Chris Lancelot: Doctors and pharma firms need each other

What should be the relationship between doctors and the pharmaceutical industry?

A recent BMJ editorial said emphatically: 'It's time for the profession to take a lead. This means saying no to gifts and hospitality, ensuring that research and clinical collaborations are transparent and unbiased in their design and reporting, refusing to be a guest or ghost author, declining the role of paid opinion leader, paying our way for information and education, and refusing industry support unless it is entirely transparent and in patients' or the public's best interests.'

This all sounds commendably high-principled. However, it is spoiled somewhat because that same edition contains 27 pages of pharmaceutical advertising.

Now I'm not actually against the BMJ carrying pharmaceutical advertising, but it does illustrate the great practical difficulty the profession has in distancing itself from the drug industry.

It is all very well to suggest that doctors eschew pharmaceutical sponsorship of educational meetings in order to avoid bias, but doesn't this also imply that the BMJ, as one of the leading opinion-makers within medicine, should refrain from carrying pharmaceutical advertisements? After all, we wouldn't want the readership to be unnecessarily influenced, now, would we?

Although at first sight it might seem best for doctors and drug companies to have no direct relationship, this stance is simplistic and potentially counterproductive. It would mean no advertisements, no promotion, no educational materials and no sponsored reprinted papers.

Given such restrictions, can we really expect information about new drugs or delivery mechanisms to get out quickly into the real world? Would news about these potential advances not be squashed at source by the groups that removed co-proxamol's licence on 'scientific' grounds - to the immense discomfort of many patients who have still found nothing else to match it?

Yes, of course the doctor-pharma relationship can get bent, but in its best form it is truly symbiotic, beneficial to both parties - and very importantly, beneficial to patients. Doctors can think for themselves, you know.

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