Say no to the free lunch

Are you a pig or a weasel? Or do you consider yourself above all that? When the BMJ published a special issue on the links between doctors and drug companies in 2003, the cover showed pigs in white coats lunching and golfing with weasel drug reps. At the time this seemed strong stuff even to those involved in editing the issue. But little has happened since to suggest that the image was wrong. In fact, every day new revelations suggest that the reality is worse.

The power of drug companies to buy influence over every key group in health care—doctors, charities, patient groups, journalists, politicians—has clearly shocked a UK parliamentary committee (p 855). It should shock us all. Can we console ourselves that companies' lavish spending on research and marketing, which far outstrips spending on independent research and drug information, leads to truly innovative treatments? No, says the committee's report. Can we rely on regulatory bodies to keep the industry in check? No, again.

What we can rely on, says Slattery-Moschkau, a former drug rep and creator of a hard hitting new film on the industry (p 911), is that drug reps are “armed and dangerous,” selected for their ability to seduce and persuade rather than their scientific skills, and armed with, among other things, details of your prescribing behaviour.

All of this might encourage new resolve to step away from the trough and stand with the good guys. So it's interesting that the American College of Physicians has refused a booth at its annual meeting to the not-for-profit group No Free Lunch, which works to reduce conflicts of interest (p 862). Interesting, too, that the US National Institutes of Health may be forced to relax its policy on conflict of interest in response to protests from staff that it is too restrictive (p 864).

The BMJ, like most academic medical journals that carry pharmaceutical advertising, is perhaps somewhere between a pig and a weasel. And those of you alert to competing interests will see that Gauthier (p 857), in line with our policy on disclosure, lists at the end of his editorial several companies he has received funding from. We take the pragmatic view that competing interests cannot be removed altogether, since few clinical experts do not have some links to industry. But this is a hard balance to keep, and perhaps we delude ourselves that we have got it right.

Ferner (p 855) indicates that “professional self delusion”—doctors' view that they are not influenced by marketing—may force external regulation. The committee recommends, for example, requiring clinicians to register all substantial gifts from industry. It also recommends limits to promotion aimed at inexperienced prescribers and more training for medical students about marketing by drug companies.

So when the drug reps call for a chat, or offer to throw a sponsored lunch, make sure you are armed with cynicism, or information, or both. Better still—however seductive they are, just say no.

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