No more free lunches: The market has us all in its grip

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7410.342 (Published 07 August 2003) Cite this as: BMJ 2003;327:342
  1. K S Madhavan, senior registrar (ksmadhavanuk{at}yahoo.co.uk)
  1. Radiation Oncology Department, St Luke's Hospital, Dublin 6, Republic of Ireland

    EDITOR—The relationship between the pharmaceutical industry and the medical profession is natural and can be constructive and cooperative, as well as dishonourable and damaging.1

    Any debate on the influence of marketing on decision making and health outcome is considered to be too doctrinaire to be worth while. The subdued response to the theme issue from hospital practitioners is testimony to their belief that it is futile. The market has us all in its grip.

    Decisions in cancer care, for example, are largely grounded in evidence when it exists. Despite the army of representatives preaching their company gospels, the existence of guidelines, protocols, and consensus statements make it difficult to influence the influential. However, the press often carries stories of another cure for cancer, and the health service is frequently accused of not providing a life saving drug. The industry thrives on this publicity.

    Promotion of new chemotherapies is often out of proportion to their real benefit. Surrogates of outcome such as response rates may be quoted to help create a niche for a drug. Radiotherapy is regarded as just another tool. Compared with other European countries and North America, where high quality radiation research and technology based studies are encouraged, few departments in the United Kingdom are able to retain a commitment to this discipline. This is partly because of a lack of backing from an ambitious industry and the marketing that goes with it. Achievements in radiotherapy, equivalent and often more clinically significant, hardly receive the fuss and attention that attends a drug.2

    Disentanglement is crucial in the United Kingdom. Hospitals could start by creating blind trust funds for education, the trusts rather than the donors setting the agenda for education.

    We are easily reassured by our own and our colleagues' integrity, but competition demands that adherence to local and national codes such as those of the Association of the British Pharmaceutical Industry (ABPI) be monitored. Politicians are readily challenged on issues of conflict of interest. The existing environment makes the medical profession's position duplicitious and untenable.


    • Competing interests KSM has had free lunches.


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