Relationships with the drug industry: Keep at arm's = length -- Angell 338: b222 -- BMJ

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Home > Comment > BMJ=20 2009;338:b222, doi: 10.1136/bmj.b222 (Published 3 February = 2009)

Published 3 February 2009, = doi:10.1136/bmj.b222
Cite=20 this as: BMJ 2009;338:b222

Analysis

Relationships with the drug industry: Keep at arm=92s length

Marcia Angell, senior lecturer in social=20 medicine

¹ Harvard Medical School, Boston, MA 02115

marcia_angell{at}hms.harvard.edu

The relationship between the drug industry, = academia,=20 healthcareprofessionals, and patients has reached an all = time low=20 andfew doubt that it is in the interests of all parties to=20 improveit. A recent report from the Royal College of = Physicians=20 attemptsto define a path towards achieving a more productive = relationship.Here we set out five contrasting views on what = the=20 ideal relationshipbetween industry and prescribers and = patients=20 should be andwhat steps need to be taken to achieve it = (doi:10.1136/bmj.b211= ,⁼²⁰doi:10.1136/bmj.b232, = doi:10.1136/bmj.b252= , doi:10.1136/bmj.b252= )⁼²⁰

I believe there should be no relationship between the drug = industry⁼²⁰and either prescribers or patients. Drug companies are = investor⁼²⁰owned businesses with a responsibility to maximise profits = for⁼²⁰their shareholders. That is quite different from the mission⁼of=20 the medical profession, which is to provide the best care⁼possible=20 for patients. I start with this simple fact, becauseit is so = often=20 obscured by the industry=92s public relations.Drug companies = are not=20 confused on this score. Their major outputnow consists of = "me-too"=20 drugs for mild or ill defined conditionsin essentially = healthy=20 people. This is because that market isbig and more easily = expanded=20 than the market for innovativedrugs for serious = diseases.¹⁼²⁰

The purpose of drug companies=92 contact with prescribers⁼is nearly=20 always to increase sales, and it usually involvespayments of = one=20 form or another. These are often disguised aseducation=97for = example,=20 sponsored continuing medical education,professional = meetings, and=20 conferences or dinner sessions tohear presentations about = drugs.=20 Companies provide meals, gifts,and subsidies of various = sorts. But=20 drug companies are not educationalinstitutions. These = activities are=20 funded from their marketingbudgets. Drug companies may, of = course,=20 provide accurate informationto prescribers, but only if it = serves=20 their commercial interests.A growing body of evidence shows = that=20 they suppress or distortinformation that does not serve = their=20 interests.²=20 Prescribersare faced with the impossible task of sorting out = good=20 informationfrom bias or misinformation.

The fact that drug companies pay prescribers to be "educated"⁼²⁰underscores the true nature of the transaction. Students = generally⁼²⁰pay teachers, not the reverse. The real intent is to = influence⁼²⁰prescribing habits, through selection of the information = provided⁼²⁰and through the warm feelings induced by bribery. Prescribers⁼join in the pretence that drug companies provide education = because⁼²⁰it is lucrative to do so. Even free samples are meant to hook⁼doctors and patients on the newest, most expensive drugs, = when⁼²⁰older drugs=97or no drug at all=97might be better for⁼the=20 patient.

Education and information should be provided by health = professionals

It is time the medical profession took full responsibility for⁼²⁰educating prescribers about prescription drugs, instead of = abdicating⁼²⁰it to drug companies.³=20 Doctors should pay for their own continuingeducation, just = as other=20 professions do. Similarly, professionalorganisations should = pay for=20 their own meetings and publications,not go hat in hand to = industry.=20 Drug companies are not charities;they expect something for = the tens=20 of billions of dollars theyinvest in marketing. The evidence = is that=20 they get it, and thatpatients foot the bill in higher drug=20 prices.

As with prescribers, the purpose of contact between drug = companies⁼²⁰and patients is to sell drugs. In the US, drug companies = spend⁼²⁰about $5bn (=A34bn; $3D{euro}$ 4bn) yearly on direct to consumer advertisingon = television.=20 The adverts are mostly for me-too drugs and aredesigned to = convince=20 viewers that one is better than another,despite the fact = that these=20 drugs are seldom compared in clinicaltrials at equivalent = doses.=20 Many seek to convince people thatthey have chronic disorders = that=20 require lifelong drug treatment.Thus heartburn is elevated = to=20 gastrointestinal reflux disease,with the implication that it = needs=20 to be treated to preventserious complications. If people can = be=20 convinced they havea treatable medical condition, then it is = an easy=20 step to sellthem drugs to treat it. Many doctors connive in = this=20 deceptionbecause it is easier to write a prescription than = to=20 counselchanges in diet or to offer reassurance. We need to = stop=20 acceptingthe fiction that marketing, whether to prescribers = or=20 patients,is good education.

Cite this as: BMJ 2009;338:b222

Competing interests: None declared.⁼

Provenance and peer review: = Commissioned; not=20 externally peerreviewed.

References

Angell M. The truth about the drug companies: = how they=20 deceive us and what to do about it. New York: Random House, 2004.
Turner EH, Matthews AM, Linardatos E, Tell = RA,=20 Rosenthal R. Selective publication of antidepressant trials and its = influence=20 on apparent efficacy. N Engl J Med 2008;358:252-60.[Abstract/Free Full Text]⁼²⁰
Relman AS. Industry support of medical = education.=20 JAMA 2008;300:1071-3.[Free Full Text]⁼²⁰

=20 CiteULike =20 Complore =20 Connotea =20 Del.icio.us Digg Reddit =20 Technorati What's this? =

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