Consider These Five Different Points Of View Presented By The British Medical Journal In Its February 3, 2009 Edition
(Posted by Tom Lamb at DrugInjuryWatch.com)
On February 4, 2009, the Royal College of Physicians of London (RCP) published a report entitled "Innovating for Health: Patients, Physicians, the Pharmaceutical Industry and the NHS", prepared by a working group chaired by Richard Horton (editor of the Lancet), which consists of 70 pages with 42 recommendations.
The British Medical Journal (BMJ), in its February 3, 2009 edition, took the occasion of this report's publication to present five different and distinguished perspectives on the issue of what is the proper relationship between doctors, patients, and drug companies. In the preface to each of these five articles in its February 3 edition, the stage is set by BMJ in this manner:
The relationship between the drug industry, academia, healthcare professionals, and patients is widely held to be at an all time low, and it is in the interests of all parties to improve it. A recent report from the Royal College of Physicians gives 42 recommendations aimed at forging a more productive partnership with industry. Here we set out five views on what the ideal relationship between industry and prescribers and patients should be and what steps need to be taken to achieve it. [citations omitted]
To give you a sense of the five different positions advocated in these BMJ "Analysis" section articles, below we are providing the first paragraph of each item. Of course, if interested, you are encouraged to click-thru to the full version of these relatively short articles and continue reading.
We start with "Relationships with the drug industry: More regulation, greater transparency", by Harlan M, Krumholz, of Yale University School of Medicine, and Joseph S. Ross, of Mount Sinai School of Medicine, in New York:
The relationship between drug and device companies, the medical profession, and the public is at a critical juncture. Individuals who have placed their interests in profit and influence over patients and public health have overshadowed much of the good work and reputations of those who have engaged in constructive interaction. As a result, public perception of the drug industry, doctors and scientists is at an historic low. The public is well served when industry, clinicians, and academicians work together for the common good, generating new knowledge and ensuring appropriate and rapid dissemination of effective products to save lives and improve quality of life. To restore the public’s trust we must set a path forward that encourages ethical collaboration and discourages activities by industry, researchers, or practising doctors that are largely self serving or place financial benefit above patients and the public good. Setting explicit standards of conduct for interactions between industry and both patients and physicians can assist all parties. We propose six. [footnotes omitted]
Next -- and we are following the order in which the BMJ set them forth in its print publication -- is "Relationships with the drug industry: Keep at arm’s length", by Marcia Angell, a senior lecturer in social medicine at Harvard Medical School:
I believe there should be no relationship between the drug industry and either prescribers or patients. Drug companies are investor owned businesses with a responsibility to maximise profits for their shareholders. That is quite different from the mission of the medical profession, which is to provide the best care possible for patients. I start with this simple fact, because it is so often obscured by the industry’s public relations. Drug companies are not confused on this score. Their major output now consists of "me-too" drugs for mild or ill defined conditions in essentially healthy people. This is because that market is big and more easily expanded than the market for innovative drugs for serious diseases. [footnote omitted]
The third article is "Relationships with the drug industry: Collaboration to improve care", by Gordon Coutts, a vice president and general manager of Schering Plough UK:
Healthcare professionals and patients need to have the most up to date information on all the treatment options available to them, including medicines. There is therefore a legitimate place for a responsible relationship between the drug industry and the NHS, prescribers, and patients. This relationship should support the promotion of good medical care, improve health outcomes, and reduce health inequalities. It should include the provision of information to guide valid patient choice.
For a fourth perspective, we look to "Relationships with the drug industry: Build trust based on good science", by Scott Gottlieb, a health policy analyst at the American Enterprise Unit, in Washington, DC:
Medical treatments are becoming increasingly more individual, with respect to both disease and patient. They are also becoming more complex, and precise diagnoses and close monitoring are needed to optimise their use. In this environment, consumers and doctors need to work more closely with product developers. Yet increasing regulation of the drug industry is restricting its ability to disseminate the results of its clinical studies. This risks shrinking the opportunities patients have to improve their health. In the face of regulatory steps to restrain their scientific speech, drug makers need to take new steps in their relationship with doctors and patients and establish transparent guidelines for those interactions. They should also focus more squarely on matters of advancing science, monitoring for safety, and improving health education.
Finally, there is "Relationships with the drug industry: Focus on better information", by
Richard Tiner, medical director at the Association of the British Pharmaceutical Industry, in London:
The primary role of the research based drug industry is to discover, develop, license, and market innovative medicines to prevent, treat, or cure disease. This role has a prime benefit for patients but also helps prescribers in their role of managing disease. The UK industry is committed to a stable and pragmatic partnership with the government and the NHS on medicines—one that enshrines value for money, reward for innovation, and ensures greater availability of new medicines to patients. This should lead to the industry being seen as a trusted partner in the provision of health care by both prescribers and patients.
Certainly, these five BMJ articles give one plenty to think about concerning the issue of what is the proper relationship between doctors, patients, and drug companies.
Now it's time to let us know which of the above positions you agree with -- or present your own ideas and thoughts on this important social policy issue -- by submitting a Comment, below.