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Rapid Responses: Rapid Responses published:
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The study shows our product have more side effects or less effective than the other drug?
- A.K Al-Sheikhli,MRCPsych DPM (30 May 2003)
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CANCER CHEMOTHERAPY IN UNDERPRIVILEGED NATIONS : WHO IS MOST BENEFITED – PATIENT, DOCTOR OR INDUSTRY
- Pankaj Chaturvedi (2 June 2003)
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EBM: Evidence Based Marketing?
- Dirk Van Duppen (3 June 2003)
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Humorous or tasteless?
- Alexander S.D. Spiers (3 June 2003)
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Re: Humorous or tasteless?
- Michael O'Donnell (4 June 2003)
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"Free Lunch learning is better than lunch free learning!"
- Sidha Sambandan (8 June 2003)
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Re: "Free Lunch learning is better than lunch free learning!"
- Thomas Ng (8 June 2003)
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Sponsorship
- Jane M Hawdon (10 June 2003)
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A.K Al-Sheikhli,MRCPsych DPM, Locum Consultant Psychiatrist Manor Medical Centre,2 Manor Court Avenue,Nuneaton CV11 5HX,England.
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30th,may,2003 Dear Editor,It was interesting to see several articles published in the BMJ,exploring the relationship between doctors and drug industry(Journal,2003),I would like to comment on those papers, 1.Infact they discuss a very sensitive issue at present time,relationship between drug companies,and doctors,could be also medical students(using the concept of primacy effect in interpersonal relationships , a term borrowed from clinical psychology),and the newly graduated doctors. 2.It is well known fact that one of the means to change public opinon ,among which are medical professionals,nursing staff,medical organizations,medical journals...etc is by the use of financial support which could be through direct or indirect way,supporting of meetings,research,attendance of conferences,or present a gift to the department,hospital or medical school,as for example a Positron Emission Tomography ..? 3.Regarding the publication in medical journals,and presentation of papers at conferences especially those sponsered by drug companies,I quite agree they tend to be biased towards their product,several papers published in different medical journals during the last century illustrate for e.g the statistical errors are high among papers published in different medical journals , in which they present numerical results!1,2,3,4. 4.It will be interesting to see a single study sponsered by a drug company and either published in a medical journal or presented in a conference which show their product either less effective than other drugs or have more side effects?,5. With my best regards Yours sincerely, Dr.A.K.Al-Sheikhli References 1.Gore,SM,Jones IG,Rytter EC,Misuse of statistical methods:critical assessment of articles BMJ from January to March 1976,Br Med J 1977,1(6053):85 2.White SJ,Statistical errors in papers in the British Journal of Psychiatry,Br J Psychiatry 1979 Oct,135::336-42 3.McGuigan SM,The use of statisics in the British Journal of Psychiatry,Br J Psychiatry 1995;167(5):683-8 4.Porter AM,Misuse of correlation and regression in three medical journals,J R Soc Med 1999 Mar;92(3):123-8 5.Al-Sheikhli AK,Atypical antipsychotics ,less extrapyramidal symptoms & effect on serum prolactin,but other side effects..?,bmj?cgi/eletters/325/7358/243#24510,8 Aug 2002. Competing interests: None declared |
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Pankaj Chaturvedi, assistant surgeon Tata Memorial Hospital
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The editorial by Jane Smith BMJ 2003;326 (31 May) prompts me to bring out an alarming situation in underprivileged countries with regard to physician – industry nexus. Though chemotherapy ( CT) has marginally changed the outcome in most of the common cancers, industry is promoting CT as option that improves quality of life or diseases free survival without affecting survival. Impoverished nations harbor huge number of cancer patients therefore chemotherapy industry has located a big market in such nations. The sale of chemotherapy has increased manifolds with static mortality rates. Few weeks of increased disease free survival or questionable improvement in QOL hardly matters when you have to mortgage your belongings to finance the chemotherapy. Unlike western countries, most patients in such nation either bear the cost themselves or drain out the limited resources of their employer. For example, the cost of 100 mg of paclitaxel alone is approximately rupees 3500 ( $ 78) which is sufficient to feed a poor family for 4 to 5 months. Unwarranted use of chemotherapy assumes greater significance in contrast to multivitamins, cosmetic, vitality drugs etc because it is not only financially crippling for the patient but also deprives him of whatever little good life he is left with. The promotion and downfall of high dose chemotherapy and autologous bone marrow transplantation is a burning example of how patients were lured in an ineffective protocol. Chemotherapy research and sale is propelled not by the desire to help patients, but by the avarice of drug companies. The average cost of developing one new drug is estimated to be $300 million to $600 million and pharmaceutical companies spend more than $11 billion each year to promote and market their drugs. (1)This cost of advertising (which includes gifts and other promotional offers to the physicians) is ultimately borne by the patient! Some companies are paying the physicians for each vial of chemotherapy that they prescribe. It is not surprising that apart from medical oncologists, even surgeons and radiation oncologist are showing profound interest in chemotherapy practice. CT industry pays millions of dollars in sponsoring the attendance of their patron physicians in international conferences and symposias at exotic locales. Medical representatives in developing nations have replaced the conventional continuing medical education with in- office confusing medical education. Drug companies seek out researchers who happen to be getting positive results. To make the situation worse some white skinned faculty will be flown to such dark skinned nations for presenting a nicely worded statistical jargon hyper-inflating advantages of their products. Absence of national guidelines, poor patient awareness and lack of dedicated cancer centers are other attributable causes to this malpractice. Often industry sponsored clinical trials use surrogate end points that may not even distantly correlate with more important clinical end points and the hyper - selective projection of favorable results overwhelms most practitioners (2,3,4,5) . The industry is diverting most of its research and drug trials to such nations to avoid the stringent conditions prevailing in west. Friedberg et al. reported that 5 percent of industry-sponsored pharmacoeconomic studies of cancer drugs reached unfavorable conclusions about the company's products, as compared with 38 percent of studies with nonprofit funding that reached similar conclusions. (4) Seventy percent of the money for clinical drug trials in the United States comes from industry rather than from the National Institutes of Health (NIH). References 1. Mathieu MP, ed. Parexel's pharmaceutical R & D statistical sourcebook 1998. Waltham, Mass.: Parexel International Corporation, 1999. 2. Stelfox HT, Chua G, O'Rourke K, Detsky AS. Conflict of interest in the debate over calcium-channel antagonists. N Engl J Med 1998;338:101-6. 3. Davidson RA. Source of funding and outcome of clinical trials. J Gen Intern Med 1986;1:155-8. 4. Cho MK, Bero LA. The quality of drug studies published in symposium proceedings. Ann Intern Med 1996;124:485-9. 5. Friedberg M, Saffran B, Stinson TJ, Nelson W, Bennett CL. Evaluation of conflict of interest in economic analyses of new drugs used in oncology.JAMA1999;282:1453-7 Competing interests: None declared |
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Dirk Van Duppen, General Practitioner Group Practice Medicine for the People, B-2100 Antwerp, Belgium
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This week's content of the BMJ suggests that EBM can stand sometimes for "Evidence Based Marketing" or even "Evidence Base Misleading" instead of for "Evidence Based Medicine". Industry seems today one of the main sources of bias in Evidence Based Medicine. Congratulations for having the courage to publish this material. Competing interests: None declared |
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Alexander S.D. Spiers, Professor of Medicine (retired). N/A
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It is very appropriate that this issue of the BMJ carefully examines the relationships between doctors and drug companies. A convincing case is made for improvement, particularly in reporting the results of research. Unfortunately, the illustration on the front cover is not appropriate. At best it would be considered flippant. As a median point it could be considered tasteless. By many it would be considered highly offensive. Doctors are not pigs and drug company representatives are not reptiles. Worst of all is the figure in the bottom right hand corner: most emphatically, patients are not guinea pigs. Regrettably, it is true that some doctors may be unduly influenced by rewards, that some companies may not have the purest motives, and that patients may suffer because of the publication of biased results. Surely these matters are far too serious to be depicted in a cartoon. Competing interests: None declared |
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Michael O'Donnell, Writer and one time doctor Loxhill GU8 4BD
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No "matter" is "far too serious to be depicted in a cartoon". Those who doubt the truth of that dogmatic statement should look at the cartoons of Hogarth, the cartoons that David Low produced during the Second World War, the cartoons now being drawn by Steve Bell, and all the cartoons in between in which gifted artists made memorable comments on none too trivial matters. Michael O'Donnell Competing interests: None declared |
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Sidha Sambandan, GP Yare Valey Medical PRactice, 202 THorpe rd, Norwich, NR1 1TJ
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The degree of influence of drug industry depends to a great extent on the individual targetted. When will the BMJ "disentangle" from the Drug Industry? How much was gained from the Drug adverts on this issue? (16 FULL PAGES! excluding BMA News and Classfied Ads supplement + wrappers). Strangely, it has dropped to 16 from the 26 full pages of Drug Adverts in the BMJ of 25th of January! This is despite charging over £300 to the subscribers. I shudder to think what would become of the educational courses of very high standard that are often entirely sponsored by the Drug Industry. Majority of the doctors are not seduced by the marketing. My observation is that the Pharmacists in Primary Care Organisations and Nurses are far more influenced by the drug industry over the last six years. I wonder what research evidence we have for this. Over the last few years the industry has been marketing directly to the public via the internet, and media. Some academic posts too are being sponsored by the Drug Industry. Do we have to throw away the baby with the bath water? What is needed is "Mindful practice" by critically appraising the so called "Evidence Based Medicine" in the light and context of our professional practice. This requires an insight and awareness of the hidden agendas of the person or organisation trying to influence us, by listening to what is being said, but paying attention to what is not being said! Competing interests: None declared |
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Thomas Ng, Senior Medical Advisor PL6 5HH
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I would like to clarify an important issue that direct marketing to the general public is forbidden in UK, though it is "legal" in the US. Any promotion from the pharmaceutical companies is abided by the ABPI Code of Practice [in this case, Clause 20( Relations with the General Public and the Media) and Clause 21(the Internet)]. Competing interests: currently working in a CRO specialised in early phase clinical studies |
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Jane M Hawdon, Consultant nenatologist UCLH NW5 1HZ
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After reading your editorials and articles on the subject of sponsorship, I picked up pH7 - The Parliamentary Health Magazine. I note 15 of its 55 pages contain adverts for various commercial health-related companies, including providers of private health care. Competing interests: None declared |
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