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Margaret McCartney: Forever indebted to pharma—doctors must take control of our own education

BMJ 2015; 350 doi: (Published 13 April 2015) Cite this as: BMJ 2015;350:h1965

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Precautionary approach to pharmaceutical company information is sound

Of course, everyone selectively quotes research articles when they argue a position. Otherwise, academic articles would be somewhat unwieldy collections of whole research papers. Responses to our review follow a common pattern. People who have a tendency to agree with the precautionary message of our review, like Dr McCartney, focus on the associations of pharmaceutical information and prescribing harms. People, like Dr Goh, who tend to disagree with the precautionary message frequently present a longer version of the conclusion including all the inherent doubt associated with a systematic review of heterogenous, largely observational studies, and then dismiss the conclusion.
Dr Goh argues that our precautionary conclusion is not evidence based, but I would disagree. One of the strengths of a systematic review is that it looks at all the available literature on a subject. One of the frequent claims of the pharmaceutical industry and doctors who attend their meetings is that their information is beneficial. For me, the most surprising finding of our review was that we could not find evidence to support this argument.1 The evidence for prescribing harm is mixed and observational but it seems unlikely that a randomized controlled trial of pharmaceutical promotion to doctors will be conducted even though the industry clearly has the means, expertise and resources to conduct such a trial. Since our review has been published, the pharmaceutical industry has not presented convincing research evidence that their information to doctors is beneficial. In the absence of benefit and with some evidence of harm, we considered the precautionary principle to be a reasonable and careful conclusion to the evidence we reviewed. Pointing out the limitations of our review, something all diligent academics should do, does not invalidate our conclusions which were that doctors should avoid pharmaceutical information unless evidence of benefit emerges.1
Dr Goh reassures us that he takes a healthily skeptical/ cynical approach to meetings involving commercial information. However, there is no evidence that this is a defence against industry influence. Doctors have been shown to have a higher opinion of their own ability to resist pharmaceutical influence than their peers.2 Dr Goh also suggests that in return for not attending commercially sponsored meetings he should be paid more. I am not sure that other highly educated professions, such as lawyers who fund their own continuing education, and the general public would be sympathetic to the proposal that orthopaedic surgeons be paid more to meet their professional development responsibilities, but that sentiment does illustrate the challenges facing those promoting independent medical education.
The onus is on those who don’t agree with the precautionary conclusion of our review to provide evidence showing the benefit of information from pharmaceutical companies. In the meantime, I would recommend supporting Dr McCartney’s call for independent medical education.3
1. Spurling GK, Mansfield PR, Montgomery BD, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review. PLoS Med 2010;7(10):e1000352.
2. Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med 2001;110(7):551-557.
3. McCartney M. Margaret McCartney: Forever indebted to pharma--doctors must take control of our own education. BMJ 2015;350:h1965.

Competing interests: No competing interests

08 June 2015
Geoffrey K Spurling
University of Queensland
Discipline of General Practice, University of Queensland, Level 8 Health Sciences Building, Building 16/910, Royal Brisbane & Women’s Hospital. Herston QLD 4029