The influence of big pharma
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7496.855 (Published 14 April 2005) Cite this as: BMJ 2005;330:855All rapid responses
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I hope the criticisms of the medical drug industry relationship is not just another doctor bashing exercise. What is wrong with valuing a doctors contribution and paying £5000 to lecture at a meeting. Some medical meetings have registration fees of several hundred pounds and may have thousands of delegates. The NHS idea that doctors work for very little is out dated but still goes on. I have seen such improvement in treatments of so many condition since I qualified and would point out that almost none of these would exist without the drug industry. They must be doing something right. How can they be criticised for advertising their products when these products work. I have always appreciated drug representative who should be given credit for teaching doctors about new products and thus inproving and saving the lives of countless patients. Is this not the point? I bet others feel as I do
Keatley.adams@bolton.nhs.uk
Competing interests: Have been sponsored to attend medical meetings
Competing interests: No competing interests
Kudos to the new editor of the BMJ Fiona Godlee for her courageous stand against the influence of pharmaceutical companies ("say no to the free lunch") (1), reinforced by RE Ferner's editorial on ("The influence of big pharma") (2).
As a physician practicing in a developing country, I am alarmed that big pharma is able to taint health practioners and others in advanced western countries, buying influence from politicians, charities, doctors and health professionals among others. Angel (3) had earlier exposed the industry for what it is - a conglomerate of profiteering outfits with little or no interest in the welfare of patients. One had hoped that the most powerful developed nations - the only ones able to act against drug companies - would set in motion, a process that will force the pharmaceutical industry to reform in the interests of patients.
Whilst I share the concerns raised by Godlee and Ferner, I plead with health professionals and politicians to spare a thought for poor developing nations where no one is able to regulate the pharmaceuticaal companies, who in effect dictate health policy and practice. The pharmaceutical companies have exploited developing nations for a very long time, and give nothing in return to these poor countries. They are not interested in developing drugs or vaccines for the prevalent diseases in poor countries - malaria, tuberculosis and HIV/AIDS, to mention but a few - because they know that these countries would not be able to afford the costs that would geenerate profit. This is a shame, and I appeal that the civilised Western nations assist in forcing drug companies to imbibe the culture of global ethical responsibility.
Competing interests: Physician and researcher in a developing country.
Competing interests: No competing interests
R.E. Ferner expresses concern about the expense of improving regulation of the pharmaceutical industry.1 However, this would surely be money well spent, if it halted the relentless increase in prescription costs. There has been an 85% increase in real terms over 10 years since 1993 in the net ingredient cost of prescriptions dispensed in the community in England, amounting to an average annual increase of 6.3% (see chart).2
Ferner's editorial also seems somewhat selective in describing the report by the House of Commons Health Committee.3 The recommendations amount to more than the maintenance of a public register by the GMC of "all substantial gifts, hospitality, and honorariareceived by members". He does mention the suggestion of the development of a clinical trials register, with the requirement that full information be put on the register as a condition of the marketing licence. Even more control over clinical trial data would be obtained by following the suggestion made by Marcia Angell that an independent body take over drug trials from the companies, who would no longer be permitted to control clinical testing of their own drugs.4
Among the recommendations not mentioned by Ferner is that there should be an independent review of the Medicines and Healthcare products Regulatory Agency (MHRA). A more independent, proactive body, which could at least be involved in the design of clinical trials, if not undertake them itself, may better reflect patients' needs and society's expectations. Also, the recommendation about funding research other than that in the drug companies' interests is important. For example, specific funding should be made available for research into the adverse effects of medicalisation.5
Effort is needed to produce unbiased information on which clinical practice can be based. Investment is required to reduce the exploitation of patients by modern medicine. As noted by John Stone in his rapid response, the way that RE Ferner's editorial tails off into fatalism in its final sentence is unfortunate.
- Ferner RE. The influence of big pharma. BMJ 2005; 330: 855-856 (16 April), doi:10.1136/bmj.330.7496.855 [Full text]
- Department of Health. Prescriptions dispensed in the community. Statistics for 1993-2003: England. http://www.publications.doh.gov.uk/prescriptionstatistics/index.htm
- House of Commons Health Committee. The influence of the pharmaceutical industry. http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/42/42 pdf
- Angell M. The truth about drug companies: How they deceive us and what to do about it. New York: Random House, 2004
- Moynihan R, Smith R. Too much medicine? BMJ 2002; 324: 859-860 [Full Text].
Competing interests: None declared
Competing interests: No competing interests
Editor
You, in your editorial (Editor's choice), Ferner1 and Lenzer2, all comment adversely on the behaviour and status of drug industry representativfes. This reflects the natural tendency of even reputable journals such as the BMJ to publish bad news ahead of good.
Whilst accepting the needs for the concerns expressed in these comments, spare a moment to consider the positive aspects of the pharmaceutical industry and particularly the doctors (pharmaceutical physicians) that have chosen to work for drug companies. They are doctors first and foremost and those that are members of the Faculty of Pharmaceutical Medicine (the vast majority) are trained in and endorse the Faculty’s Guidelines on Ethics in Pharmaceutical Medicine.(Available on the FPM website www.fpm.org.uk) Pharmaceutical physicians working for such companies effectively act as the ethical conscience of the industry and have a statutory role to play in signing off any promotional material as well as fulfilling a responsibility to take part in the training of representatives. Much of the criticisms expressed would legitimately be far worse if pharmaceutical physicians had not properly exercised their professional roles and their consciences in fulfilling their duties.
Medicines remain a fundamentally important aspect of treatment of disease, but newer and better medicines are needed all the time and their responsible promotion is essential. Let not continuing research, to the highest possible standards, be jeopardised by unwarranted and constant criticism of everything the industry does.
Dr Frank Wells
1. Ferner RE The influence of big pharma. BMJ 2005;305:857-858 2. Lenzer J Confessions of a drug rep. BMJ2005;305:911
Competing interests: Retired pharmaceutical physician
Competing interests: No competing interests
I think the way that RE Ferner's article tails off into fatalism in its final sentence rather than seizing the moral imperative is deeply unfortunate:
"Unbiased clinical trials, objective drug data, and perfect pharmacovigilance are desirable but probably illusory and certainly expensive."
On what basis are we prepared to pay for the products, if we will not pay for proper controls and monitoring? Nothing about the pharma suggests that is owed some permanent debt of trust. It has to be policed, and like everything else that has to be policed the policing has to paid for.
Most of all we do not need an atmosphere of institutional fatalism and despair from the outset.
Competing interests: None declared
Competing interests: No competing interests
Clinical pharmacology – in need of resuscitation
Editor,
Ferner is right to highlight the need to resuscitate undergraduate education in clinical pharmacology in his Editorial about the influence of big pharma [1]. It seems obvious that, at a time when the numbers of drugs, medication errors, and dissemination of misinformation about drugs are all increasing, a specialty whose mission statement includes the desire to foster safe and effective use of medicines should be thriving. In fact, clinical pharmacology seems to be undergoing a slow and inexorable decline. Not only is clinical pharmacology disappearing from modern medical curricula, the numbers of specialists are also dwindling.
In its review of the consultant workforce in the medical specialties between 1993 – 2003 the Royal College of Physicians found that clinical pharmacology and therapeutics was the only medical specialty to contract in size (-24%) in contrast to the overall expansion in specialist numbers during that period of 79% [2]. It went on to predict that annual expansion of at least 10% per annum over the next decade was required for the specialty to return to an appropriate size [3]. Clinical pharmacologists are ideally placed to ensure that medical graduates are better prepared for the complexities of prescribing in the modern era. Now is the moment for the Department of Health and medical schools to decide that the DNR order should be withdrawn.
Simon RJ Maxwell
David J Webb
1. Ferner RE. The influence of big pharma. BMJ 2005;330:855-856.
2. The Federation of the Royal Colleges of Physicians of the United Kingdom. Census of Consultant Physicians in the UK, 2003: Data and commentary. London, November 2004.
3. Royal Colleges of Physicians. Consultant physicians working with patients. 3rd Edition. London, February 2005.
Competing interests: SM was Vice-President (2002-2004) and DW is currently a member of Council of the British Pharmacological Society
Competing interests: No competing interests