A Mediapart investigation published on 24 March 2015 calls into question the behaviour, during the 1990s and 2000s, of several members of the French Health Products Agency's drug approval committees and of the National Authority for Health committee that plays a key role in determining the price of drugs in France and what percentage of their cost will be covered by national health insurance (1). According to this investigation, members of these committees, including a chairman and a vice-chairman, secretly advised pharmaceutical companies for years: "this group of consultants, who often met with pharmaceutical company representatives in Marseille, did not guarantee a favourable decision. The companies knew that. They simply hoped that the committee would look more kindly on them. With no guarantees" (our translation) (1).

This alleged misconduct, which will be referred to the courts, is unacceptable and shows yet again the level of indulgence or even denial shown towards conflicts of interest in the French medical and pharmaceutical world. In fact this indulgence and this denial are taught during health professionals' university training, reinforced during their continuing education, and rewarded by the career of "key opinion leader" and the media exposure it entails. But it is patients who lose out, too often exposed to choices that are not the best for them and that in some cases are unjustifiable.

The responsibility does not only lie with health professionals and those who teach them. What are public authorities and policy makers waiting for to defend the public interest and get tougher on stamping out conflicts of interest in the field of health and pharmaceuticals? Why is there insufficient public funding for health professionals' educational needs, in particular for their continuing education? When will public authorities and policy makers understand that the "savings" they make by allowing drug companies to fund the education of health professionals are illusory, since the companies recover these costs through higher prices and higher sales of drugs reimbursed by public health insurers? And above all, this illusion is harmful, because it undermines the quality of care patients receive.

Complete transparency is required over the links between health professionals and industry: the French version of the "Sunshine Act", which is supposed to provide this transparency, is currently a sham, because the most lucrative ties remain concealed. The €11 meals that unconsciously influence health professionals are disclosed. But nothing is revealed about contracts for "work" or "advice", worth thousands or tens of thousands of euros, that influence decision makers on a grand scale.

Most probably as a result of Mediapart's revelations,  the French Parliament voted in favour of bringing to light all of the links that exist between the drug and device industry and health professionals, particularly those within regulatory authorities assessing health products and those responsible for education.

This unanimous reaction by lawmakers suggests they have understood the Mediator° disaster was not an exception, but the product of a harmful system, at work in France and beyond. An opportunity for France to be an example to follow in this area, rather than a champion of conflicts of interest and irrational drug use.

©Prescrire 21 April 2015

Reference:
1- Hajdenberg M and Pascariello P "Les gendarmes du médicament faisaient affaire avec les labos" Mediapart 24 March 2015: 7 pages.