No more free lunches: Doctors and journals in the South cut off drug companies at their peril

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7410.341-b (Published 07 August 2003) Cite this as: BMJ 2003;327:341
  1. Joseph Ana, managing editor (info{at}bmjwa.com)
  1. BMJ West Africa, Luton LU2 7AE

    EDITOR—Abbasi and Smith raise major ethical issues in their editorial.1 However, the widening gap between the North and the South globally is most glaring in healthcare delivery, training, and information dissemination.

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    In already rich countries drug companies compete to spend money on doctors and other prescribers, whereas in Africa and most of Asia, doctors sweat in their attempts to get drug companies' help. In the South, where resources are meagre and inconsistent, doctors who heed Abbasi and Smith's advice do so at their peril because they may not be able to conduct research or publish papers. Poverty stricken doctors, although aware of the ethical conundrum of the handouts from drug companies, find that they cannot break the link with drug companies because to do so may mean no patient care.

    The link can be broken if governments and global monetary institutions will support doctors' research, publications, and training. Locally published journals do not survive without drug companysupport because the subscription base is lamentable.

    Probably doctors prescribe more after visits from drug representatives, but I doubt that this applies to the majority. Doctors are guided by their knowledge about the efficacy, side effects, tolerability, and cost of the drugs they prescribe. Doctors know that patient compliance would disappear if patients thought that doctors prescribe in response to freebies.

    In West Africa there is no luxury of drug company overindulgence. We welcome suggestions on how to make drug companies reach patients through doctors and support local health programmes and publications.


    • Competing interest BMJ West Africa, like most journals, seeks advertisements from drug companies with mixed results.


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