Lancet withdraws its support of document on collaboration between doctors and drug industryBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f770 (Published 05 February 2013) Cite this as: BMJ 2013;346:f770
All rapid responses
Some pharmaceutical companies operate for profit, including in some jurisdictions where company directors have a statutory responsibility, and perhaps a fiduciary duty, to shareholders to enhance the fortunes of the business by any legal means, including having their employees and contractors do whatever they legally can to sell drugs.
If that means providing biased information at 'education' sessions, making 'friendships' which engender reciprocity and obligation on the part of the health care provider despite the patients' interests being side-lined, then that's what will happen with collaboration.
The patients' interests (and everyone else's) are secondary to the shareholders' interests in some jurisdictions, probably including the UK.
Until that tension is addressed, we have a problem with collaboration.
Competing interests: No competing interests
It is encouraging to note that the Lancet has withdrawn its support for the Ethical Standards in Health and Life Sciences Group (EHLSG) document (1), but this still leaves some 17 other bodies including the BMA, RCP and DoH signed up to it. Will these bodies now also consider withdrawing their support? Belonging to both the BMA and RCP I feel very uncomfortable about such an association.
Like others I was horrified when I encountered the document and contacted Sir Richard Thompson who co-chairs EHSLG to ascertain the names of the clinicians on the committee and those involved in drawing up the document together with their declarations of conflict of interest. Although Sir Richard has kindly agreed to supply this information, nearly 3 months later I am still awaiting this. I imagine this delay is largely caused by the fact that this information has to be sought as a consequence of my request. Given that even when I served on local Medicines Management committees such declarations were a standard requirement, I am astonished that such declarations were not mandatory for anyone involved in the EHSLG.
David Griffith Retired Geriatrician
1. Hawkes N. Lancet withdraws its support of document on collaboration between doctors and drug industry. BMJ 2013;346:f770
Competing interests: No competing interests
We are encouraged by The Lancet’s withdrawal of support from the Ethical Standards in Health and Life Sciences Group’s “Guidance on collaboration between healthcare professionals and the pharmaceutical industry” . This document makes claims that are demonstrably wrong. The document claims that data from industry sponsored trials are publicly available. This is an issue that has taken centre stage recently due to the pressure from the Alltrials.net and the UK Government’s Committee to inquire into clinical trials and disclosure of data. It is clear that data from industry sponsored trials are not currently publicly available. The document also claims that drug reps are a useful source of information for healthcare professionals , although best evidence suggests that seeing drug reps can lead to higher prescribing frequency, higher costs, or lower prescribing quality .
The process for developing this document and collaborating with signatories is unclear. Although the subtitle for the document is “Ethics, transparency, partnership”, the Ethical Standards in Health and Life Sciences Group (ESHLSG) is far from transparent. There is no publicly available information on the structure or process for the group and no explanation of the process for collaboration with partners.
We welcome The Lancet’s withdrawal from this document and yesterday the announcement from The Medical Schools Council that it intends to work with the Ethical Standards in Health and Life Sciences Group to improve the “Guidance on collaboration between healthcare professionals and the pharmaceutical industry”. However, while the document remains to be factually incorrect, we call upon the remaining signatories, including the Royal Colleges and the BMA, to withdraw their support.
 Ethical Standards in Health and Life Sciences Group. Guidance on collaboration between healthcare professionals and the pharmaceutical industry. 29 Mar 2012. Available from www.abpi.org.uk/our-work/library/guidelines/Pages/collaboration-guidance...
 Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review.
Competing interests: MK is the chairperson of Healthy Skepticism UK, an organisation working on the Bad Guidelines campaign (www.badguidelines.org)
We welcome the BMJ’s coverage  of our campaign .
In their quote for the article  and their recent press release , the ABPI fail to address the inaccurate statements in the guidance document . Not for the first time, they misleadingly conflate the release of patient level data from clinical trials – the subject of an EMA consultation – with the release of trials results. Any unnecessary delays in publishing Clinical Study Reports from hidden trials may lead to patients coming to harm and are thus unacceptable.
Nigel Hawkes’ article  underplays the findings of Geoff Spurling’s systematic review . The review found trials that demonstrated receipt of information from pharmaceutical companies – including attendance at sponsored meetings – results in worse prescribing and trials that found it has no effect or mixed effects. They found no studies suggesting such information improves prescribing. Given this, the authors concluded ‘we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies’.
1. Hawkes N. Lancet withdraws its support of document on collaboration between doctors and drug industry. BMJ 2013;346:f770.
2. See www.badguidelines.org [accessed 9 February 2013].
3. ABPI. ABPI response to Lancet editorial on collaboration guidance. 5 February 2013. Available from http://www.abpi.org.uk/media-centre/newsreleases/2013/Pages/050213.aspx [accessed 9 February 2013].
4. Ethical Standards in Health and Life Sciences Group. Guidance on collaboration between healthcare professionals and the pharmaceutical industry. 29 Mar 2012. Available from www.abpi.org.uk/our-work/library/guidelines/Pages/collaboration-guidance... [accessed 9 February 2013].
5. Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review. PLoS Med2010;7(10):e1000352.
Competing interests: I have worked on trials that have received support from GSK and Pasante. I am involved in Conflict Free Conferences and the Bad Guidelines Campaign. I have not benefited financially from these relationships.
The Ethical Standards in Health and Life Sciences Group must implement transparency.
Hawkes reports that the Lancet has withdrawn its support from guidance outlining how healthcare professionals could collaborate with the drug industry, but has failed to properly investigate the case.(1)
Why it has taken 10 months for the Lancet’s withdrawal? In April 2012, Tom Yates pointed an accusing finger at the guidance on the forum of Healthy Skepticism, a NGO defending health care from misleading and harmful marketing .(www.healthyskepticism.org/) This allowed a flow of BMJ rapid responses to a news article announcing the guidance, which surprisingly failed to give critical insights.(2), http://www.bmj.com/content/344/bmj.e2489?tab=responses)
Two rapid responses appeared later on in the print version and were commented.(3) In spring the Lancet published a piece challenging its support for the guidelines.(4)
Why have other major national healthcare organizations (various royal colleges, the BMA, the Department of Health, the Welsh and the Scottish governments) which supported the guidance, remained silent?
The Association of the British Pharmaceutical Industry stated in a press release on 5 Feb 2013 that it is not responsible for the guideline but the "Ethical Standards in Health and Life Sciences Group" (ESHLSG) is, and encourages us to visit its website.(http://www.abpi.org.uk/media-centre/newsreleases/2013/Pages/050213.aspx)
The ESHLSG website is very poorly informative (www.eshlsg.org/). There is no organizational chart, no names except those of Sir Richard Thompson and Deepak Khanna, and no budget.
Davis and Abraham are sadly right when they wrote that unethical and corrupt behaviour endemic in the drug industry is indicative of wider systemic problems. (5) The august organizations that support the guidance must disclose who participated in the guidance and the minutes of the working groups.
1 Hawkes N. Lancet withdraws its support of document on collaboration between doctors and drug industry. BMJ 2013;346:f770
2 Dyer C. Collaboration with drug industry won’t affect clinical decisions, says new guide. BMJ 2012; 344.
3 Thompson R, Khanna D. Guidance on collaboration with drug industry. Towards greater transparency in the life science. BMJ 2012;344:e3371
4 Braillon A, Bewley S, Herxheimer A et al. Marketing versus evidence-based medicine.Lancet. 2012;380:340
5. Davis C, Abraham J. Is there a cure for corporate crime in the drug industry? BMJ. 2013 Feb 6;346:f755
Competing interests: No competing interests