Healthy Skepticism Updates
Update 2007-05-31
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HS members’ discussion list
Some of the things we do don’t work, others do. Last year we set up a web discussion forum for our members. There have been very few contributions to that forum. By contrast one of the most successful things we have done this year is set up an email discussion list for our members. The feedback from members is that many are finding the list very helpful.
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New video: "Drug Reps Talk Shop"
PharmedOut's new video, "Drug Reps Talk Shop", is now available at:
http://pharmedout.org.
The video features two drug sales reps talking about how they use prescribing data and samples to influence what drugs physicians give to patients. Here's a quote about the real purpose of samples: "first one's free, then you pay, then you're hooked."
Propaganda Conference
Strathclyde University in Glasgow is organising a conference on propaganda to take place on 7-9 September 2007.
See: http://gs.strath.ac.uk/content/view/240/130/
One of the key themes of the conference is disease mongering. Of particular interest, in the context of the conference overall, is the role of the media, including both mass and academic media, in disease mongering. The increasing involvement of patient groups in working with the pharmaceutical industry is of interest, as is the more general question of the regulation of industry activity, particularly in relation to drug promotion. The organisers are calling for abstracts to be submitted by 31 May.
Consumer International's World Conference
CI's World Congress 2007 will be in Sydney from 29 October - 1 November 2007.
See: www.consumersinternational.org
There will be a special session on The Ethics of Drug Promotion. Confirmed speakers for this session include Ray Moynihan (award winning health journalist) and Harvey Bale (International Federation of Pharmaceutical Manufacturers Associations).
Checking your occupation
We are keen to have correct records re everyone’s occupation so that we can send emails that are relevant to different occupational groups to all the right people but only the right people.
The illusion of invulnerability
On 5 May the British Medical Journal published arguments for and against patient groups accepting money from drug companies. The No case was written by Barbara Mintzes of the Therapeutics Initiative, Vancouver and Health Action International, Amsterdam. The Yes case was written by Alastair Kent of the Genetic Interest Group, London. The BMJ has published, as a letter to the editor, a shortened version of the following rapid response to Alastair Kent from Peter Mansfield.
Alastair Kent claims that “Patient groups are not naïve. They value their independence fiercely and are quite capable of spotting the strings that may be attached to funding.” Many doctors have similar overconfident beliefs about invulnerability to being misled by drug companies.<1> This illusion of invulnerability actually increases vulnerability.<2>
Drug companies sponsor patients’ groups as a way of promoting drugs to fulfill their legal requirement to maximize profits.<3> Drug companies can not influence all of the people all of the time but if their investments in any type of drug promotion do not achieve competitive returns on average they are ceased.<4> I don’t know of any examples of drug companies funding patient groups except for a limited time only when a relevant patent protected drug is being promoted.
In the 1840s doctors did not understand the risk of invisible microbes so were offended by the suggestion they should wash their hands. We are now going through a similar paradigm shift towards understanding the risk of invisible unintended bias from exposure to industry influence techniques. These techniques include manipulation of reciprocal obligation which can occur without our awareness.<5> Patient groups tend to reciprocate by lobbying governments to pay for overpriced drugs rather than lobbying the companies to reduce their prices.<6,7>
Funding for patient groups could be increased and the alleged problems with government funding reduced by abolishing patents to allow price competition and using the savings to fund research, education, health promotion and other activities of patients groups via competitive grants.<8>
1. Mansfield PR, Lexchin J, Wen LS, Grandori L, McCoy CP, Hoffman JR, Ramos J, Jureidini JN. Educating Health Professionals about Drug and Device Promotion: Advocates' Recommendations. PLoS Med 2006:3(11): e451
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030451
2. Sagarin BJ, Cialdini RB, Rice WE, Serna SB. Dispelling the illusion of invulnerability: the motivations and mechanisms of resistance to persuasion. J Pers Soc Psychol 2002 Sep ;83(3):526-41
3. Harnessing Patient Power: Strategies for speeding drug approval, building and retaining market share. Business Insights. 2004 Jan http://www.piribo.com/publications/regulation_policy/harnessing_patient_power.html
4. Garai PR. Advertising and Promotion of Drugs. In: Talalay P, Editor. Drugs in Our Society. Baltimore: John Hopkins Press; 1964. http://www.healthyskepticism.org/global/news/issue/hsin03-10
5. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003 Jul 9 ;290(2):252-5
6. Burton B. Drug companies told that sponsoring patients' groups might help win approval for their products. BMJ 2005 Dec 10 ;331(7529):1359
7. Ferner RE, McDowell SE. How NICE may be outflanked. BMJ 2006 May 27 ;332(7552):1268-71
8. Mansfield P. Industry-Sponsored Research: A More Comprehensive Alternative. PLoS Med 2006 ;3(10): e463
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030463
Healthy Skepticism’s aims
1. Improving health by reducing harm from inappropriate, misleading or unethical marketing of health products or services, especially misleading pharmaceutical promotion.
2. Investigating and communicating about marketing practices.
3. Promoting healthy skepticism about marketing practices via advocacy, research and education.
4. Developing, supporting and evaluating initiatives to reduce harmful marketing practices, including reform of regulations and incentives.
5. Developing, implementing and evaluating educational strategies to improve health care decision making, including evaluation of drug promotion.
6. Supporting compassionate, appropriate, sustainable, evidence-based health care, provided according to need, for optimal health outcomes.
7. Providing practical opportunities to advance the aims of Healthy Skepticism Inc.
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