Healthy Skepticism Library item: 18774

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Henry D
Doctors and Drug Companies: Still Cozy after All These Years
PLoS Med 2010 Nov 2;
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000359

Abstract:

The relationships between doctors and drug companies are controversial and have long been scrutinized by researchers, ethicists, professional bodies, and legislators [1]. In recent years, growing concerns about these ties, and allegations of some corrupt practices, have engendered a large amount of coverage in the media and professional journals [2]–⁴.

In my experience, the main concerns about close ties between companies and doctors are that 1) they lead to inappropriate prescribing that can harm patients; 2) they create divided loyalties for doctors between the health system, their patients, and manufacturing companies, which is a conflict of commitment as well as a conflict of interest; 3) they lead to use of unnecessary and expensive medications with consequent costs falling on health care systems and patients; 4) they may lead to medicalisation of human variation, i.e., “disease-mongering”; and 5) they diminish the professional standing of doctors in the eyes of the public and governments, which leads to a reduced ability to advocate for the health of patients, for the public, and on behalf of the profession.

In response to community concerns, legislators have tried to improve the transparency of the relationships between doctors and drug companies-for example, the recently passed Physicians Payments Sunshine Act in the United States, and mandatory disclosure requirements for companies in Australia [5],⁶. These require public reporting of certain types of industry-sponsored activities; in Australia this includes the nature of the sponsored meetings, the venues, any hospitality provided, and overall costs [6].

In response to widely voiced concerns, professional bodies around the world have tightened their codes of conduct, and the state of Massachusetts passed legislation banning gifts from drug and device manufacturers [7]–⁹. Drug companies are trying to reduce some of their more egregious activities, such as provision of lavish gifts and entertainment, and overly generous travel support. Recent revisions to the Code of Practice of the Pharmaceutical Research and Manufacturers of America specifically prohibit these activities [8]. Such activities have long been the focus of those who have questioned the relationships between doctors and drug companies. They have also been the main target of the legislative responses in the US and Australia. But, open-ended activities such as “unrestricted” research grants, “educational” grants, membership in speakers’ bureaus and advisory panels, consultancies, and stock-holding could be of greater concern, through an insidious blurring of professional boundaries and obligations [10]. There is evidence that these types of ties are common among specialist physicians [11]….