Published 3 February 2009, doi:10.1136/bmj.b234
Cite this as: BMJ 2009;338:b234

Analysis

Relationships with the drug industry: Build trust based on good science

¹ American Enterprise Unit, 1150 17th Street, NW, Washington, DC 20036, USA

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.b222, doi:10.1136/bmj.b211, doi:10.1136/bmj.b252, doi:10.1136/bmj.b232)

Medical treatments are becoming increasingly more individual, with respect to both disease and patient. They are also becoming more complex, and precise diagnoses and close monitoring are needed to optimise their use. In this environment, consumers and doctors need to work more closely with product developers. Yet increasing regulation of the drug industry is restricting its ability to disseminate the results of its clinical studies. This risks shrinking the opportunities patients have to improve their health. In the face of regulatory steps to restrain their scientific speech, drug makers need to take new steps in their relationship with doctors and patients and establish transparent guidelines for those interactions. They should also focus more squarely on matters of advancing science, monitoring for safety, and improving health education.

Science not marketing

A large part of the industry’s current problems stems from the way its relationship with academic physicians and medical institutions has evolved over the past few decades. Formerly, the industry depended on academic doctors to conduct basic and clinical research. Now more of that work is done in house.¹ As a consequence, the relationships forged with the academic medical community are often based on marketing related activities. This feeds the regrettable perception that drug makers ally themselves with medical thought leaders to advance marketing goals, not science, and that information they generate cannot be trusted.

Relationships should be predicated on genuine scientific work. This doesn’t mean that drug makers should stop engaging leading physicians to help companies generate and share information about new advances, but that they need to engage with doctors who had a role in discovering those advances rather than those with no or little link to the underlying science. The latter creates the unfortunate appearance that opinions are being rented; the former is unassailable, as a scientist is the most appropriate champion for his work.

Overcoming mistrust

As patients are taking an increasingly active role in treatment decisions drug companies need to take new steps to improve health literacy and patient education while they continue to invest in better ways to monitor the performance and safety of their products. Unfortunately, the existing mistrust means that policy makers continue to create restrictions that impede the ability of drug companies to speak to patients. This creates information asymmetry and denies patients the opportunity to receive truthful, non-misleading information about new products, thus hurting health outcomes.^{2 3} It also leads to a regulatory edifice that makes it harder for drug companies to monitor the performance of their drugs by talking directly with patients and makes it harder for them to provide targeted information to patients on proper use of prescription drugs. The bottom line remains that the drug firms remain one of the few actors in this marketplace with the financing and incentives to share and collect information. Under proper regulation, public health imperatives should compel us to make better use of these resources on behalf of patients.

Cite this as: BMJ 2009;338:b234

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Competing interests: SG has accepted speaking fees from branded pharmaceutical companies and does regulatory consulting work for Vertex Pharmaceuticals.

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

References

1. Bodenheimer T. Uneasy alliance—clinical investigators and the pharmaceutical industry. N Engl J Med 2000;342:1539-44.[Free Full Text]
2. Sentell TL, Halpin HA. Importance of adult literacy in understanding health disparities. J Gen Intern Med 2006;21:862-6.[CrossRef][Web of Science][Medline]
3. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA 2002;288:475-82.[Abstract/Free Full Text]

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