Issue 26 / 18 July 2011

THERE have been major changes in the relationship between the medical profession and the pharmaceutical industry in the past couple of decades.

Gone are the days of free travel and junkets — and rightly so. No longer is it appropriate for doctors to accept expensive gifts. To this end, guidelines have been developed by the relevant medical professional bodies and the pharmaceutical industry.

However, this is a complex issue, particularly as the industry currently plays a significant role in the areas of education and research.

Increasingly, it is recognised that if a meeting or conference is sponsored by industry, the content must be independent of the sponsors and any potential conflicts of interest in the organising committee declared. Conflicts of interest for all speakers should also be declared.

This recognition should extend to travel for partners or friends to these meetings, which should not be paid for by industry. Smaller meetings such as grand rounds or departmental meetings should not be sponsored.

The pharmaceutical industry relies heavily on the medical profession for the development and testing of its products, principally through clinical trials. And there is no doubting these trials are essential if new drugs are to be made available to patients.

To avoid potential conflicts of interest in this area, payments for clinical trials or other research should be made to institutions not to individual practitioners and these payments must be appropriate for the amount of work done.

Researchers must retain their independence when interpreting and presenting results of sponsored research. It goes without saying that any sponsorship should be declared when a researcher discusses the findings in an open forum.

Many senior doctors are members of pharmaceutical company and other industry group advisory boards. These groups can guide the relevant companies on policy but should be conducted according to appropriate standards.

The pharmaceutical and other medical industries are fully entitled to promote their products. After all, they invest enormous sums of money into developing products that would not otherwise become available, such as statins, proton pump inhibitors, the many antihypertensive agents, anti-TNF agents and antiviral agents. These drugs have led to significant improvements in both quality and duration of life.

However, it is essential that individual products be promoted by their intrinsic benefit and not by what benefit the prescriber may receive. This is what patients expect.

Yet, complex issues remain. For example, should drug advertising still be allowed in medical journals?

Emergency Medicine Australasia recently decided that it should not. Although this may be an extreme reaction to perceived problems with the pharmaceutical industry, they encouraged other journals to follow suit.

Relationships between doctors and industry should be open and honest on both sides. It is up to each of us to deal with industry in an open and ethical manner and to be aware of, and declare, any conflicts of interest that may exist.

One simple test is to ask, not “what’s in it for me?” but rather “what’s in it for them?”.

Warwick Selby is a Sydney gastroenterologist and clinical associate professor of medicine at the University of Sydney. He is a member of the advisory boards of Abbot, Ferring Pharmaceuticals and MSD. He is a paid speaker at educational courses for Given Imaging.

Associate Professor Selby will be a speaker at a seminar titled “Doctors and the drug industry” in Sydney on 2 August as part of the University of Sydney Controversies and Leadership in Health Seminars.

Posted 18 July 2011

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