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Home > Comment > BMJ
2009;338:b222, doi: 10.1136/bmj.b222 (Published 3 February 2009)

Published 3 February 2009, doi:10.1136/bmj.b222
Cite
this as: BMJ 2009;338:b222

Analysis

Relationships with the drug industry: Keep at arm’s length

Marcia Angell, senior lecturer in social
medicine

1 Harvard Medical School, Boston, MA 02115

marcia_angell{at}hms.harvard.edu

The relationship between the drug industry, academia,
healthcare professionals, and patients has reached an all time low
and few doubt that it is in the interests of all parties to
improve it. A recent report from the Royal College of Physicians
attempts to define a path towards achieving a more productive
relationship. Here we set out five contrasting views on what the
ideal relationship between industry and prescribers and patients
should be and what steps need to be taken to achieve it (doi:10.1136/bmj.b211,
doi:10.1136/bmj.b232, doi:10.1136/bmj.b252, doi:10.1136/bmj.b252)

I believe there should be no relationship between the drug industry
and either prescribers or patients. Drug companies are investor
owned businesses with a responsibility to maximise profits for
their shareholders. That is quite different from the mission of
the medical profession, which is to provide the best care possible
for patients. I start with this simple fact, because it is so often
obscured by the industry’s public relations. Drug companies are not
confused on this score. Their major output now consists of "me-too"
drugs for mild or ill defined conditions in essentially healthy
people. This is because that market is big and more easily expanded
than the market for innovative drugs for serious diseases.1

The purpose of drug companies’ contact with prescribers is nearly
always to increase sales, and it usually involves payments of one
form or another. These are often disguised as education—for example,
sponsored continuing medical education, professional meetings, and
conferences or dinner sessions to hear presentations about drugs.
Companies provide meals, gifts, and subsidies of various sorts. But
drug companies are not educational institutions. These activities are
funded from their marketing budgets. Drug companies may, of course,
provide accurate information to prescribers, but only if it serves
their commercial interests. A growing body of evidence shows that
they suppress or distort information that does not serve their
interests.2
Prescribers are faced with the impossible task of sorting out good
information from bias or misinformation.

The fact that drug companies pay prescribers to be "educated"
underscores the true nature of the transaction. Students generally
pay teachers, not the reverse. The real intent is to influence
prescribing habits, through selection of the information provided
and through the warm feelings induced by bribery. Prescribers
join in the pretence that drug companies provide education because
it is lucrative to do so. Even free samples are meant to hook
doctors and patients on the newest, most expensive drugs, when
older drugs—or no drug at all—might be better for the
patient.

Education and information should be provided by health professionals

It is time the medical profession took full responsibility for
educating prescribers about prescription drugs, instead of abdicating
it to drug companies.3
Doctors should pay for their own continuing education, just as other
professions do. Similarly, professional organisations should pay for
their own meetings and publications, not go hat in hand to industry.
Drug companies are not charities; they expect something for the tens
of billions of dollars they invest in marketing. The evidence is that
they get it, and that patients foot the bill in higher drug
prices.

As with prescribers, the purpose of contact between drug companies
and patients is to sell drugs. In the US, drug companies spend
about $5bn (£4bn; 4bn) yearly on direct to consumer advertising on television.
The adverts are mostly for me-too drugs and are designed to convince
viewers that one is better than another, despite the fact that these
drugs are seldom compared in clinical trials at equivalent doses.
Many seek to convince people that they have chronic disorders that
require lifelong drug treatment. Thus heartburn is elevated to
gastrointestinal reflux disease, with the implication that it needs
to be treated to prevent serious complications. If people can be
convinced they have a treatable medical condition, then it is an easy
step to sell them drugs to treat it. Many doctors connive in this
deception because it is easier to write a prescription than to
counsel changes in diet or to offer reassurance. We need to stop
accepting the fiction that marketing, whether to prescribers or
patients, is good education.

Cite this as: BMJ 2009;338:b222

Competing interests: None declared.

Provenance and peer review: Commissioned; not
externally peer reviewed.

References

Angell M. The truth about the drug companies: how they
deceive us and what to do about it. New York: Random House, 2004.

Turner EH, Matthews AM, Linardatos E, Tell RA,
Rosenthal R. Selective publication of antidepressant trials and its influence
on apparent efficacy. N Engl J Med 2008;358:252-60.[Abstract/Free Full Text]

Relman AS. Industry support of medical education.
JAMA 2008;300:1071-3.[Free Full Text]

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