US medical schools should say no to pharma support
BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39569.475428.DB (Published 08 May 2008) Cite this as: BMJ 2008;336:1035
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Dear Sir
I really do have to protest at your handling of this issue. I wrote to you two weeks ago in response to the article regarding drug lunches and predictably this was not published, whilst the "fashionable" article criticising drug company sponsorship was. Fiona Godlee in this week's journal states that the "tide does seem to be turning" (re anti- sponsorship opinion). This is hardly surprising; you can make almost anything "appear" to happen if you conduct a policy of selective publication of the views you wish to promote. The problem in this debate is the narrow minded, blinkered approach that the "campaigners" seem to adopt. The real issue is HOW to fund education. The fact is that in this country in particular, but seemingly in the majority of the rest of the world also, by far the majority of education is paid for by industry support either directly or indirectly. Governments or any other "independent" provider have demonstrated a singular reluctance to provide the necessary funds (which is not that surprising as there is not anything very tangible in this activity - government's do not win elections on how many doctors they send to scientific conferences). So how is education to be funded if the only willing and relaible source is switched off?
Please do not misunderstand me, I have no particular love of drug company support - no-one would be more delighted than me if the NHS provided me with an adequate budget to attend 2 or 3 meetings a year and I did not have to go cap in hand to various companies seeking sponsorship. However, I do wish to keep myself up to date and well educated and personally I find no substitute in education for going to a meeting and actually talking with the people who are proposing new ideas. Until there is some other means of funding this activity we are not left with any alternatives. The same of course applies to medical journals as Fiona Godlee acknowledges.
However, it needs to be recognised that this is part of the economy of the whole world, one cannot go any where or do anything these days without being reminded that the building, you are in or the show you are attending or the program you are watching is sponsored by somebody. It seems therefore that nobody can fund anything without commercial support. It is naive and ambitious in the extreme to expect that medicine alone can stem this "evil" tide. It is equally disingenuous to compare a brilliant advertising camapign's effect on the mass market with the effect of more level headed sponsorship on a more intellectually discerning audience.
Yes it is right to have this debate, but part of that debate needs to be how alternative funding streams can be developed. However, it seems unlikely that in the forseeable future an alternative altruist is going to step forward and fill the gap. Perhaps our efforts should be directed to making sure that we are all able to recognise sponsorship and most importantly occult forms of sponsorship. We are all intelligent people, capable of making discriminating decisions regarding clinical treatments on a daily basis. Apart from where dishonesty is involved there is absolutely no reason why we should not be capable of recognising the potential effects of sponsorship and including them in our decision making processes.
Competing interests: None declared
Competing interests: No competing interests
The correct web address for the report is http://www.aamc.org/research/coi/industryfunding.pdf The link in the article is missing an "a" Well done for their initiative, be intersting to hear what happens in June!
Competing interests: Nil
Competing interests: No competing interests
It was with interest I read the news by Janice Hopkins Tanne regarding the pharmaceutical support to medical school in the United States. The Association of American Medical colleges suggested that their member medical school might prohibit pharmaceutical and device manufacturer from providing gifts, foods and travel to doctors, faculty members, and students. I would like to thank the author to highlight this time demanding issue.
This situation regarding pharmaceutical gift is worse for developing countries than the develop countries. In prospect of developing country, I would like to emphasis that some doctors are prescribing medicine containing poor ingredient due to gift from the pharmaceutical company. In the previous issue Patel K1 also discussed about the bad impact of pharmaceutical gift about prescribing the new drugs. Some medicines are prescribes in the developing country only for pharmaceutical industry interest. Streptococcus pyogene are still 100% sensitive to empirical drugs penicillin2 but doctors would like to prescribe third or fourth generation cephalosporin and new flroroquonole for treating pharyngitis and tonsillitis in developed countries. As a result normal flora in nasopharynx like Streptococcus pneumoniae and Haemophilus influenzae became resistant in developed countries rather than developing country.
In conclusion drug should be prescribed for patients benefit rather than commercial. Not only in Unites States but also all medical schools in the world might say no to pharmaceutical support.
I declare that I have no conflict of interest.
*Dewan Sakhawat Billal, Ph.D
billalds@wakayama-med.ac.jp
Department of Otolaryngology, Wakayama Medical University, Wakayama 641-8509, Japan
1. Patel K. Why I love a free lunch. BMJ 2008;336:962-a. (26 April.) doi: 10.1136/bmj.39556.557234.94.
2. Billal DS, Fedorko DP, Yan SS, Hotomi M, Fujihara K, Nelson N, Yamanaka N. In vitro induction and selection of fluoroquinolone-resistant mutants of Streptococcus pyogenes strains with multiple emm types. J Antimicrob Chemother. 2007 ;59:28-34.
Competing interests: None declared
Competing interests: No competing interests
Pharma support or bias
The Pharmaceutical Companies are very busy promoting their own interests.
Perhaps more in the USA but also all the way around the world, if they can get in.
At Ministerial levels and those Departments of Health they bamboozle the laymen civil servants and impress upon them the great benefits that their products will convey over and against those now in current use. Which are described as mere placebos and of no worth. Whereas their own packaged products are "scientific" and of greater benefit. These super-salesmen should be denied access to the Minister or whoever.
What indeed is left today of the 1960 British National Formulary?
Over the years the local Chemist and dispensing Pharmacist have been encouraged indeed instructed not to make up prescriptions written out by the doctors and instead their own more expensive Proprietaries are only on offer.
There was little need for this change. The old prescriptions were efficacious. It was mere sales-talk and persuasion that the "new" and pretty were better.
Time and again one notices the subsidy of research, of production of glossy magazines, of contributing to or even buying of complete ceremonial regalia for Medical Associations, all are paid for by some Pharmaceutical Company.
This is surely wrong.
If contributions wish to be made for research it should be unbiassed and not in favour of one of their own products.
Large food companies also promote research into Lipid metabolism yet their dehydrogenated Vegetable Oils and Trans-fats are the cause of those very heavy lipids being laid down. They didn't used to be when everyone lived on a little Pork Fat, Beef Dripping and Butter. Our enzymes digested them.
Margarine and those other Bio-fuels are food-substitutes and meant for Dr. Diesel's motor engines not the human body.
Let the Pharmaceutical Companies indeed contribute to research but give the money to a Central Fund. No harm in their providing a new lecture theatre or a swimming pool. Everyone would be grateful. But no- one would feel compelled to prescribe their products.
Competing interests: None declared
Competing interests: No competing interests