Marcia Angell makes it plain:
The fact that drug companies pay prescribers to be “educated” underscores the true nature of the transaction. Students generally pay teachers, not the reverse. The real intent is to influence prescribing habits, through selection of the information provided and through the warm feelings induced by bribery. Prescribers join in the pretence that drug companies provide education because it is lucrative to do so. Even free samples are meant to hook doctors and patients on the newest, most expensive drugs, when older drugs — or no drug at all — might be better for the patient.
This is from an essay in a special issue of BMJ dedicated to the relationship between pharma and doctors. In another essay, BMJ editor Fiona Godlee takes doctors to task for consenting to the huge influence pharma has had on medical research and practice. She starts with a quote from health services researchers and Cochrane Collaboration co-founder Iain Chalmers:
“I do not blame industry for trying to get away with anything that is normally considered to be its primary purpose, which is to make profits and look after its shareholders’ interests. It is our profession that has colluded in all of this and been prepared to go along with it–we are the people to blame because we need not have stood for it.”
By “all of this” I assume Chalmers means the many ways in which drugs are promoted in the guise of science, education, and information: the misreporting of industry funded research, the use of ghost writers and key opinion leaders, the provision of free courses and conferences. His words echo Suzanne Fletcher’s in the BMJ last year (2008;337:a1023, doi:10.1136/bmj.a1023). For these practices to flourish, doctors have had to at least acquiesce, if not actively take part, as researchers, guest authors, paid opinion leaders, and recipients of gifts and hospitality.
As our cover image shows, it takes two to tango. It’s time for the profession to take a lead. This means saying no to gifts and hospitality, ensuring that research and clinical collaborations are transparent and unbiased in their design and reporting, refusing to be a guest or ghost author, declining the role of paid opinion leader, paying our way for information and education, and refusing industry support unless it is entirely transparent and in patients’ or the public’s best interests.
Some thoughtful, well-informed examinations of the troubled spot medicine and many doctors feel themselves in right now. Many of the essays are, refreshingly, free.