Healthy Skepticism Library item: 20590

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Publication type: Journal Article

Arie S
Doctors’ groups are criticised for endorsing pro-industry guidelines
BMJ 2013 Oct 9; 347:
http://www.bmj.com/content/347/bmj.f6066

Abstract:

An attempt to bring closer collaboration between doctors and the drug
industry has had to be abandoned because of unbridgeable differences
between the two sides.

The Ethical Standards in Health and Life Sciences Group (ESHLSG), a high
profile attempt at partnership between medical royal colleges, leading
industry bodies, academics, the BMA, and the NHS Confederation, has told
the BMJ it is disbanding.

The decision came after criticism of the group for publishing guidance
on collaboration between healthcare professionals and the drug industry
and on clinical trial transparency that included several statements that
were pro-industry and not considered to be based on evidence.1

The author and campaigner Ben Goldacre condemned “the great and the
good” in the medical world for having endorsed the guidelines, saying
that they had given false reassurance to patients and professionals on
some of the most important problems facing medicine today.

However, Tim Evans of the Royal College of Physicians said that the
group had been useful. “The group has reached a time when it needs to
change and evolve into something different,” he said, in a joint
interview given with the co-chairman of the group, Deepak Khanna,
president of the Association of the British Pharmaceutical Industry
(ABPI). “The group ESHLSG will be disbanded.”

“The ESHLSG was a great forum to have a debate and create
recommendations, but it’s not really a policy setting organisation,”
said Khanna.

On Monday 7 October the guideline documents and other pages of the
group’s website were removed and a statement published saying that the
group would be turned into a forum led by healthcare professions in 2014.

The demise of the group raises questions over the potential for any kind
of high level collaboration across the divide in the health sector
between those involved in giving care and those making profits. The
group’s administration was funded by members’ subscriptions, though the
ABPI funded the group’s research on issues such as medical education and
financial disclosure, also published on the single remaining page of the
group’s website.2 The group was formed in 2011 after an earlier
initiative by the Royal College of Physicians, which the BMJ questioned
at the time.3

A BMJ news report about the publication of the guideline documents last
year triggered criticism online over controversial statements about how
doctors and drug companies should interact.4 These included statements
such as “Industry plays a valid and important role in the provision of
medical education” and another saying that drug company representatives
“can be a useful resource for healthcare professionals.”

Concerns were also raised that guidance on transparency of clinical
trials failed to acknowledge widespread concern that much data that were
not favourable to new products were being suppressed. When a campaign
called Bad Guidelines was launched in February 2013 by Goldacre and
others to question the guidance (http://badguidelines.org) the BMA
withdrew from the group.

The remaining 18 members announced in March that the two documents were
under review, but after six months in which members exchanged views on
the documents they failed to produce new versions. In a September
meeting healthcare members decided that the group was not working, and
the group’s scheduled quarterly meeting was cancelled.

Evans acknowledged that the guideline documents had been a “failure” and
that the group had believed, “naively,” that it would be possible to
find agreement between its extremely diverse members on controversial
issues and was forced to recognise that “one size doesn’t necessarily
fit all.”

Goldacre said, “Doctors and academics need clear guidance, and if this
organisation couldn’t deliver it there’s a real problem.” He said that
most organisations had failed to give clear answers to him about how
they had decided to endorse the guidance documents.

The BMA, which left the group in March 2012, said that it had not been
given enough time to assess the documents and that concerns it had
raised with the group had not been heeded.

“It seems industry pushed hard to produce a document that said,
‘Everything’s fine,’” Goldacre said. “By giving their endorsement, the
great and good of the medical world gave false reassurance, to patients
and professionals, on some of the most important problems facing
medicine today. Their failure to give a clear account of how they came
to endorse these documents is very worrying.”

BOX
Membership of the Ethical Standards in Health and Life Sciences Group

The original 19 members:
Academy of Medical Royal Colleges
Association of the British Healthcare Industries
Association of the British Pharmaceutical Industry
British In-vitro Diagnostics Association
British Pharmacological Society
Faculty of Pharmaceutical Medicine
Institute of Healthcare Management
NHS Confederation
Royal College of General Practitioners
Royal College of Nursing
Royal College of Physicians of London
Royal College of Physicians of Edinburgh
Royal College of Psychiatrists
Royal College of Surgeons of England
Royal Pharmaceutical Society
Royal College of Anaesthetists
Royal College of Surgeons of Edinburgh
Royal Society of Medicine
BMA

Two observer members:
General Medical Council
Prescription Medicines Code of Practice Authority

The Lancet, the Department of Health for England, and the governments of
Scotland and Wales all endorsed the guideline documents as non-members.
The BMJ endorsed one document, on transparency in clinical trials.

Notes
Cite this as: BMJ 2013;347:f6066

Footnotes
bmj.com Feature: How a marriage with big pharma ended in divorce (BMJ
2013;347:f6062, doi:10.1136/bmj.f6062)
For information on the BMJ’s campaign for open data go to bmj.com/open-data.

References
Arie S. How a marriage with big pharma ended in divorce. BMJ2013;347:f6062.
Arie S. Survey finds support for payments to doctors from commercial
companies to be made public. BMJ2013;347:f6093.
Collier J. Doctors, patients, and the pharmaceutical industry.
BMJ2009;338:b443.
Dyer C. Collaboration with drug industry won’t affect clinical
decisions, says new guide. BMJ2012;344:e2489.