Intended for healthcare professionals

Views & Reviews Personal View

Patients can’t trust doctors’ advice if we hide our financial connections with drug companies

BMJ 2014; 348 doi: (Published 15 January 2014) Cite this as: BMJ 2014;348:g167

Re: Patients can’t trust doctors’ advice if we hide our financial connections with drug companies

Some years ago I was taken aback by a BMJ front page depicting doctors drinking from the trough of big pharma and while it may have provoked some self examination, clearly it was not enough for the BMJ observations which devotes three sequential pages (BMJ 2014; 348:24-26) recently to the ‘exposition’ of doctors who might engage with industry and the industry itself for ‘creating diseases’. I think there should be some balance however to these arguments.

Maybe any declaration of ‘who pays this doctor’ should include all employers including the NHS, as a potential ‘conflict of interest’. Certainly I witnessed more harm to patients from NHS policies such as the ‘trolley wait’ initiative in the early 2000s than anything I could imagine from meeting a pharmaceutical representative. Witnessing the effective ‘gagging’ of senior colleagues was scarier than an advertisement for testosterone gel!

Founding ‘doctor transparency’ initiatives is an admirable development but may carry its own unavoidable biases through the investment in self and entrenched beliefs. Observing modern medical professionals might in any way defend ‘paternalism’ as a ‘good’ is as naive as saying medicine would have advanced as much in the last thirty years without pharmaceutical inventions, many by doctors working with and within the pharmaceutical industry who may or may not have higher salaries than others for their expertise in these fields (which should also be acknowledged in ‘whopaysthisdoctor’).

BMJ readers would all agree raising awareness about tobacco but do we also agree raising it about a ‘new disease’ like atrial fibrillation for example, would be bad (despite what the NEJM might say) as there are new anticoagulants for stroke prevention that aren’t made in a generic ‘pirate cove’ somewhere that might make money for a pharmaceutical company.

There are many conflicts of interests and personal biases in the medical world that interfere with medical decisions on treatment strategy, patient care and delivery of such care so let’s have true balance and declare them all including journalistic & political beliefs.

Competing interests: I am employed by Tallaght Hospital a voluntary hospital. I have served on remunerated advisory boards to Boehringer Ingelheim, Bayer and Pfizer for their new anticoagulant agents, the development of which I believe will help greatly advance stroke prevention. I am not a member of any political party. I am not envious of those richer or who make more money than me for their innovation, expertise or endeavour.

03 February 2014
D. Ronan Collins
consultant in geriatric and stroke medicine
Tallaght Hospital Dublin
Tallaght Dublin