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Analysis Commercial Influence in Health: from Transparency to Independence

Pathways to independence: towards producing and using trustworthy evidence

BMJ 2019; 367 doi: (Published 03 December 2019) Cite this as: BMJ 2019;367:l6576

Commercial influence in health: from transparency to independence

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Re: Pathways to independence: towards producing and using trustworthy evidence

Dear Editor

The BMJ’s initiative to focus on the commercial influence on scientific research and medical practice is both welcome, and to those of us of us fighting to against interests that damage patients and consumers, long overdue. Health Action International (HAI) is grateful for the opportunity to contribute to this important discussion.

Since its inception, HAI has always concerned itself with the influence pharmaceutical companies have on medical professionals’ prescribing and treatment habits. The evidence is clear - exposure to information from pharmaceutical companies does not lead to net improvements in prescribing but has been shown to negatively affect prescribing and professional behaviour.1

We are far from alone in our concern about pharmaceutical marketing, as this BMJ effort has highlighted. However, not enough is being done to tackle harmful marketing practices and more attention must be given to the commercial influences targeting medical students and healthcare professionals in training.

We know that healthcare professionals encounter promotional materials during their studies, yet most medical students do not obtain adequate education on how to critically respond to pharmaceutical promotion. 85.2% of medical students surveyed in France (n=2,101) reported feeling inadequately educated about conflicts of interest arising from interactions with the pharmaceutical industry.1

Medical students are the future of the healthcare systems on which we rely. But they are often left with little understanding of the impact commercial influence has, and will continue to have, on them throughout their studies and when they begin prescribing medicine in medical practice. A recent study has shown how little contact with students is needed to impact their behaviour: the US study of 280,000 doctors found an association between accepting even just one sponsored meal and higher prescribing of sponsors’ medicines, with additional or costlier meals associated with even higher prescribing.2 Engaging first-hand with medical students, time and again we have heard concerns about medical schools’ inaction when it comes to educating students about the impact of even the most (seemingly) innocuous pharmaceutical promotion.

By giving medical students the tools to critically evaluate the information provided by pharmaceutical companies, and to assess each treatment option thoroughly and objectively, we are supporting ethical clinical practice, and patient-, rather than pharmaceutical company-led healthcare.

HAI has fought to counter the influence of pharmaceutical promotion with a series of tools for medical students, from our recently re-modelled Fact or Fiction guide, workshops at European universities (more to come in 2020), to our ongoing webinar series on the subject which reaches as far afield as Nigeria and Australia. Meanwhile, in France, the National Association of French Medical Students (ANEMF), La Troupe du RIRE and Formindep continue to work tirelessly to put this issue on the map, and with great success: most notably seen in the adoption of calls for conflict of interest proposals being taken up by the national body representing Deans of National Educational Institutions. The student led activism of Universities Allied for Essential Medicines (UAEM) chapters across Europe is another great asset to the efforts to change the way faculties approach marketing on their campuses.

Student mobilisation has been instrumental to putting the issue of conflict of interest on the agenda, and by continuing to work with partners and student groups like these, we can expand our reach in 2020. But without concerted action to regulate pharmaceutical promotion, or to embed tools like the those we have developed into medical curricula, the spectre of undue influence will shape medical systems across Europe for years to come.

1. Health Action International, Fact or Fiction: What Healthcare Professionals Need to Know about Pharmaceutical Marketing in the European Union, available:
2. BMJ 2019;367:l6576, available:

Competing interests: No competing interests

13 February 2020
Eleanor M J White
Policy Advisor, Health Action International
Alexander W Lawrence
Amsterdam, the Netherlands