Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Not just a free lunch
- Helen M Annis (8 August 2003)
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Free gifts: time to grow up
- Andrew N Bamji (8 August 2003)
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Posters and Patsies
- David G Wilkinson (8 August 2003)
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Doctor's Dilema
- B.C. Rao (10 August 2003)
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Time to put this to bed
- Dennis Preece (12 August 2003)
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It's an "arms race", and we win.
- John F Bolton (13 August 2003)
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Limiting Bias through Cognition
- John A Noviasky (14 August 2003)
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Protecting patients - a ludicrous excercise?
- Gurli Bagnall (21 August 2003)
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Helen M Annis, retired/ locum consultant psychiatrist NW3 5RE
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The recent APA meeting in San Francisco (to which I went at my own expense - although many of my colleagues were 'sponsored' by Big Pharma) was an absolute pigfest. Each morning and evening six drug companies offered 3 course breakfasts and gourmet dinners. And there were fantastically expensive 'free' evening events, the best for me being an evening opening of the excellent new Asian Art Museum, all exhibits on display, and superb food and drink on offer, courtesy of Eli Lilly, to whom I'm grateful. 2500 attendees, I was told by museum staff when I re-visited next day. So, Simon, there's a lot more than pens and sandwiches out there, as you must surely be aware. Competing interests: None declared |
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Andrew N Bamji, Consultant Rheumatologist Queen Mary's Hospital, Sidcup, Kent UK
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Simon Wesseley has hit the nail on the head. The problems of the NHS are too vast for us to waste time in petulant and childish outbursts about undue influence. In some parts of the world our self-flagellation over the issue would, indeed, raise concerns as to whether we were entirely sane. If my Trust cannot afford to fund a specialist nurse, and a pharmaceutical company puts up the money for one, do I turn it down? If a gift or grant makes my working life easier, and directly or indirectly benefits my patients, then I will take the money. However, right now, if anyone is listening, I could do with a fan... Competing interests: My department received a substantial grant from a drug company to fund a rheumatology specialist nurse and, like others, my desktop is littered with useful widgets |
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David G Wilkinson, Consultant in Old Age Psychiatry Moorgreen Hospital, Southampton SO30 3JB
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Whilst I think the general ‘wake up and smell the coffee’ responses to the BMJ 31 May edition on the Pharma / doctor relationship are probably pragmatic those of us who are branded as KOL's (Key Opinion Leaders) by the industry have a greater responsibility to see through the hype. There are two important areas where I think influence is perhaps less overt:- We are often approached to be lead author/presenter of, as yet unpublished, data from our clinical trials as poster presentations at large medical conferences. These are produced to give the marketing teams some of the latest findings to cite and are often put together with that in mind. As a result the conclusion drawn, which is the only part most casual readers can be bothered to glance at, is often tendentious along the lines of 'so our drug is best’, despite no clear evidence of that presented in the data. Without ever having had any independent peer review, these posters are often widely cited in review articles. There may indeed be several posters all produced from the same data leaving out salient points like the fact that the primary outcome measure was not achieved in favour of some part of a secondary measure that manages to achieve an acceptable p value. It remains the role of the KOL who agrees to author this in exchange for being offered free attendance at the meeting to be vigilant. We must be sure we keep faith with the data by making sure we read all drafts and especially the final one to make sure all our comments and suggestions have been accepted. We can of course, and do, refuse too attach our names to them but they will then be presented by company medics and we will have no way if influencing what is written at all. Secondly, I have recently come to realise that one can be a patsie if one is not careful. There are not only far too many conferences these days but also far too many evening meetings/ half day seminars etc apparently of good educational value sponsored by drug companies. At first one is flattered to be asked to present ones data or review one’s favourite subject area to colleagues, and the few hundred pounds for giving up half a day and evening seems fair recompense. However, one comes to realise that the audience may be less of a target than the speakers. The companies who can gather together three or four KOL’s at one place to talk about the effects of their compound have achieved a major marketing coup and the audience of 6 disaffected clinical assistants and SpR’s may not be their real target. Think about it. If we remember our role to provide sound evidence for, but not to act as, marketeers we can continue to work with pharma to further the needs of our patients and continue to develop innovative new treatments without feeling in any way compromised and use our positions to moderate the excesses reported in the letters on this subject. Competing interests: I have spent 15 years in psychopharmacology research with all the main companies and accepted sponsorship for CPD meetings and speaking |
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B.C. Rao, Family Physician 847,2nd Cross,7nth Main,H.A.L. 2nd Stage,Bangalore 560008.India8
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The good professor may be an exception that he has not become a lackey despite the inducements and has retained his clinical impartiality. He is more an exception than the rule. We doctors do get influenced by the drug promoters and sometimes favour one at the expense of the less aggressive one. I see it all around me. The inability or ‘why should I pay when some one is giving it for free’ attitude that most of us have, prevents us from paying for our education needs. The result is that we end up promoting a drug or equipment when we should not be doing it. But the problem is, often the drug or equipment promoted is of excellent quality and would one then consider unethical using it? B.C.Rao Competing interests: None declared |
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Dennis Preece, Retired An NHS Patient and Carer
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I agree with Simon Wellesley, this agonising about doctors being corrupted by the pharmaceutical industry is nonsense. As a patient and a carer of some long standing. I have not met a doctor yet that has not wanted to do the best for me and my family. Sometimes they have not done so but I am sure, this is not because they are in the pay of a drug company. It is usually because either they do not have the resources to meet our needs or are not sufficiently clued up to do so. In the case of the latter, it is surely sensible that they keep in touch with the latest developments in the world of pharmacology. I think we can trust the medical profession not to let a free lunch sway there opinion much and lets face it without the efforts of the pharma industry, there would be a lot more unhappy people around, including myself with cancer and my wife with arthritis and diabetes and my son with schizophrenia. So please lets have a bit less moralising in the BMJ and a bit more debate about some of the things we can do within the NHS, that might help doctors to do a better job. Dennis Preece ( Oxford ) Competing interests: None declared |
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John F Bolton, Clinical Fellow in Urology Bristol Royal Infirmary, Bristol, BS2 8HW
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Some respondents have placed great store by the fact that if no significant increase in sales were to result from contacts with medical sales personnel, then why would the drug companies sink so much money into this pursuit? This is believed to be "commercial" proof of the efficacy of medical sales reps. I think this argument is flawed. My view is that the drug companies, especially in fields where competition is fierce, are engaged in an "arms race". Continued promotion of a drug merely maintains its current market status. Failure to so market the drug would result in loss of sales. This is not the same as saying marketing results in an increase in sales. For example, developing further nuclear weapons by one of the world's superpowers will not increase their ability to destroy the Earth, as this ability is saturated. However, failure to compete is accompanied by a fear that their destruction may be slower than the competition's. In this arms race, we, the doctors, are not the "targets" - we are are the "defence industry". We can gain from the companies' internecine rivalry, while continuing the pursuit of our own agendae. Sure, in a perfect world, the drugs would be sold at cost, and the NHS could then pay for all our further education that we use to its end. In the meantime, the best way to prevent any one company having undue control over your activities is to allow equal access to all of them. Doing this, you will not only continue your education, but you'll also have a pen to write notes with. Competing interests: JB has, like many other doctors, received some pharmaceutically-derived "free" lunches and pens. JB's wife is also a medical sales rep. |
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John A Noviasky, Clinical Pharmacy Coordinator 13501
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I am happy to read the letters about this topic which has been acceptable behavior for many years but is now being readressed and dealt with in an open forum. I feel that we must set personal thresholds for interaction as to what we will accept and what we will decline. For example; I have spoken for industry and have accepted travel expenses, but no honorarium. For me, If I were to make money on an engagement, I believe that would open potential for influence(besides, my wife would spend it on something we don’t need anyway). On the other hand, I do eat the lunches provided remembering the following as best I can. I must be aware of any bias at the time of interaction (in this case, Chinese take-away) and then cognizant of any change in thinking or action taken as a result. Finally, if I do make a change, I make myself complete a thorough literature search and/or contact experts that I trust. It sounds tedious but I keep in mind those studies which show that practitioners that feel they are not influenced, often see influence in fellow practitoners. Competing interests: Have spoken for industry but not accepted honorarium |
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Gurli Bagnall, Independent Patients/ Rights Campaigner Mar;borough Sounds, 7372, New Zealand
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Professor Wessely makes it clear that the medical profession is for sale, that bribery is the norm and it’s time for its members to grow up and accept that fact. I suspect many of his colleagues would say, “Speak for yourself.” Using the same logic, one assumes it must also be acceptable for politicians to receive backhanders to supply arms to dictatorships; to grant lucrative contracts to firms that lack expertise; to smooth the way for the dumping of toxic waste in areas where living creatures will be adversely affected. There is no denying that these things happens, but should a democratic nation accept it? Has “ethics” become a dirty word? Within the medical profession, we just have to look at the iatrogenic statistics as far as they are known to see the flaw in Wessely’s argument. Nor can we forget the services of certain medical advisers to the insurance industry. Their “opinions” gave their masters the excuses they needed to reject legitimate claims and recently a US court order was issued to UNUM requiring that compensation be paid to their clients who had been cheated out of millions of dollars. If the opinion makers had been required to meet part of that compensation, would these conflicts of interest still be deemed to be the “latest non-problem”? If Wessely is so concerned that articles about these matters are eroding public trust then surely he should be more circumspect about making comments such as (quote) “….nowhere does it say that I cannot see patients—yet isn't ‘protecting patients’ the point of this ludicrous exercise?" Competing interests: None declared |
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