health care because exposure to drug promotion correlates with suboptimal health care.² That includes the subtle promotion in disguise that makes involvement in medical education profitable for drug companies.

The main barrier to progress is doctors' denial that we are often adversely influenced by drug promotion. This denial arises partly from ignorance of the evidence about drug promotion,^{3 4} partly from overconfidence,² and partly from refusal to believe that evidence because it is seen as insulting our self esteem.⁵ We need to move from the illusion that being misled is unlikely or shameful to accepting that it is normal for humans to be vulnerable to misleading promotional techniques.⁵ There is no proved method for obtaining more good than harm from exposure to drug promotion¹ so we should all follow Fugh-Berman's call to stop being lapdogs to the pharmaceutical industry.

¹ Healthy Skepticism, 34 Methodist Street, Willunga, SA 5172, Australia peter@healthyskepticism.org

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Competing interests: I am the Director of Healthy Skepticism Inc. www.healthyskepticism.org

References

1. Fugh-Berman A. Doctors must not be lapdogs to drug firms. BMJ 2006;333:1027-a. (11 November.)[Free Full Text]
2. Mansfield PR, Lexchin J, Wen LS, Grandori L, McCoy CP, Hoffman JR, Educating health professionals about drug and device promotion: advocates' recommendations. PLoS Med 2006:3(11):e451. medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030451
3. Norris P, Herxheimer A, Lexchin J, Mansfield P. Drug promotion: what we know, what we have yet to learn
4. Healthy Skepticism Library. www.healthyskepticism.org/library.php
5. Mansfield P. Accepting what we can learn from advertising's mirror of desire. BMJ 2004;329:1487-8.[Free Full Text]

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