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Rapid Responses: Rapid Responses published:
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The illusion of invulnerablity
- Peter R Mansfield (6 May 2007)
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Should patient groups accept money from drug companies? Yes
- Walter Vermeylen (9 May 2007)
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Between a Rock and a Hard Place: Patient groups & drug companies
- Sally Crossing Crossing (21 May 2007)
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Peter R Mansfield, Director, Healthy Skepticism Inc 34 Methodist St, Willunga SA 5172 Australia
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Alastair Kent claims that “Patient groups are not naďve. They value their independence fiercely and are quite capable of spotting the strings that may be attached to funding.” Many doctors have similar overconfident beliefs about invulnerability to being misled by drug companies.<1> This illusion of invulnerability actually increases vulnerability.<2> Drug companies sponsor patients’ groups as a way of promoting drugs to fulfil their legal requirement to maximize profits.<3> Drug companies can not influence all of the people all of the time but if their investments in any type of drug promotion do not achieve competitive returns on average they are ceased.<4> I don’t know of any examples of drug companies funding patient groups except for a limited time only when a relevant patent protected drug is being promoted. In the 1840s doctors did not understand the risk of invisible microbes so were offended by the suggestion they should wash their hands. We are now going through a similar paradigm shift towards understanding the risk of invisible unintended bias from exposure to industry influence techniques. These techniques include manipulation of reciprocal obligation which can occur without our awareness.<5> Patient groups tend to reciprocate by lobbying governments to pay for overpriced drugs rather than lobbying the companies to reduce their prices.<6,7> Funding for patient groups could be increased and the alleged problems with government funding reduced by abolishing patents to allow price competition and using the savings to fund research, education, health promotion and other activities of patients groups via competitive grants.<8> 1. Mansfield PR, Lexchin J, Wen LS, Grandori L, McCoy CP, Hoffman JR, Ramos J, Jureidini JN. Educating Health Professionals about Drug and Device Promotion: Advocates' Recommendations. PLoS Med 2006:3(11): e451 http://medicine.plosjournals.org/perlserv/?request=get- document&doi=10.1371%2Fjournal.pmed.0030451 2. Sagarin BJ, Cialdini RB, Rice WE, Serna SB. Dispelling the illusion of invulnerability: the motivations and mechanisms of resistance to persuasion. J Pers Soc Psychol 2002 Sep;83(3):526-41 3. Harnessing Patient Power: Strategies for speeding drug approval, building and retaining market share. Business Insights. 2004 Jan www.piribo.com/publications/regulation_policy/harnessing_patient_power.html 4. Garai PR. Advertising and Promotion of Drugs. In: Talalay P, Editor. Drugs in Our Society. Baltimore: John Hopkins Press; 1964. www.healthyskepticism.org/publications/editions/2003/10.php 5. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003 Jul 9;290(2):252-5 6. Burton B. Drug companies told that sponsoring patients' groups might help win approval for their products. BMJ 2005 Dec 10;331(7529):1359 7. Ferner RE, McDowell SE. How NICE may be outflanked. BMJ 2006 May 27;332(7552):1268-71 8. Mansfield P. Industry-Sponsored Research: A More Comprehensive Alternative. PLoS Med 2006;3(10): e463 http://medicine.plosjournals.org/perlserv/?request=get- document&doi=10.1371/journal.pmed.0030463 Competing interests: Healthy Skepticism is funded by individual subscriptions and occasional small contracts. In the past 5 years we have provided services for many organisations including universities, Consumers International, Der Arzneimittelbrief (Germany), Drugs and Therapeutics Information Service (Australia), Health Action International, National Prescribing Service (Australia) and the Royal Australasian College of Physicians. |
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Walter Vermeylen, Employer B-3000 Leuven
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In Belgium all patient groups concerned with rheumatic diseases have started a platform saying "Together we are strong". We strongly work together with professional rheumatologists, but also with pharmaceutical companies.
This is no problem at all, even financially. From the beginning they have to make a strong commitment: we decide what will be done with the money, but we strongly cooperate. Now we work with a lot of respect, patient companies for the pharmaceutical companies, pharmaceutical companies for patient groups, professional healthcare for patient companies etc...
We strongly believe in our statement: "Together we are strong". But it has to be positive for every group, and then, no doubt about it, it works perfectly. Walter Vermeylen
Competing interests: None declared |
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Sally Crossing Crossing, Chair, Cancer Voices NSW Cancer Voices NSW 2065 (Australia)
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SIR Patient groups and drug companies – between a rock and a hard place. As an independent patient group, we read with interest the YES and NO cases for accepting money from drug companies. We value our independence, as the voice of people with a specific disease, as this is what makes us fully credible when talking to decision- makers. This is an important debate and one most health consumer groups must consider when deciding their policies about sources of funding. Transparency is fine and very important. However, it doesn’t remove the real or perceived association with a funding provider, whether industry or government – and both, as pointed out, bring their challenges. Neither does it remove the normal social response not to upset those who help you. In Australia we have been told pointedly that the Pharmaceutical Benefits Advisory Council (the body which decides which drugs get government subsidy) will not engage seriously with any consumer group which accepts industry dollars. The PBAC would argue that we could be conflicted when pursuing subsidy for drugs if we were in receipt of funding from the drug industry. We are also aware that public sector funding can be even more controlling, if less tainting. Some Australian health consumer groups have managed to attract funding from sectors not related to their area of interest. But this is only effective if the group has Deductible Gift Recipient status with the Australian Tax Office – which allows the donation to be tax deductible. And if the cause is a publicly appealing one. The rub here is that few such groups, especially if they engage in advocacy to help their members, are entitled to this status. What to do? A group which I chair, Cancer Voices NSW, operates solely in the interests of people affected by cancer, and is guided totally by its member’s needs, concerns and ideas. We work on a shoe string, using committed volunteers and get some funding and pro bono assistance from our better-off members and cancer organisations. This means we must be very focussed in use of scarce resources – maybe a good discipline? A number of groups do indeed find themselves between a rock and a hard place when needing money. But we do not see “purity” as a “cop out” as opined by Alistair Kent (5 May BMJ), but as a pragmatic, realistic way to make sure those you wish to influence will listen to you. If someone has a better solution to the problem, let’s hear it! SALLY CROSSING AM
Competing interests: None declared |
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