94% of physicians have a financial relationship with the pharmaceutical industry. Could this affect their judgement when prescribing drugs?

New England Journal of Medicine 2007 Apr 26;356(17):1742-50

A national survey of physician-industry relationships.

Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D.

Institute for Health Policy, Massachusetts General Hospital-Partners Health Care System and Harvard Medical School, Boston, MA 02114, USA


3 Replies

  • I think the answer is "of course it does", that's why the pharmaceutical industry does it. However, conflicts of interest are more complex than just money from the pharma industry, and often more than just "follow the money". As an example, most UK doctors are employed by the NHS, and advised by NICE, which pay for the drugs, so the NHS has a financial interest in NOT prescribing. And a doctor will naturally support their own discipline against a degree of evidence (look at the current mammography debate). The NIH spends 3 times more on AIDS research than on mental health research, despite the vastly greater burden of psychiatric illness. These are vested interests rather than financial interests, but the effect is often the same. I think that the pharma industry needs very strong (external) regulation indeed, but we do need to ask ourselves what the alternative might be. The bathwater is very dirty indeed, but we need to look after the baby as well.

  • This is a 2007 US national survey. I think it is only appropriate to quote it in those terms and important to remember that while there may be some relevance to other countries we cannot generalize. I am wondering about austalasia for instance.

  • In the UK, it most certainly does. Now in the UK GP's (general family doctors) have much more control over their own budget spending and which drugs they will or won't prescribe. This leaves Dr's open to bribery or financial incentives let's say, from the pharma's who offer them new drugs. It's unclear what oversight is in place to ensure this doesn't happen.

    Another alarming thing I've noticed, is that many GP's in the UK aren't all that clued up on many drugs they're prescribing (probably because they prescribe so many and are so over-worked). For example, one drug I was recently prescribed has been linked to cancer in tests on rats in the first round of clinical testing. This was dismissed and the drug was licensed, but a more recent re-evaluation test based on newer testing procedures, revealled the drug produced another type of cancer (T-cell) in rats also.

    When I informed the GP about this, she had not only no knowledge of the fairly recent finding about the T-cell cancer, but also the previous study even! I found that quite alarming. They say a Dr is supposed to act in the patients best interests and never do anything which could harm a patient. Well prescribing drugs which produce cancer in animals and not even knowing about this can't be considered acting in the patients best interests in my book.

    This also goes to show, that each patient should have some involvement in their own healthcare and treatment options. Don't blindly follow what a Dr tells or gives you. Do your own research and ask questions.

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