Healthy Skepticism Library item: 1320

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: news

Feinmann J.
Tricks of the trade: Extravagant freebies, insider 'experts' and biased research... Should we be concerned about the way the pharmaceutical industry woos our GPs?
The Observer 2003 Jun 29
http://www.guardian.co.uk/theobserver/2003/jun/29/features.magazine47

Full text:

Who is writing your prescription? Consider the least likely scenario, when you next take a health problem to your doctor – and it could well be that the drug that he or she prescribes is the fruit of bribery and corruption rather than evidence-based medicine.The idea of your doctor pocketing a brown envelope full of unmarked notes in return for prescribing a dodgy drug is, of course, ludicrous. But nearly 50 years after the pharmaceutical industry first introduced a voluntary code of practice to regulate its relationship with doctors, there is growing concern that the treatment doctors hand out may be increasingly influenced by that hugely successful and wealthy group of companies known as ‘big pharma’.It’s hardly a new worry. For years, there have been sporadic scandals about doctors enjoying freebie holidays and ‘essential’ conferences in exotic locations. But new research is starting to document the impact of what some regard as aggressive marketing strategies at every level of health care.A report in the BMJ last month identified the pharmaceutical company or ‘drug rep’ as a key player in such strategies. With one rep for every 10 or so doctors, this employee is the source of pens, mugs and generous wining and dining of doctors and their colleagues – as well as organising research sponsorship and travel to overseas conferences.Though most doctors don’t think that they are affected by these mutual back-scratching exercises, there is growing evidence that they are wrong. Research by Bristol GP Dr Chris Watkins shows that GPs who see drug reps at least once a week are more likely to prescribe drugs for conditions that will probably clear up on their own and are especially likely to use new, expensive products promoted by their visitors.Doctors who see the most drug reps are more likely to be over worked in deprived areas. ‘To some extent,’ he says, ‘it seems they fulfil a pastoral role that no one else is providing for doctors who frequently feel isolated.‘Last year, Glasgow GP Des Spence had an advisory post, which meant he influenced prescribing practices for half a dozen local practices, when, he says, he started receiving invitations to meetings abroad, ‘endless’ lunches and dinners and offers of substantial fees for lectures and chairmanships – and felt he was finally getting the recognition he deserved?. That is until his wife made him realise that he was ‘just being used and manipulated by big pharma, that it was the patients they were interested in, not me’.The ABPI’s (Association of the British Pharmaceutical Industry) voluntary code of practice is broken ‘every day’, he claims. Along with hundreds of doctors, Spence has signed a ‘just say no to drug reps’ pledge on the American website nofreelunch.org.Of course, even if doctors shun the drug rep, they are still likely to be influenced by the industry. Around half of postgraduate education for doctors is funded by industry. And around two-thirds of clinical trials in Britain are funded by the pharmaceutical industry.A new study shows that such research is four times more likely to be biased in favour of the product belonging to the sponsors than independent studies. Tricks of the trade include selecting a poor quality or inappropriate comparator to make the favoured drug look more effective as well as ‘disappearing’ studies with poor outcomes.Equally worrying, medical experts featured in press coverage of the latest pharmaceutical breakthrough or disaster could well have been ‘recruited and trained as opinion leaders to speak on behalf of the sponsoring company,’ says the BMJ.So what’s to be done? Dr Watkins would like more government regulation to restrict pharmaceutical industry promotional activity, though with the industry’s profits six times higher than other companies, he admits it’s a move politicians may not be enthusiastic about.And while most of the Royal Colleges are tightening their guidelines on how doctors should interact with industry, all are against what the Royal College of Physicians calls the ‘extreme puritanical position’ of banning industry sponsorship for education and conferences. ‘Many new products are extremely beneficial to patients, yet there’s sometimes a tendency to equate the pharmaceutical industry with the tobacco industry,’ says Professor Cornelius Katona of the Royal College of Psychiatrists.David Pink, chief executive of the Long-Term Medical Conditions Alliance, is also concerned that there is an ‘unholy alliance between those people who feel that the pharmaceutical industry is an international conspiracy to make people unhealthy, and others, often politicians, who want to ration their products’. His proposal is that rather than try to regulate for a squeaky-clean medical profession, what’s really needed is a better-informed public. At the moment, people who are anxious about the latest scare stories about anti-depressants or where to get help with impotence have no single source of unbiased detailed information. Certainly, one alternative solution being proposed by the Consumers Association, is the introduction of ‘a central, independent and impartial source of information on medicines and treatments’, funded by a ‘tax’ levied on the industry.Meanwhile, if you want to check out how independent-minded your doctor is but feel embarrassed about asking how often he or she sees a drug rep, check out the surgery desk. An array of pens or coffee cups bearing a pharmaceutical company logo could be a sign that you need to change your GP.