Published 5 February 2009, doi:10.1136/bmj.b463
Cite this as: BMJ 2009;338:b463

Editor's Choice

Doctors, patients, and the drug industry

In the Royal College of Physicians’ report on relations between industry, academia, and the NHS (doi:10.1136/bmj.b442) Iain Chalmers is quoted as saying, "I do not blame industry for trying to get away with anything that is normally considered to be its primary purpose, which is to make profits and look after its shareholders’ interests. It is our profession that has colluded in all of this and been prepared to go along with it—we are the people to blame because we need not have stood for it."

By "all of this" I assume Chalmers means the many ways in which drugs are promoted in the guise of science, education, and information: the misreporting of industry funded research, the use of ghost writers and key opinion leaders, the provision of free courses and conferences. His words echo Suzanne Fletcher’s in the BMJ last year (2008;337:a1023, doi:10.1136/bmj.a1023). For these practices to flourish, doctors have had to at least acquiesce, if not actively take part, as researchers, guest authors, paid opinion leaders, and recipients of gifts and hospitality.

As our cover image shows, it takes two to tango. It’s time for the profession to take a lead. This means saying no to gifts and hospitality, ensuring that research and clinical collaborations are transparent and unbiased in their design and reporting, refusing to be a guest or ghost author, declining the role of paid opinion leader, paying our way for information and education, and refusing industry support unless it is entirely transparent and in patients’ or the public’s best interests.

Will the RCP report make a difference, as its instigator Ian Gilmore hopes (doi:10.1136/bmj.b439)? Our editorialist Joe Collier thinks not (doi:10.1136/bmj.b443). He calls the report "flawed" and a missed opportunity. But I am more hopeful. It seems to me that we may have reached a turning point. Trust in the industry has fallen so low among large swathes of the profession and the public that industry itself now sees that corrective action is critical for business. If its undoubted contribution to health and the economy are to be properly acknowledged and built upon, it too has to take a lead and change its approach.

We have commissioned five commentaries on the relationship between industry, doctors, and patients. Scott Gottlieb calls for less but better regulation (doi:10.1136/bmj.b234). Gordon Coutts, a company chief executive, praises joint working initiatives such as "find and treat" strategies for patients at high risk (doi:10.1136/bmj.b232). Richard Tiner, an industry spokesman, believes that current regulation provides robust controls (doi:10.1136/bmj.b252). Harlan Krumholz and Joseph Ross call for explicit standards of conduct including greater transparency, an end to industry funding of continuing medical education, tighter regulation for industry funded research, and an end to payment and intimidation of clinical opinion leaders (doi:10.1136/bmj.b211). Finally, former journal editor Marcia Angell says there should be no relationship because the missions of industry and health care are so fundamentally different (doi:10.1136/bmj.b222). Which view is most in line with yours? You can vote and give us your comments on bmj.com.

Cite this as: BMJ 2009;338:b463

---

Competing interests: FG gave oral evidence to the RCP’s working party. The BMJ Group receives revenue from a range of sources, including the pharmaceutical industry.

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

This article has been cited by other articles:

• Mundorff, M. B (2009). Drug companies are not alone. BMJ 338: b761-b761 [Full text]  
• Alves, T. L., Reed, T. (2009). Independent data for patients. BMJ 338: b766-b766 [Full text]  

Rapid Responses:

Read all Rapid Responses

So free we seem, so fettered fast we are!

BM Hegde
bmj.com, 6 Feb 2009 [Full text]

Doctors, Drug Companies and Medical Journals

Christopher M Thorpe Thorpe
bmj.com, 6 Feb 2009 [Full text]

Drug industry and some scientific society:the blameable partnership.

Vincenzo Fricchione Parise
bmj.com, 6 Feb 2009 [Full text]

They are not alone

Michael B. Mundorff
bmj.com, 8 Feb 2009 [Full text]

Big Pharma and Little Doctors

Hugh Mann
bmj.com, 8 Feb 2009 [Full text]

Clinical Trials of Therapy versus Medication: Even in a Tie, Medication wins

Jonathan Leo, et al.
bmj.com, 5 Mar 2009 [Full text]

Another multi-stakeolder forum but some important conclusions on independent information for patients

Teresa Leonardo Alves, et al.
bmj.com, 11 Feb 2009 [Full text]

Drug Companies & Doctors: A Story of Corruption

Anthony G Cummins
bmj.com, 12 Feb 2009 [Full text]

What can we do to protect our professionalism?

Rahul Bhattacharya
bmj.com, 13 Feb 2009 [Full text]

Potential conflicts of interest: more information from JAMA

Sharon Davies
bmj.com, 11 Mar 2009 [Full text]

Re: Clinical Trials of Therapy versus Medication: Even in a Tie, Medication wins

Steven N Wagner
bmj.com, 20 Mar 2009 [Full text]

NIH promotes the rise of merchant investigators.

Richard G Fiddian-Green
bmj.com, 22 Mar 2009 [Full text]

David and Goliath?

Peter M English
bmj.com, 25 Mar 2009 [Full text]

Re: Potential conflicts of interest: more information from JAMA

Peter J Flegg
bmj.com, 25 Mar 2009 [Full text]

Stealth Advertising and Academic Stalking

David O Antonuccio, Ph.D., et al.
bmj.com, 30 Mar 2009 [Full text]

Re: Clinical Trials of Therapy versus Medication: Even in a Tie, Medication wins

Robert G. Robinson
bmj.com, 15 Apr 2009 [Full text]

Conflicts Regarding Conflicts About Conflicts of Interest

Jeffrey R. Lacasse, et al.
bmj.com, 17 Apr 2009 [Full text]

Re: Conflicts Regarding Conflicts About Conflicts of Interest

Laura S. Boylan
bmj.com, 24 Apr 2009 [Full text]

Online poll

Find out more >>