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No more free lunches

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7400.1155 (Published 29 May 2003) Cite this as: BMJ 2003;326:1155

Rapid Response:

Who pays for lunch is not important when you are out with your real friends

Doctors and drug companies are naturally and necessarily closely
linked. We share many common goals and objectives (but also some that are
different). Furthermore, a large proportion of the staff of drug companies
are the very same doctors and research scientists that we trained with.
Most importantly neither Doctors nor drug companies can exist without the
other and it is therefore essential that we have a close collaboration and
understanding. This close collaboration has been essential for the
progress of medicine and by definition has thus been to the immense
benefit of patients. As your article points out all significant advances
in drugs (and technology)over the past 60 years have been developed by
drug companies. Without these advances medicine would be virtually
powerless, (and largely pointless).

Naturally, any organisation which operates within a free market must
also be concerned with its own survival and profitability. However, this
is not fundamentally
"evil",indeed we are extolled the virtues of the free market on a daily
basis. If only the health service operated in a free market it would be
much more efficient and effective we are told. Well you can't have it both
ways if the free market is good for the goose....

Corporate hospitality is not something invented by the drugs
industry, it exists wherever the free market exists and yet the rest of
the free world seems to survive the pernicious influence of these
seductive temptresses. The reason is because the hospitality is also part
of the free market and is by definition freely available. We are not
trapped like moths in the bright glare of this hospitality because there
is equally as much hospitality available from the next company and the
next. Indeed when hospitality is so freely available why would anyone want
to restrict their options to one particular provider? Thus there is no
logic behind the "corruption" concept. However, what the drugs industry
has done is to imaginitevely use this hospitality in an immensely
constructive and helpful way, a way that benefits doctors and patients
(indeed it would not be too much to say mankind). I know of no other
agency that would have been prepared to fund the enormous progress of the
past 60 years, and take on the additional responsibilty of educating the
health providers. Certainly we have repeatedly been shown that
governments are not prepared to do it (most are pretty ruluctant to even
fund the delivery of health care - the fruits of this research!). Whilst
charities simply do not have enough funds to take over the whole
responsibility of research and development. I am not suggesting that
these companies do this out of a spirit of generosity, but it is the very
fact that they have a vested interest that makes them willing to take it
on.

Those bodies that undertake research have a necessary duty to
disseminate the results of that research, who else could do it?
Inventions can only be explained by those that understand them. However,
it is equally true that the enthusiastic but partial originator may not be
able (or willing) to see the flaws. It is the duty of the educated
audience to sift and digest the information, sometimes to accept,
sometimes to reject and sometimes to refine. It matters not who funds
this process it only matters that it happens at all and the audience
maintains its impartiality. The competitive free market ensures that even
if some individuals are tempted to lose sight of their impartiality they
will always be counterbalanced by someone else with a different axe to
grind, the free market ensures that we are flooded with different view
points and fosters healthy debate and cotroversy. I believe that it would
actually be detrimental if the task of educating health providers was put
solely into the hands of a single agency, who would control the way
opinion was driven then?

The ideal system might be one where generous philanthropists fund all
research, but shall we come back down to the real world. The ideal
practical solution is one where drug companies fund research (yes, because
they have a vested interest and therefore a motivation) but the possible
excesses of the drug companies are kept in check by collaboration with
independent doctors, hospitals and departments - and surprise surprise
that is what we have. This is because everything in the world develops by
evolution and evolution as we know may not produce the best result, but it
produces the result that works and is suited to that particular
environment. It would not be unreasonable to ask for increased monitoring
of the health of this symbiotic system but to prevent it would be to
strangle the lifeblood of research and indeed education itself.

Competing interests:  
None declared

Competing interests: No competing interests

03 June 2003
michael a james
consultant cardiologist
taunton & somerset nhs trust, musgrove park, taunton, somerset, ta1 5da