Spanish doctors say “no thank you” to drug industry giftsBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1579 (Published 08 September 2008) Cite this as: BMJ 2008;337:a1579
Healthcare professionals in Spain are beginning to fight back against the pressure that the drug industry exerts on them to prescribe particular products. Professionals from a wide range of medical fields have created the No Gracias (“No thank you”) group, part of the international No Free Lunch movement, a network of non-profit organisations that aim to “encourage health care providers to practise medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion” (www.nofreelunch.org).
One of the organisers of the recently launched Spanish group, Carlos Ponte, head of the intensive care unit at Asturias Central Hospital, in Oviedo, northern Spain, said, “This platform aims to impact on, and to change, the relations between the drug industry, public sector health bodies, healthcare professionals, and patients and citizens.” Many professionals who have joined the group wear a “No Gracias” badge on their white coats to promote discussion with patients about the group’s aims.
Juan Gervás, a GP in Madrid, said, “The No Gracias platform is an effort to promote relations between the industry and doctors that are based on transparency, independence, and proportion. It would be a positive step if No Gracias were to be seen as a necessary movement, even by the industry itself.”
No Gracias was an initiative of the Federation of Associations for the Defence of Public Health (Federación de Asociaciones para la Defensa de la Sanidad Pública). The federation, influential in Spain, also has a subsidiary in Colombia that, through the Gamma Idear Foundation, coordinates similar activities in other countries in South America, including Bolivia, Ecuador, Peru, and Venezuela.
No Gracias was established after several instances over the past few months of leading Spanish media outlets, including the Discovery Salud global health news magazine and Informativos Tele 5 (Channel 5 news), reporting cases of multinational drug companies offering incentives to doctors to prescribe their products. These incentives have included not only gifts, meals, and travel but also cash.
The group’s main objective is to put an end to such practices. It warns: “The penetration of the drug industry into health care has resulted in a complex network of interests and collusion that affects the whole sector. The industry finances professional training, an area severely neglected by the public sector, by offering free courses, meetings, trips, meals, and presentations. Health centres open their doors to company sales representatives who, with their gifts of greater or lesser value (presented as “educational opportunities”), generate a sponsorship culture that damages the autonomy of the professional and the rationale behind the prescription.”
Patients and the drug industry have conflicting interests, the group argues. At a meeting launching the No Gracias group, Joan-Ramon Laporte, professor of pharmacology at Barcelona Autonomous University, said that other consequences of industry influence on prescribing is an increase in the number of prescribing errors and in the cost of drugs to the public sector health service.
No Gracias is steadily building support among healthcare professionals. Since the group’s launch less than four months ago 1200 people have signed up to its manifesto (www.nogracias.eu/v_juventud/apartados/pl_entidades.asp?te=5016).
“We are not looking to confront health professionals but to guide them back to good practice,” said Carmen Ortiz, president of the Federation of Associations for the Defence of Public Health. “We want to build an ethical framework that values the professional’s work, the rational use of drugs, and good governance practices in public institutions,” she added.
Since September No Gracias has published an electronic newsletter featuring news and information. “This is an interactive monthly newsletter for all those who have signed our manifesto, to express the diverse efforts made by the group as a whole, said Dr Ponte. “The organisation wants to build an open space where professionals, citizens, consumers’ organisations, and trade unions can work together. Although we are in constant dialogue with those who write prescriptions, this is a political and social problem.”
The group has organised several sessions in Spanish healthcare centres where health professionals can discuss the differences between drug companies’ information material and objective scientific evidence. No Gracias is also in discussion with various Spanish regional governments (in Spain, each regional administration decides its own health policy) about implementing policies that put the citizen’s right to health before a business’s right to make a profit.
Several regional health administrations have agreed to finance continuing professional development for some doctors. Previously in Spain the drug industry paid for almost 100% of the training that doctors received after completing their university studies.
Another suggestion the group has made is that the health authorities should promote pharmacology bulletins in each region. These are usually the most independent sources of information on drugs for health professionals.
Things are changing in the Spanish healthcare system. Medical professionals admit that they are part of the reason why some ethical issues were ignored previously, and now they want to change attitudes.
“We have started a debate in the universities,” said Dr Ponte. “The Oviedo University Medical School is following in the footsteps of the University Medical Schools at Stanford and at Pennsylvania, which have declared themselves ‘pharma free.’ Other Spanish medical schools are interested in this idea.”
But the No Gracias group also recognises that it needs to take action outside the profession and has taken steps to bring the debate into the Spanish parliament, recognising that the influence of drug companies in the healthcare system requires action at the national level.
Cite this as: BMJ 2008;337:a1579
Miguel Jara is a freelance journalist and author of Traficantes de Salud (“Dealers in Health”).