No more free lunches

Of course I am influenced by reps. The industry would not employ them
otherwise.
Are doctors different from other people? Why should we miss out in, a
capitalist-individualist society on the perks that other professionals
get? If a stockbroker gets a "free " lunch why not a doctor?

Doe it matter which SSRI I prescribe ? I very much doubt it.Given the
way companies use the licensing system (depression with panic, without
panic with anxiety without OCD etc)I am not convinced that one is better
than the others so Ill use the one that gives the best dinner.

Medicine may be moving from a Hippocratic profession( I never took
the oath by the way) to a technical activity.
Freebies are part of that

Competing interests:  
Been to drug comopany meetings and lunches
SHares held in industry

From a haematologist's perspective, I can't deny that development of
new medications has revolutionised cancer therapy, and benefited many
patients. It would be foolish to demonise drug companies out of hand. What
is fascinating , however, is the way in which highly educated medical
professionals have fallen so heavily for the company-provided trinkets,
trips and entertainment. It would seem that something is lacking in our
professional lives - perhaps the often onerous nature of work, together
with remuneration well below that of our business counterparts, ongoing
anxieties with medical negligance litigation, and the decline in the
esteem in which doctors are held in the community. Drug companies are able
to make doctors feel special and well looked after, which is something
Area Health Services, HMOs NHS etc do not.It is not our interests to have
insight into the relationship, which is essentially a business one. We
should realise that we are vulnerable and should recognise that dinners
etc are provided, not because we are lovely hardworking people (although
that may be true) but on a strictly "cash for comment" basis

Competing interests:  
Addicted to post-its

This issue of the BMj has obviuosly raised a lot of interest amongst
the medical profession.

I must confess, I have used drug company money to organise several
educational meetings.I have always tried my best to keep the
meetings/conferences unbiased and free from the influence of the industry.

On the other hand I have attended several meetings which have been
purely promotional .Iam not afraid to use my common sense and my training
to be able to differentiate the evidence .

Unless we can listen to what the drug companies have to say to us how
can we make our choices .I feel it is important we listen to all views and
sometimes if there is a lunch thrown in ,its our choice whether we take it
or not.

Competing interests:  
None declared

What a sad and dispiriting issue of the BMJ this week (May 31st
2003). Acres of newsprint, numerous articles in various shapes and forms,
and to tell us what? Pharmaceutical companies manufacture drugs, and,
amazingly enough, also promote them. And who do they promote them to – the
people who prescribe their products – namely doctors. Astonishing. And
sometimes doctors, who represent humanity in all its shapes and forms,
succumb to these blandishments. What a surprise.

So it seems that the pharmaceutical industry systematically promote
and protect their interests. Given their scale, and contribution to the
national economy (which probably does more good to health, incidentally,
than the products they promote) this is hardly surprising, but is it
unique?

I have in my career to date received 53 research grants. My Dean
hopes that I will receive many more. These have come from 20 sources,
mainly research councils, government departments and medical charities,
with only one from a pharmaceutical company – grant number 12 out of 53. I
have, however, like all academics, had dealings with industry at many
levels over the years, just as I have had dealing with people who support
research from a variety of different institutions and constituencies. And
all of them have agendas and special interests. Few can be said to be
funding research purely out of a disinterested pursuit of the truth,
science for science’s sake. Those who spend our money – be it raised by
taxation or from charitable donations, are as aware of their
constituencies as any one else. Indeed, many have rather more powerful
agendas than even pharmaceutical companies – some subtle, some not subtle
at all.

And I have succumbed to these pressures myself? But of course. Grow
up. When one approaches a funding body, even the saintly MRC or Wellcome,
let alone the single issue charities or government, one knows what is
flavour of the month, the current political concern, the bee in the bonnet
of the Chief Executive, the particular piece of political correctness
needed to achieve success this year, and the roads down which one should
not travel. As every academic who has ever had a grant rejected (and is
there another other academic?) will tell you, good science is the ticket
of entry, but doesn’t guarantee the prize.

And what about the blandishments from industry? Have they perverted
my clinical practice over the years? A meticulous search of the wreck that
is my desk reveals nine pens, including, miraculously, a Parker pen long
thought lost, two of which have clear company logos on them. As an
academic I travel a lot – I attend academic meetings, usually overseas, at
least once a month (personal communication from my wife, made between
gritted teeth). I think that means over 200. I am certain than on at least
four occasions I have been sponsored by industry – Pfizer, Lilley and two
others that I can’t remember, since you ask - possibly slightly more. I am
not sure. I can remember the cities (Copenhagen twice, Vienna once and
somewhere else), but not always the company. Has that made be into a drug
company lackey, slavisly promoting their products? Who can say, but I
doubt it.

It is time we all grew up. Everyone has conflicts. Everyone has
agendas. Everything affects patient care. Our own personal prejudices,
likes and dislikes, the time pressure we are under, the number of patients
left to see, family and cultural backgrounds, the influence of our
teachers for good or ill, how tired or jaded we are, the volume of
paperwork we still have to complete, fear of litigation, the list is
endless – there is very little in our lives that does not affect how we
manage patients. A few pens, a sponsored sandwich lunch for our weekly
research meeting, and even a trip to another forgetable conference,
probably are rather low in the list of things that affect our decision
making.

And what is the proposed solution for this latest non problem? If
USCF is to get its way, and we are to believe Ray Moynihan, it is an
almost unbelievable Orwellian world of supervision, prohibitions and
restrictions. I have declared above that I have received one grant out of
53 from industry. According to the proposals this means that I am to be
banned from having anything to do with medical education – “planning,
manager, teacher or author”, even if I willingly declare my tainted past.
Well, at least I will have more time to do my research. But will I?
Apparently not. I can’t quite grasp what the “rebuttable presumption”
mentioned in the article, but the sub clause that “researchers with
conflicts of interest cannot do research using human subjects” seems to
imply that even that is denied me. Even if I escape that, my professional
organisation is being urged to “probibit researchers with conflict of
interests conducting research”. So that’s out then. Teaching, research,
all gone. Oddily enough, nowhere does it say that I can’t see patients –
yet isn’t “protecting patients” from wrong doers like myself the point of
the entire ludicrous exercise?

That is sinister enough, indeed, so much so one wonders fleetingly if
this is meant as a reductio ad absurbam argument intended to self
destruct. But there is another unwelcome sub text to the theme of the
entire issue. It is easy to point out the agendas of industry. Indeed,
anyone who did not realise this is, in my opinion, too naïve to practice
medicine seriously. And one can point out similar agendas, hidden or not,
conscious or unconcious, in most of the insitutions that we come into
contact professionally – Royal Colleges, medical journalists, the BMA,
government, quangos, even, God forbid, medical journals. Sensible
reasonable people know this, and act and interpret accordingly. But what
is the result of this constant stream of articles that bring to our
attention what we already knew? It is a gradual erosion of something far
more important – that of trust. Eventually we will trust no one and
nothing. We will take nothing at face value, and see conspiracy and plot
behind every official or institutional action, prisoners of our own
paranoia. As Oonora O Neil demonstrated in last year’s seminal Reith
lectures, it is this erosion of trust in our institutions, public and
private, that may ultimately be more corrosive to the public good and well
being than a few more company pens.

Professor Simon Wessely
Conflicts of Interest scattered throughout the text.

Competing interests:  
scattered throughout the text