In France, since the withdrawal of Mediator° (benfluorex) in 2009, a "drug safety" law has been passed. The modus operandi of the French drug regulatory agency has been improved. The public has a better understanding of the concept of conflicts of interest. An official website (www.transparence.sante.gouv.fr) publishes information on financial links between pharmaceutical companies and health professionals, associations, etc. Medical student associations are no longer accepting funding from pharmaceutical companies. Greater use is being made of national health insurance data, to better assess the extent of the harmful effects of medicines. The mainstream media dare to criticise medicines, through evidence-based reporting. A months-long trial to determine any criminal liability arising from the Mediator° disaster commenced in September 2019. The firm is charged with concealing benfluorex's appetite-suppressant nature and the drug's adverse effects. The French agency is accused of allowing itself to be misled, and of failing to properly manage conflicts of interest.

Much progress has been made. And yet, harmful habits and denial still persist and are all too common in 2019.

The website www.transparence.sante.gouv.fr shows that many health professionals continue to accept "benefits", in one form or another, from pharmaceutical companies. Yet it has been proven that even small gifts, such as meals, influence their treatment choices, and can easily steer them away from what matters most: the patient's best interests. Without being aware of the influence being exerted, nor fully appreciating the possible consequences for the patient.

Health professional students still receive too little training in adopting a critical approach towards medicines, which are not always the best treatment, even when they are properly evaluated, manufactured, monitored, prescribed, dispensed and used.

Far too many patients who feel that a drug might be causing one of their problems have difficulty getting others to consider, and recognise, the link. Yet in a country like France, there are tens of thousands of new victims of drug toxicity every year.

Regulators move on to careers in the pharmaceutical industry, and vice versa, as if public and private interests were one and the same.

It often takes years before a drug that is more dangerous than useful is removed from the market.

In other words, there are still many lessons to be learned from the Mediator° disaster. It requires determination. We must face reality head-on. The ongoing trial provides the opportunity to do so. In the courtroom, and beyond.

©Prescrire October 2019

"Mediator°...now what?" Prescrire Int 2019; 28 (209): 255. Pdf, free

  > Key texts around the Mediator° disaster 

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