Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1: Entanglement
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7400.1189 (Published 29 May 2003) Cite this as: BMJ 2003;326:1189
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In Australia, >70% of General Practitioners use a software package
for
health record keeping that is sponsored by the pharmaceutical industry.
Whenever a prescription is printed, a banner ad occupies the screen for
several seconds. Some advertisements appear context sensitive to the
current prescription and patient.
If we assume that the conclusion of this issue's BMJ hot topic is
correct
- namely that prescription habits are largely influenced by advertising as
opposed to peer reviewed published evidence, then we have a situation
where marginal cost savings to the GP in the form of sponsored
software may create a more considerable cost increase to the public
health system through induction of irrational prescribing habits. Small
savings costing the nation dearly.
Competing interests:
None declared
Competing interests: No competing interests
Do the articles in this weeks BMJ condeming the unethical doctor-drug
company relationship, have bearing on drug companies advertising in
medical journals? The portrayal of running athletes next to a drug treating
arthritis or a happy smiling person next to an antidepressant in a
prestigious medical journal may lead to tendencies of some doctors to
prescribe drugs which are not indicated.
Maybe medical journals should examine whether it is ethical to allow drug
companies to use their reputation to enhance their profit margin at the
patients expense?
Competing interests:
None declared
Competing interests: No competing interests
When I was a first year medical student we were given a stethoscope, doctor's bag, reflex hammer and some books and other things. I don't even remember who sponsored the items. Many of my classmates refused the gifts as they said they could not be bought. They would be unable to prescribe for another four years; how could they be bought?
If we are that easily influenced perhaps we do not deserve the trust our patients and the public give us. We all agree that the underlying reason for free lunches, dinners, and other pharmaceutical benefits, including funding of CME and journals, is promotion. I have always made it clear to representatives of pharmaceutical companies that I make the decision based on information from many sources. I have no hesitation to contradict what reps tell me or to demand valid information. I have received information from the medical departments of pharmaceutical companies and disputed the data in discussions with reps.
On the rare occasion when a rep asks me specifically to prescribe the medication being promoted, I tell them I will do so only as appropriate. I have never been told I would receive anything only if I prescribe some product. If I did, that rep would be forbidden to return and I would file a formal complaint with his or her employer.
When I have spoken for pharmaceutical companies, I make it clear the opinions are mine alone. I discuss competing products' benefits including generic products.
Each of us is faced with a multitude of ethical dilemmas daily. We are expected to do what is best for our patients regularly. We give up personal time for them every day. We accept payment, some of us accept huge payments, for our services daily. When an interventional cardiologist recommends angioplasty rather than medical treatment, is it because he or she will be paid much more for the procedure or because it is in the patient's best interest? We choose whether to see patients more or less frequently when paid fee for service knowing full well the more we see them the more we earn. Yet, this is OK, but listening to constitutionally protected free speech is wrong?
Despite my opinion that doctors should be able to receive promotional information objectively and without undue influence, I will agree to refuse all gratuities from the pharmaceutical industry and will encourage the professional societies to which I belong to eschew all pharmaceutical support ONLY when members of Congress refuse all contributions designed to influence their decision making. If it's wrong for us, it is certainly wrong for them.
Competing interests:
I have served as consultant to and lectured for several pharmaceutical companies.
Competing interests: No competing interests
Ray Moynihan has just completed the work I started in Australia by
being associated with a TV program on Channel 9 on 5th August 2001.
Amongst the extravagance we showed was a function held for Doctors and
wives on a SHOW BOAT with semi-naked dancing girls. I took a hidden camera
and filmed many a drug company sponsored function. The resulting outrage
resulted in a change in the code of ethics in Australia and most companies
have abandoned such functions. Bribery still exists and unfortunately it
is accepted by our colleagues.
I was amazed by the attitude shown by my colleagues here, who openly
said to me that I had stopped them receiving free meals. I still wonder if
such poverty stricken doctors who rely on drug companies for a meal would
survive as a ordinary person in a third world country ?
The medical community in general and specially the so-called
consultants should stop doing a snow job on General Practioners at the
behest of Pharmaceutical Companies.
I would also ask doctors to look at references quoted in
Pharmaceutical company advertising. Mostly they are quoted as 'data on
file'..which essentially is a non refereed paper.More than 80% are drug
company sponsored and only the positive results are published.
How do I know so much? I have worked for a Pharmaceutical Company.
Competing interests:
None declared
Competing interests: No competing interests
Sir,
As all encompassing the reach of the drug companies is, we as health
care professionals have it within our power to prevent untoward influence
by these companies.
The ability to say "no" and look at evidence sceptically is one of
the most important things in medicine that has been drilled in during time
at Medical School.
If drug companies want to come and give us a free lunch and promote
their drug, so what? If we are weak minded enough to let this influence us
then we are we are not putting what we have learnt into practice from our
epidiemiology lectures at all. In the evaluating the evidence of studies
funded by drug companies we all know that these studies are going to have
an inherent bias and thus must be taken with a pinch of salt.
The actions of US medical students are commendable in banning any
hospitality from drug companies towards medical students in an attempt to
prevent bias. However this seems a "hammer to crack a nut" solution.
Surely it would it not be easier for medical students to critically
evaluate the evidence that these drug companies present at free lunches
and challenge their evidence for their products?
Surely as responsible, mature and intelligent adults we have it
within our power not to fall for the "snake oil" salesmanship sometimes
used by the drug companies?
Competing interests:
I was taken out for dinner by Phillips Medical Systems last month at the British Society of Nuclear Medicine Annual Conference. As I will not be buying a PET or CT scanner in the next 20 years, this may be of lesser influence.
Competing interests: No competing interests
What's the prognosis, doctor?
I am not very surprised by the findings presented in "Who pays for
the pizza?" If advertising didn't work, companies wouldn't spend
millions on it. From my friends in the ad world, face to face
encounters and 'friendly gestures' are key pieces of successful ad
campaigns.
Several writers have suggested that we, as highly intelligent
professionals, can resist such marketing techniques. That is a
conclusion that may be right for an individual but is not
generalizable to the population as a whole. The evidence
presented by Mr. Moynihan seems strong and deserves our
attention. When the prognosis could be serious, it is imprudent to
ignore early signs and symptoms.
Competing interests:
I am a member of the
housestaff union, JCIR.
Competing interests: No competing interests