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Saying "no thanks" to the pharmaceutical industry's undue influence

In a published response to Andrew Jack's article "Mea culpa: are multi-billion dollar fines forcing drug companies to clean up their act?" (BMJ online, 18 July  2012), Prescrire points out that the need to root out undue influence does not stop there.

Certainly, the medical profession should clean up its act, as suggested in the feature on illegal promotion of antidepressants by GSK (1), but so should health authorities.

Recent drug disasters, such as the Mediator° (benfluorex) fiasco in France, are testament to the harmful effects of conflicts of interest at the institutional level (2).

Not surprisingly then, as French prescribers have gained greater awareness of drug marketing practices (3)(4), they have adopted a critical stance towards pharmaceutical companies’ promotional activities (5); and some 19 000 of them have responded by seeking out, and paying for, their own independent information and continuing education from reliable sources, such as the French journal La Revue Prescrire (6) (Table 1). Prescrire is entirely financed by its subscribers; there are no grants, no advertising, no shareholders and no sponsors.

Table 1: Breakdown of paying subscribers to La Revue Prescrire
Occupation    September 2010 September 2011
Number % Number %
General practitioners 14 368  49.3% 16 857  48.7% 
Specialists 1 480  5.1%  1 996  5.7% 
Pharmacists 5 909  20.3%  6 872  19.8% 
Others 7 345  25.3%  8 947  25.8% 
Total circulation 29 102  100%  34 642  100% 

Why? Because access to independent, reliable data is essential for making informed decisions, with patients, about various treatment options. Critical appraisal of ‘official’ clinical guidelines from an evidence-based perspective is also relevant (7).

While many might still accept the advances of the pharmaceutical industry, one should not underestimate the growing number of healthcare professionals who opt to pay for their own continuing education and who reply “no thanks” to industry’s attempts to win them over (the cost of which ends up being paid for by patients and society at large).

> Read this response online at bmj.com

©Prescrire 23 July 2012

References:
1 - Jack A. "Mea culpa: are multi-billion dollar fines forcing drug companies to clean up their act?" BMJ 2012;345:e4865. > Read online
2 - Prescrire Editorial Staff  “The Mediator° scandal in France: key dates, key issues” Prescrire Int 2011; 20 (121): 280. > Pdf, free
3 - Prescrire Editorial Staff. "The proven, often unconscious, influence of small gifts" Prescrire Int 2011; 20 (122): 303-305. > Pdf, subscribers only.
4 - Prescrire Editorial Staff. "Key opinion leaders: used as a marketing tool by drug companies" Prescrire Int 2012; 21 (128): 163-165. > Pdf, subscribers only
5 - Prescrire Editorial Staff  “15 years of monitoring and one simple conclusion: don’t expect sales representatives to help improve healthcare quality”  Prescrire Int 2006; 15 (84): 154-159. > Pdf, free
6 - Prescrire Editorial Staff. “The "Non merci..." Charter 2012”  english.prescrire.org > Free
7- Prescrire Editorial Staff. "Clinical practice guidelines from the French National Authority for Health need improving" english.prescrire.org > Free
Read this response
online at bmj.com

For more information:

The Mediator° scandal in France:
key dates, key issues
Prescrire Int 2011;
20 (121): 280.
Pdf, free

Small gifts: proved
to have an influence,
albeit often unconscious
(December 2011)
Free

Opinion leaders' brand image
used to promote pharmaceutical
companies
(June 2012)
Free

Pharmaceutical sales
representatives: no hopes
for improved care
(June 2006)
Free

"Non merci": Prescrire =
no conflicts of interest
(August 2010 )
Free

Clinical practice guidelines from
the French National Authority
for Health need improving
(May 2009)
Free