Published 3 February 2009, doi:10.1136/bmj.b222
Cite this as: BMJ 2009;338:b222

Analysis

Relationships with the drug industry: Keep at arm’s length

¹ Harvard Medical School, Boston, MA 02115

The relationship between the drug industry, academia, healthcare professionals, and patients has reached an all time low and few doubt that it is in the interests of all parties to improve it. A recent report from the Royal College of Physicians attempts to define a path towards achieving a more productive relationship. Here we set out five contrasting views on what the ideal relationship between industry and prescribers and patients should be and what steps need to be taken to achieve it (doi:10.1136/bmj.b211, doi:10.1136/bmj.b232, doi:10.1136/bmj.b252, doi:10.1136/bmj.b252)

I believe there should be no relationship between the drug industry and either prescribers or patients. Drug companies are investor owned businesses with a responsibility to maximise profits for their shareholders. That is quite different from the mission of the medical profession, which is to provide the best care possible for patients. I start with this simple fact, because it is so often obscured by the industry’s public relations. Drug companies are not confused on this score. Their major output now consists of "me-too" drugs for mild or ill defined conditions in essentially healthy people. This is because that market is big and more easily expanded than the market for innovative drugs for serious diseases.¹

The purpose of drug companies’ contact with prescribers is nearly always to increase sales, and it usually involves payments of one form or another. These are often disguised as education—for example, sponsored continuing medical education, professional meetings, and conferences or dinner sessions to hear presentations about drugs. Companies provide meals, gifts, and subsidies of various sorts. But drug companies are not educational institutions. These activities are funded from their marketing budgets. Drug companies may, of course, provide accurate information to prescribers, but only if it serves their commercial interests. A growing body of evidence shows that they suppress or distort information that does not serve their interests.² Prescribers are faced with the impossible task of sorting out good information from bias or misinformation.

The fact that drug companies pay prescribers to be "educated" underscores the true nature of the transaction. Students generally pay teachers, not the reverse. The real intent is to influence prescribing habits, through selection of the information provided and through the warm feelings induced by bribery. Prescribers join in the pretence that drug companies provide education because it is lucrative to do so. Even free samples are meant to hook doctors and patients on the newest, most expensive drugs, when older drugs—or no drug at all—might be better for the patient.

Education and information should be provided by health professionals

It is time the medical profession took full responsibility for educating prescribers about prescription drugs, instead of abdicating it to drug companies.³ Doctors should pay for their own continuing education, just as other professions do. Similarly, professional organisations should pay for their own meetings and publications, not go hat in hand to industry. Drug companies are not charities; they expect something for the tens of billions of dollars they invest in marketing. The evidence is that they get it, and that patients foot the bill in higher drug prices.

As with prescribers, the purpose of contact between drug companies and patients is to sell drugs. In the US, drug companies spend about $5bn (£4bn; 4bn) yearly on direct to consumer advertising on television. The adverts are mostly for me-too drugs and are designed to convince viewers that one is better than another, despite the fact that these drugs are seldom compared in clinical trials at equivalent doses. Many seek to convince people that they have chronic disorders that require lifelong drug treatment. Thus heartburn is elevated to gastrointestinal reflux disease, with the implication that it needs to be treated to prevent serious complications. If people can be convinced they have a treatable medical condition, then it is an easy step to sell them drugs to treat it. Many doctors connive in this deception because it is easier to write a prescription than to counsel changes in diet or to offer reassurance. We need to stop accepting the fiction that marketing, whether to prescribers or patients, is good education.

Cite this as: BMJ 2009;338:b222

---

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

References

1. Angell M. The truth about the drug companies: how they deceive us and what to do about it. New York: Random House, 2004.
2. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008;358:252-60.[Abstract/Free Full Text]
3. Relman AS. Industry support of medical education. JAMA 2008;300:1071-3.[Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Entanglement in Scotland

David R Ball, Yehia Kamel, and Vince Perkins
BMJ 2009 338: b763. [Extract] [Full Text]

Doctors, patients, and the drug industry

Fiona Godlee
BMJ 2009 338: b463. [Extract] [Full Text]

Relationships with the drug industry: More regulation, greater transparency

Harlan M Krumholz and Joseph S Ross
BMJ 2009 338: b211. [Extract] [Full Text]

Relationships with the drug industry: Focus on better information

Richard Tiner
BMJ 2009 338: b252. [Extract] [Full Text]

Doctors, patients, and the pharmaceutical industry

Joe Collier
BMJ 2009 338: b443. [Extract] [Full Text]

Related external webpages:

Listen to the doctors and drug industry podcast special, Tessa Richards and Jane Smith interview key players in the debate.

This article has been cited by other articles:

• Ball, D. R, Kamel, Y., Perkins, V. (2009). Entanglement in Scotland. BMJ 338: b763-b763 [Full text]  

Rapid Responses:

Read all Rapid Responses

relationship with pharmaceutical industry

bill van marle
bmj.com, 9 Feb 2009 [Full text]

No doubts about the primary motivation of the pharmaceutical industry

Hany G. El-Sayeh
bmj.com, 13 Feb 2009 [Full text]

The "Free Lunch" is alive and kicking

David R Ball, et al.
bmj.com, 13 Feb 2009 [Full text]

Refuse the "free lunch" !

Alexander Spiers
bmj.com, 20 Feb 2009 [Full text]

Relationships with industry: Handshakes at arm's length

Bruce Gingles
bmj.com, 2 Jun 2009 [Full text]

Online poll

Find out more on doc2doc >>