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Rapid Responses: Rapid Responses published:
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Healthy Skepticism should be careful in linking a demise of drug promotion to better health
- Alexander W Gray (29 October 2004)
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break the vicious cycle.
- manan vasenwala (31 October 2004)
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Reform of incentives would help reduce harm from drug promotion.
- Peter R Mansfield (31 October 2004)
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Virtuous and viscious all men must be, few in the extreme but all to a degree- Pope John Paul II .
- Dr. Chandrashekhar S. M. (31 October 2004)
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teachers are corrupt,why blame new doctors
- navin k. modi, shahad-421103 (1 November 2004)
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The pharmaceutical industry cannot be trusted
- Jeffrey Mann (1 November 2004)
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Drug promotion is unethical
- Abhishek Puri (2 November 2004)
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tinkering is not enough
- Bob Brecher (2 November 2004)
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Re: tinkering is not enough
- Dr. Herbert H. Nehrlich (3 November 2004)
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World Health Organisation should have its own drug company
- Anoop D Shah (3 November 2004)
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What practice guidelines are for ?
- Takeharu Koga (2 February 2005)
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Alexander W Gray, Medical Director Ideapharma Ltd, Innovation Centre, Cranfield Technology Park, Cranfield, MK43 0BT, UK
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In her article "Doctors and drug companies are locked in vicious circle", Melissa Sweet reports Dr Mansfield of Healthy Skepticism to say that "In an ideal world promotion of drugs would be banned. If this was not achievable, the more it was limited the better the results would be for health". Dr Mansfield most certainly needs to provide evidence that reducing drug promotion promotes health. In what way is the promotion of drugs within their licence in line with evidence of their clinical benefit deleterious to health? Does he seriously suggest that there is an inverse relationship between promotional spend and the health of a nation? Do countries with a high promotional spend (such as the US) have poorer health than those where the promotional spend is low? In making this unestablished link, he treats drugs like tobacco: The difference is that drugs improve, not harm, health. As with many observers of the industry, Dr Mansfield fails to make any distinction between the terms "promotion", "marketing" and "education" conducted by pharmaceutical companies. Just a few lines below his comments, a further news item in the BMJ reports that pharmaceutical companies "shoulder more than half the costs of formal continuing education programmes in medicine". There way be a prid pro quo for companies in providing medical education, but the result is extended access to agents that have passed through a licensing process because they have demonstrable benefits for human health. For example, the active promotion of ACE inhibitors has resulted in substantial reductions in morbidity and mortality amongst patients with cardiovascular disease. In what way then has the promotion of ACE inhibitors been deleterious to health? Without the promotion and educational activities of drug companies, we would still be overcoming the inertia of practitioners and payors to use drugs that have clear benefits to patients. Dr Mansfield seems unable to understand that the pharmaceutical industry, far from being a leach on society in the way that he presents it, funds the overwhelming bulk of medical research, and much of medical education. It has provided almost all of the drugs that many take daily, with clear benefits in quality of life, morbidity and mortality. Without the industry, both the quality and length of life of the population would not have improved by anywhere near the margin it has done over the last century. In what sense then does pharmaceutical promotion "harm health"? Such funding for R&D and education requires drug companies to profit from their drugs. The absence of profit would prevent these activities. I suspect that most who read this journal, myself included, would like nothing more than to see drugs created by philanthropy. But I would ask Dr Mansfield whether he could find organisations comfortable with spending billions every year on research, with a 1 in 10 chance of success for each compound. Most drugs in development are failures, not successes. Not even the most philanthropic would take such risks. Does Dr Mansfield deliver healthcare to patients for no return? The time has come to lift the lid on those who seem to have a better way to develop and promote drugs. They need to stop believing that philanthropy is a serious alternative to the current commercialisation of drug development. Communism in the development of pharmaceuticals, as in the management of society, is an unachievable fantasy. Better to work with the industry in areas such as clinical trials registries, and in providing guidelines for engagement between industry and healthcare professionals, where much remains to be done, than trying to promote an unachievable utopia of drug development. Competing interests: Alexander Gray works as a consultant to the pharmaceutical industry |
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manan vasenwala, consultant-cardiologist k.k.heart center, aligarh-202002.india
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one of the ways in which the vicious cycle can be broken is stressing evidence based medicine in the medical curriculum.in addition, the nhs should provide a copy of ebm booklet to every person employed in the nhs along with bnf, semi-annually or ebm class can be included in the bnf itself. the drug companies should be roped in to provide these finances. based on the data provided by the nhs in ebm book or bnf, the physicians thus would conduct the management of patients. treatment modalities should be grouped into class 1-3, class 3 being the least useful, where only a few random publications are present.also in every seminars and symposia and get-togethers, it should be mandatory for the drug companies organising the same to state the position of the product they are promoting in the ebm book. in this way, there will be a check on the drug companies from going into an advertising blitz. even in advertisement of drugs, companies should state in small print similar to " this is ebm- class 3" akin to tobacco warning "injurious to health". finally for practising physicians, the only sure way is to read certain standard texts before prescribing the new drugs. Competing interests: None declared |
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Peter R Mansfield, Director Healthy Skepticism Inc, 34 Methodist St, Willunga SA 5172, Australia, www.healthyskepticism.org
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I thank Melissa Sweet for her concise report and Alexander Grey for his important questions about Healthy Skepticism’s contribution to the UK House of Commons Health Committee inquiry into the influence of the pharmaceutical industry. We recommend reforms designed to: 1. Increase regulation of drug promotion 2. Improve medical decision making 3. Redesign the incentives for doctors 4. Redesign the incentives for drug companies Copies of our memorandum are available at our website: www.healthyskepticism.org <1> Melissa Sweet is correct to call our proposals “radical” in the sense that they address the roots of the problems so as to treat the causes of inappropriate drug use. However our proposals are not politically extreme and few of them are new. Most of the components are already well tested. Since our memorandum was written we have an economic revaluation of four proposals for reform of research funding has found that a proposal by US Representative Dennis Kucinich is the best or equal best on all criteria.<2> That is very similar to, and entirely consistent with, our proposals for funding research. However our proposals also cover all the other functions of the pharmaceutical industry. We don’t suggest changing the level of public funding for the pharmaceutical industry that already occurs in countries such as the UK but our proposals may justify increases. Our key proposal is for taxpayers’ money to be spent via separate publicly accountable open competitive tender systems for separate functions (research, manufacturing, promotion, education, etc). This would enable incentives to be aligned with good performance in those functions. It would also enable for-profit and non-profit organisations (eg Universities) or consortia including both to compete on merit for contracts that would provide more reliable, sustainable and higher returns on investment. To make our proposals politically achievable we have designed them to benefit not just the public but also health professionals and pharmaceutical industry staff. I don’t know if Alexander Grey deliberately used the straw man fallacy<3> or made an honest attempt to guess our position and got it completely wrong. I will respond to his challenges in order. Our 9 page memorandum includes the following introduction to the evidence about drug promotion: “All of the studies, that we are aware of, that measure the impact of exposure to and attitudes towards drug company information on the quality of medicines use support the same conclusion. The more doctors depend on drug company information, the more medically inappropriate and expensive their prescribing.<4-15> It is likely that drug promotion can be beneficial when the following
conditions are met:
However, those conditions are rarely met. The percentage of new drugs that have any medical advantage over older cheaper drugs has been assessed as only 23% during 1989-2000 in the USA and only 10.5% during 1980-2003 in France.<16,17> A major economic study of drug promotion in The Netherlands concluded that the 'average effect of [drug] marketing on price elasticities is unambiguously welfare-negative. This is because the effect we see is an effect after correcting for quality differences and this allows us to interpret the lower sensitivity to prices as brand loyalty not supported by product characteristics. This is socially undesirable.'<18> We conclude that drug promotion is an effective tool that can be used for good or ill. However, currently drug promotion does more harm than good.” The root cause of inappropriate drug promotion is inappropriate incentives. Unless the incentives can be redesigned we recommend that drug promotion be reduced to the extent achievable. Alexander Grey asked: “Do countries with a high promotional spend (such as the US) have poorer health than those where the promotional spend is low?” The answer is that the US spends more per capita on health than any other country but has lower healthy life expectancy at birth than Andorra, Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Iceland, Israel, Italy, Japan, Luxemburg, Malta, Monaco, Netherlands, New Zealand, Norway, San Marino, Slovenia, Spain, Sweden, Switzerland and the UK.<18> However, drug promotion is only one of the reasons why US healthy life expectancy (69.3 years) is so low and little better than Cuban healthy life expectancy (68.3 years).<19> Opposite to Alexander Grey’s assertion we advocate distinguishing between education (increasing knowledge and skills) vs promotion (persuasion and motivation aimed at behaviour change) by paying for them separately. Alexander Grey asked: In what way then has the promotion of ACE inhibitors been deleterious to health? The answer is that there has probably been direct harm because these drugs are probably less beneficial for hypertensives than chlorthalidone<20> but certainly major harm from opportunity costs because they are more expensive. Contrary to Alexander Grey’s assertion we have not presented the pharmaceutical industry as a leach but rather as a product of inappropriate incentives. We note that in countries such as the UK taxpayers fund research and medical education via high prices for drugs. Taxpayers would get better value for money by funding these functions separately as outlined above. Alexander Grey asked whether we could find organisations comfortable with spending billions every year on research, with a 1 in 10 chance of success for each compound. The answer is that this is what governments, insurance companies and individuals already do if they pay for or subsidize drug prices set higher than manufacturing costs so as to provide incentives for research. Our proposals for better value for money via improved accountability and targeting would increase their comfort as well as improving health. Alexander Grey asked: Does Dr Mansfield deliver healthcare to patients for no return? I receive payments per session as a general practitioner. My research work is funded by competitive grants so I am already practicing what we advocate. Alexander Grey falsely accuses us of communist fantasies. By contrast, competitive tendering is a well proven way to get value for money that transcends ideologies. Alexander Grey asserts that “not even the most philanthropic” would take the risk of investing in drug research. However, the development of penicillin by Florey et al at Oxford University was funded by philanthropically by the Rockefeller Foundation so philanthropy has been proven in the past. Philanthropy remains an important motivation for many people who organise or participate in research. Our proposals harness philanthropy better than the current system but do not rely on it. Instead our proposals are designed to provide better return on investment than is likely to be achieved in the future if the current system is not reformed. 1. Mansfield PR. Healthy Skepticism about drug promotion. Memorandum for the UK House of Commons Health Committee Inquiry: THE INFLUENCE OF THE PHARMACEUTICAL INDUSTRY Healthy Skepticism Inc 2004 www.healthyskepticism.org/advocacy/2004/UK_Inquiry.htm 2. Baker D. Financing Drug Research: What Are the Issues? Center for Economic and Policy Research (CEPR) 2004 www.cepr.net/publications/patents_what_are_the_issues.htm 3. www.fallacyfiles.org/strawman.html 4. Becker MH, Stolley PD, Lasagna L, McEvilla JD, Sloane LM. Differential education concerning therapeutics and resultant physician prescribing patterns. J Med Educ 1972;47:118-27. 5. Linn LS, Davis MS. Physicians’ orientation toward the legitimacy of drug use and their preferred source of new drug information. Soc Sci Med 1972;6:199-203. 6. Mapes R. Aspects of British general practitioners’ prescribing. Med Care 1977;15:371-81 7. Haayer F. Rational prescribing and sources of information. Soc Sci Med 1982;16:2017-23. 8. Ferry ME, Lamy PP, Becker LA. Physicians’ knowledge of prescribing for the elderly: a study of primary care physicians in Pennsylvania. J Am Geriatr Soc 1985; 33:616-21. 9. Bower AD, Burkett GL. Family physicians and generic drugs: a study of recognition, information sources, prescribing attitudes, and practices. J Fam Pract 1987;24:612-6. 10. Cormack MA, Howells E. Factors linked to the prescribing of benzodiazepines by general practice principals and trainees. Family Practice 1992;9:466-71. 11. Berings D, Blondeel L, Habraken H. The effect of industry- independent drug information on the prescribing of benzodiazepines in general practice. Eur J Clin Pharmacol 1994;46:501-505. 12. Caudill TS, Johnson MS, Rich EC, McKinney WP. Physicians, pharmaceutical sales representatives, and the cost of prescribing. Arch Fam Med 1996;5:201-6. 13. Mansfield PR, Lexchin J. Scepticism and beliefs about new drugs. Healthy Skepticism International News 2001;19:1/6 www.healthyskepticism.org/editions/2001/IN0106.htm 14. Caamano, F.; Figueiras, A., and Gestal-Otero, J. J. Influence of commercial information on prescription quantity in primary care. Eur J Public Health. 2002 Sep; 12(3):187-91. 15. Watkins, C. Harvey, I. Carthy, P. Moore, L. Robinson, E. Brawn, R. Attitudes and behaviour of general practitioners and their prescribing costs a national cross sectional survey. Qual Saf Health Care. 2003 Feb; 12(1)29-34. 16. National Institute for Health Care Management (NIHCM) (2002) Changing patterns of pharmaceutical innovation. www.nihcm.org/innovations.pdf 17. Industrial interests versus public health: the gap is growing. Prescrire International April 2004;13:70:71-76 18. de Laat E, Windmeijer F, Douven R. How does pharmaceutical marketing influence doctors’ prescribing behaviour? CPB Netherlands ’ Bureau for Economic Policy Analysis The Hague, March 2002 www.cpb.nl/nl/pub/bijzonder/38 19. Annex Table 4 Healthy life expectancy (HALE) in all WHO Member States, estimates for 2002. World Health Report WHO Geneva 2004. www.who.int/whr/2004/annex/topic/en/annex_4_en.pdf 20.ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002 Dec 18;288(23):2981-97. Competing interests: I am a General Practitioner, an Australian taxpayer, an occasional patient and Director of Healthy Skepticism. |
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Dr. Chandrashekhar S. M., Medical Director, Auron Healthcare P O BOx 9168, Dubai UAE
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Dr Gray's response to Melissa Sweet's article mirrors the current polarised world of doctor-industry relationship. Life is seldom in black and white.It is mostly shades of gray.Both their positions are perhaps extreme and the often ignored middle-ground appears to be the way forward. No body doubts that drugs improve health,but the manner in which the industry has moved away from addressing the real medical needs of the world,with its huge resources focussed more on marketing muscle flexing, creatng profitable diseases/therapies than towards discovering really innovative drugs is not in the interest of both humanity and industry. The industry really needs to introspect and implement course correction.There is enough data in public domain to show that business factor rather than medical need dictates choice of R&D venue & spending. Emergence of orphan drugs, neglected diseases are examples of patients losing out to stakeholders. "The absence of profits would prevent these (R&D and education)activities" right. But the quest for incremental profits through "me-too" drugs, analogs, next-in-class drugs would in the long run discourage discovery of new receptors, enzymes, ion-channels and other "targets". I agree fully with Dr Gray that philanthrophy is not a serious alternative to commercialised drug development. At the same time the industry has to prove to the society that its raison d'etre is not profits but the discovery of really effective and safe medicines for diseases that matter.The current groundswell of negative public opinion on both sides of the Atlantic clearly suggests that the industry needs to re-align its priorities. Doctors are really at the heart of this matter: they can engage the industry to develop the drugs that really make a difference to patients.No industry can corrupt the doctor who does not want to be corrupted. In the final analysis "virtuous and viscious all men must be; few in the extreme but all to a degree".The industry should make decent profits in return for its efforts in R&D.It is all a matter of degree. Competing interests: I am medical director of pharmaceutical company. |
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navin k. modi, private practicing dermatologist maharashtra ,india, shahad-421103
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sir, its very heartening that some doctors are really bothered about the issue. i do not know about other countries but here in India i find it highly unfortunate scene as far as doctor -pharma nexus is concerned . you can get anything prescribed from doctors no less than head of departments of various medical colleges for petty incentives. when teachers are irrational and corrupt , why blame new doctors? the funny part is that the same corrupt doctors only are office bearers of all big medical associations and they only conduct all clinical trials ! I donot see any ray of hope in our country at the moment. your,s dr, navin modi Competing interests: None declared |
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Jeffrey Mann, Retired physician Salt Lake City, UT 84103
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Alexander Gray stated in his rapid response letter [1] that "Dr Mansfield most certainly needs to provide evidence that reducing drug promotion promotes health. In what way is the promotion of drugs within their licence in line with evidence of their clinical benefit deleterious to health? Does he seriously suggest that there is an inverse relationship between promotional spend and the health of a nation? Do countries with a high promotional spend (such as the US) have poorer health than those where the promotional spend is low? In making this unestablished link, he treats drugs like tobacco: The difference is that drugs improve, not harm, health." First of all, Alexander Gray implies that drug companies only promote drugs in line with evidence of their clinical benefit. I think that the "real world" evidence supports a different conclusion. I think that drug companies promote their drugs only to increase their market share, and that they frequently overstep the boundary of EBM-supported evidence. By doing so, they act like tobacco companies (and harm society), because increased expenditure on expensive trade-name drugs diminishes the amount of money that can be more fruitfully spent on more clinically useful health care services. A good example of that phenomenon is the promotion of Vioxx (rofecoxib), instead of cheap generic NSIADs, for the treatment of common inflammatory conditions. Billions of dollars were used to promote that drug (which directly increases the drug's costs because all marketing expenditures are added to the drug's cost), and billions of drugs were spent by drug consumers to purchase that drug, even though there is no EBM evidence that rofecoxib is better than standard NSIADs like ibuprofen and naproxen. In fact, the harm:benefit ratio actually disfavors the use of rofecoxib (which is associated with an increased risk of adverse of cardiac events). By wasting billions of dollars on a trade- name drug that didn't offer a better risk:benefit ratio than a similar generic drug, the health of the nation is being harmed by the wasting of "potential" health care dollars that could be better used to fund more clinically useful health care services. The same phenomenon applies to the promotion of Nexium, as an alternative to an off-patent form of a similar proton pump inhibitor drug. Nexium is not superior to similar over-the- counter proton pump inhibitors, and any expenditure on Nexium likewise harms society by unnecessarily wasting "potential" health care dollars. There is also substantial evidence to support the belief that small drug companies are developing the few innovative drugs that are presently being introduced into society's drug armamentarium, and that the major pharmaceutical companies are mainly spending their money producing "me too" drugs that are no better than off-label generic drugs. Alexander Gray states "Dr Mansfield seems unable to understand that the pharmaceutical industry, far from being a leach on society in the way that he presents it, funds the overwhelming bulk of medical research, and much of medical education. It has provided almost all of the drugs that many take daily, with clear benefits in quality of life, morbidity and mortality. Without the industry, both the quality and length of life of the population would not have improved by anywhere near the margin it has done over the last century. In what sense then does pharmaceutical promotion "harm health"?" It is true that the pharmaceutical industry has produced the overhwelming bulk of medical research pertaining to the drugs that many take daily. However, I disagree that it has done so in a cost-effective manner. Most of the medical research dollars have been spent on developing "me too" drugs that do not significantly advance the health of the world's citizens. As Peter Mansfield has pointed out in his memorandum [2]-- "Rather than aiming at greatest medical need, current systems for paying drug companies reward research and development of “me too drugs” for chronic conditions of people who have the greatest capacity to pay." By doing so, pharmaceutical companies are acting like a leach on society. They are draining society of health care dollars that could be spent on developing innovative drugs that treat serious diseases like malaria, instead of being spent on more "me too" drugs that treat non-urgent conditions like erectile dysfunction. I think that the appropriate response to this scandalous situation should be multi-pronged. I think that society should fund health care research mainly via government- sponsored (tax-payer funded) clinical research, and that all clinical research should be performed by independent clinical research units that are "sequestered". Private pharmaceutical companies that develop innovative drugs in their research laboratories, should be obliged to pay a user-fee to have those drugs clinically tested by those independent "sequestered" clinical research units. It is only by instituting an "independent" clinical research system, which totally separates independent clinical researchers from private pharmaceutical companies (who fund the clinical research by paying user-fees), that society can be relatively certain that its research dollars are being fruitfully spent. I think that Peter Mansfield's so-called "radical" suggestions are far too tepidly radical [2], and I do not think that they will not solve this serious problem. Alexander Gray states that the pharmaceutical industry is responsible for much of society's medical education. I don't know to what degree this statement can be conceived to be true, but I think that society should ensure that pharmaceutical companies have no connection with medical education, whatsover. Individual physicians, and professional physician organisations, should totally refuse to have any medical education financed in anyway by pharmaceutical companies. Medical education should only be provided by independent medical schools, independent professional medical organisations and independent medical educational entities. I think that medical schools and professional medical organisations have done a poor job of providing community clinicians with systematic reviews of scientifically valid EBM evidence in such a manner that community clinicians are educationally well informed. It is a travesty that most community clinicians mainly acquire their limited knowledge of recent EBM evidence from drug company representatives, drug company sponsored socio- educational meetings, and drug company sponsored non-peer reviewed, "throw -away" medical journals. The major blame for this travesty lies with the medical profession (individually and collectively) -- it should ensure that clinicians are educated by people who have no 'conflict of interest' connection with the pharmaceutical industry. A "no free lunch" attitude must become the prevailing attitude! Jeff Mann. References: 1. Gray, A. Healthy Skepticism should be careful in linking a demise of drug promotion to better health. BMJ rapid response letter. October 2004. 2. Mansfield PR. Healthy Skepticism about drug promotion. Memorandum for the UK House of Commons Health Committee Inquiry: THE INFLUENCE OF THE PHARMACEUTICAL INDUSTRY Healthy Skepticism Inc 2004 www.healthyskepticism.org/advocacy/2004/UK_Inquiry.htm Competing interests: None declared |
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Abhishek Puri, Dr. Patiala-147001, Punjab, India
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This article raises the typical debate between haves and havenots. As the title suggests,it has been conclusively proved that drug promotion affects prescription of Physicians.Inducements have a long term role to play in the same. In developing countries,public spending on health is either static or declining.Herein much of the void is filled in by private practitioners who remain an ideal target for drug companys' representatives. In the past 15+ years much of the research has veeered off to designer drugs i.e.for obesity or hypertension.The drug industry is silent on the new therapies for Malalria or re-emerging infections which account for nearly 10% of the global disease burden.Where is the "increased spending on research" Mr.Gray?Could you provide facts and figures?How can you account for increased stock holding of the drug company promoters? Drug companies spend more on advertising than the consumer good companies.Obviously increased advertising,by any means,means more sales and hence more profits.This is because of the inherent price differential of the marketed drugs from the actual costs of production.Who pays in the end?The consumer. I wish there were better regulation of the promotion.Specially in those countries where there is not much to differentiate the generics.Pharmaceutical companies have a lot to say for instead of getting in the denial mode as the previous response seems to suggest. Competing interests: None declared |
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Bob Brecher, Reader in Moral Philosophy School of Historical & Critical Studies, University of Brighton Brighton BN2 1RA
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The article highlights a fundamental problem about the role of the pharmaceuticals and what might be termed the collaboration of the medical profession with that role. Unhappily, however, piecemeal changes are neither realistic nor adequate. Until and unless the production, supply and development of drugs is taken out of the hands of private interest and profit -- that is to say, decommodified -- the problem will remain. Regulation, even if well-intentioned rather than merely cosmetic, will always be circumvented, and by both parties. In short, the issue, like so many in contemporary medicine, is inescapably a political one. Properly to resolve it rather than merely to tinker with the details of exploitation, would require a shift in political thinking that is scarcely conceivable. Nonetheless, the argument needs to be made, however unrealistic it may seem in the context of the actually existing political order -- otherwise even the ideal will be lost to future generations. Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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I thank Bob Brecher for his comments, they are spot on. The disgraceful collaboration between Establishment Medicine and Big Pharma must stop. If this has to be done by heavy handed methods like draconican legislation so be it. It seems to be a human thing to be always in the mood to embrace corruption as we can clearly see in the alternative health 'industry' where many products are pushed that have questionable efficacy but sport obscenely high prices. Many doctors see nothing wrong with being wined and dined by Pharma Reps in exchange for practicing their particular brand of evidence based medicine.And, I might add that a large percentage of practicing physicians have lost touch with who they are and how ridiculous the concept of omnipotence actually is. Some of them practice under false pretenses, most of them enjoy the full support of Big Pharma and few of them remember what they went into their profession for. I like the Chinese concept of paying the doctor out of each person's pocket to keep them well and have the payment stop if the patient gets sick. While I am not radical enough to support the idea that all business is -by its very nature- corrupt it must be obvious to all that the bedcovers need to be yanked off the medical-pharmaceutical love affair, COMPLETELY, to expose all sleazy activities and punish the players by public ridicule and appropriate chastity measures. In this day and age, the priorities of many have fallen out of order and our current dilemma will not be solved until the prospect of unlimited amounts of those proverbial pieces of silver is taken out of what really ought to be called Profit-Base-Health Care. Competing interests: None declared |
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Anoop D Shah, Medical student University College London, London, WC1E 6BT, United Kingdom
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The main problem is that new drugs are developed by private companies but most of their income consists of public money (e.g. via the National Health Service in the United Kingdom). Thus public money is being given to private companies to use as they wish, and some of it is used to research and market unneccessary new drugs. Drug companies are trying to make a profit and are naturally expected to make decisions which are best for themselves, and they are competing against similar companies which do likewise. I think that research for new drugs would be best carried out by an organisation which is not required to make a profit, and can set its research priorities for the greatest overall benefit for mankind. One way might be to significantly increase funding for the World Health Organisation so that it can run its own drug company, which would be financed partly from the grant and partly from drug sales and licence fees. Competing interests: Former employee of Medicines and Healthcare products Regulatory Agency, UK |
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Takeharu Koga, Attending physician Kurume University School of Medicine, Department of Internal Medicine, Kurume, 830-0011 Japan
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I'd like to point out that some of the practice guidelines, which are growing rapidly in number, can be very powerful advertising tool and boost sales of pharmaceutical companies. The companies are deeply involved in the whole process of making the guidelines; they pay for the meetings, committees, participants, and authors of the guidelines. They also play an active role in spreading the guidelines. All of these efforts can be paid back if their products are 'officially' recommended in the guidelines. Dominant drug companies are conducting large clinical studies to label their product as 'highly recommened' in the guidelines. These trends have potential harm to deviate medical practice and can result in a great profit to the pharmaceutical companies at the expense of patients. Competing interests: None declared |
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