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Collaboration with drug industry won’t affect clinical decisions, says new guide

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2489 (Published 02 April 2012) Cite this as: BMJ 2012;344:e2489

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Re: Collaboration with drug industry won’t affect clinical decisions, says new guide

It is disappointing to see [1] so many reputable organisations join the Association of the British Pharmaceutical Industry in endorsing such a damaging and ill conceived document [2]. Unreferenced statements such as 'Healthcare and industry professionals are able to manage their relationships with each other without compromising clinical decision making' [2], at odds with a growing body of evidence [3], are unhelpful.

We would like to suggest an alternative set of principles for consideration:

1) Despite its flaws [4], we are probably stuck with the current model of pharmaceutical R&D, at least in the short to medium term.

2) If industry wish to make information on their products available, they can publish in a peer reviewed journals like the rest of us. Clinicians should treat this data with caution, as funding source is strongly associated with reported outcome in published trials [5].

3) It is difficult to assess how others' conflicts of interest might affect their account of the evidence base. For this reason, we should demand review articles and medical education be delivered, in almost all cases, by people with no industry links [6]. The presence of people with significant industry links on guideline committees [7] is totally unacceptable.

4) Industry codes of conduct usually have limited impact – the ABPI code is a good example of this [8].

5) Patients would be shocked if they realised the extent to which our profession is dependent on industry. Blanket bans on contact with industry reps, of the kind imposed in several American medical schools [9], are a step in the right direction.

1. Dyer C. Collaboration with drug industry won’t affect clinical decisions, says new guide. BMJ 2012; 344: e2489.
2. Ethical Standards in Health & Life Sciences Group. Guidance on collaboration between healthcare professionals and the pharmaceutical industry. Available from http://www.abpi.org.uk/our-work/library/guidelines/Documents/Guidance%20... (accessed 18 April 2012).
3. Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, Vitry AI. Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review. PLoS Med 2010; 7(10): e1000352.
4. Trouiller P, Olliaro P, Torreele E, Orbinski J, Laing R, Ford N. Drug development for neglected diseases: a deficient market and a public-health policy failure. Lancet 2002; 359(9324): 2188-94.
5. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003; 326(7400): 1167-70.
6. See http://www.conflictfreeconferences.com (accessed 18 April 2012).
7. Neuman J, Korenstein D, Ross JS, Keyhani S. Prevalence of financial conflicts of interest among panel members producing clinical practice guidelines in Canada and United States: cross sectional study. BMJ 2011; 343: d5621.
8. Herxheimer A, Collier J. Promotion by the British pharmaceutical industry, 1983-8: a critical analysis of self regulation. BMJ 1990; 300: 307-11.
9. For an up to date summary of regulations, see http://www.amsascorecard.org (accessed 18 April 2012).

Competing interests: TAY and CJR recently set up a scheme (see www.conflictfreeconferences.com) to accredit medical education which is independent of industry. We are have no financial conflict of interest. In 2009, TAY assisted with a study which used point of care HIV tests provided free of charge by Pasante. In 2010-11, TAY worked as a research fellow on a study part funded by GSK.

20 April 2012
Tom A Yates
MRC Advanced Course Masters Student in Epidemiology (a)
Carl J Reynolds, CT1 in Acute Medicine (b)
a) London School of Hygiene and Tropical Medicine
Keppel Street, London WC1E 7HT b) Chelsea and Westminster Hospital