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Emergency Medicine Australasia

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Vol 26 (6 Issues in 2014)
Edited by: Geoff Hughes
Print ISSN: 1742-6731 Online ISSN: 1742-6723
Impact Factor: 1.22

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  • Press Release
February 07, 2011

Doctors and Big Pharma: emergency physicians draw a line in the sand

Doctors need to stop being used as agents of the drug industry in the complex financial arrangement between drug companies and consumers, according to the writers of an editorial in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.

Patients around the world will have noticed drug company logos on items on their doctors’ desks, but may not be aware that sponsorship extends to advertising in medical journals and even freebie trips for doctors.

“It is time to show leadership and make a stand, and medical journals have a critical role to play in this,” said Professor George Jelinek, Medical Director and Professorial Fellow in the Emergency Practice Innovation Centre and the University of Melbourne at St Vincent’s Hospital, and Professor Anthony Brown, from the Department of Emergency Medicine at Royal Brisbane and Women’s Hospital and the School of Medicine at the University of Queensland.

“At Emergency Medicine Australasia we have therefore drawn a line in the sand, and have stopped all drug advertising forthwith.

“We invite other journals to show their support and follow suit by declaring their hand and doing the same.”

Emergency Medicine Australasia is one of the first journals worldwide to take this stand.

The move followed a discussion by Australasian emergency physicians on the detrimental effects of the drug industry in medicine.

Amongst the issues involved are that the industry, one of the most profitable in the world, distorts research findings, such that drug company-sponsored research is around four times as likely to be favourable to its product than independently funded research. 

Also,

  • authors of company-sponsored research are far more likely to recommend a company’s drug than independent researchers;
  • researchers with industry connections are more likely to publish data favourable to a company’s product than those without;
  • selective reporting of results by industry is likely to inflate views of the efficacy of company products;
  • the drug industry has been shown to engage in dubious and unethical publishing practices, including guest and ghost authorship, and apply pressure to academics to withhold negative findings; and
  • the industry spends enormous amounts of money on advertising, which has been shown to change the prescribing practices of doctors, increasing sales in a dose-related manner to the volume of advertising.

“Meanwhile doctors (and indeed journal editors) generally deny they are influenced, yet clearly they are,” said Professors Jelinek and Brown.

“Drug companies value drug advertising in medical journals because it works. It is regarded as highly effective by pharmaceutical marketers, generating at least US$2-5 in revenues for every dollar spent, with growing returns in the long term.

“But this works both ways. Medical journals have equally played a big a part of the problem. Large medical journals keenly solicit drug advertisements as evidenced by adverts they themselves place in publications such as Medical Marketing and Media, a publication aimed at the drug companies.”

The authors maintain that marketing of drugs by the pharmaceutical industry, whose prime aim is to bias readers towards prescribing a particular product, is fundamentally at odds with the mission of medical journals, which is to provide evidence-based, objective data and to eliminate bias where possible, so that doctors and other health professionals can make sound judgements based on the best available evidence, when prescribing for their patients.

“The duty of drug companies is to make profits for their shareholders; this is in conflict with the ethical duty of doctors to provide sound, unbiased advice for their patients.

“Doctors have a fiduciary relationship with their patients, and have an obligation to protect them from those who would use that relationship for profit.”

Claims made about particular pharmaceuticals in advertisements placed in medical journals are often supported by evidence that is neither of reasonable quality, nor independent, Professors Jelinek and Brown said.