A TROUBLING RELATIONSHIP
Big Pharma and the medical profession are too close, doctor says
Big Pharma wining and dining doctors, paying physicians for speeches and funding clinical trials.
Those are examples of the troubling relationship between the pharmaceutical industry and the medical profession explored in the new book Doctors in Denial: Why Big Pharma and the Canadian Medical Profession are too close for comfort. Author Dr. Joel Lexchin, an expert in pharmaceutical policy who spent more than 30 years as an emergency room doctor in Toronto, spoke with the Star about his fourth book.
The book, looks at the pharmaceutical industry and its relationship with the medical profession, including organizations, institutions and individual doctors. Lexchin argues Big Pharma’s influence is felt in medical schools, research, the development of practice guidelines and the prescribing habits of doctors.
“I wrote this book not to attack the medical profession or even the pharmaceutical industry, but because I’m concerned about the extent of the relationship,” said Lexchin, professor emeritus at the School of Health Policy and Management at York University. “Both parties have different values. And when those values clash, people get hurt.”
Your book notes that many doctors say they’re immune from influence and are offended by the suggestion they could be swayed by attending an industry-sponsored dinner or educational event. Why don’t you think that’s possible?
We think we’re invulnerable, that our medical training means we approach things with scientific objectivity. But we really don’t. Doctors don’t realize they can be influenced at a subconscious level. Drug companies give gifts to individual doctors or medical organizations, such as money, a dinner invitation or drug samples. That creates a gift relationship. Once you get a gift you feel you need to repay it. For example, an American psychologist looked at how people responded to Hare Krishnas handing out flowers and requesting a donation. Most people didn’t want a flower, but if they took one, many gave a donation because they’d gotten a gift and felt they had to reciprocate.
You mention various situations between industry and the medical profession that can a create conflict of interest or the perception of a conflict. What relationship do you find most troubling?
The relationship between the sales reps and doctors. Doctors see sales reps, to a certain extent, as friends. Sales reps are trained to learn about doctors, their families, what they like and don’t like. So from the doctor’s point of view, this is a relationship where you may talk about drugs, but you’re talking with a friend. The sales reps are trained to view doctors as their clients, to develop a relationship that results in doctors prescribing more of their company’s products.
I suspect a lot of doctors would say they know when they’re being sold to and when someone is trying to pull one over on them.
A lot of them would. I don’t think every doctor is influenced every time. But drug companies are spending about $550 million a year in Canada on salaries and expenses for sales reps. They wouldn’t spend that if they weren’t getting a return for it.
Why is the relationship between Big Pharma and doctors bad for the patient?
Drug companies are in business to make money, they have an incentive to play up good points about their products and play down the bad points or safety issues. Doctors, on the other hand, see their role as helping people and providing good quality care. And when you’re getting information that’s biased and acting on that information, then doctors aren’t delivering the best care to patients. That’s the real danger.
You note that industry has funded research that may otherwise not have been done, paid for new departments in cash-strapped institutions and given doctors free drug samples that benefit patients who don’t have a drug plan. Still, you find the relationship between the industry and medical profession troubling. Do you see any benefits?
The relationship, to a certain extent, has evolved because the government has not stepped up. Per capita, we fund medical research at one third the level in the United States. The Canadian Institutes of Health Research budget is about $1 billion a year and the National Institutes of Health in the U.S. is about $30 billion. And why are free drug samples necessary? Because about one in 10 Canadians have no drug insurance and if doctors want to make sure they get the medications they prescribe the only way to do that might be through drug samples. Drug companies have come up with products that are very useful — to that extent, the relationship is good. But I don’t think that’s who should be giving doctors the information.
Is the medical community putting patients first or unwittingly supporting industry’s goal to make more profit?
Both. I’ve worked with thousands of doctors and the number who consciously are not looking out for the best interests of their patients can be counted on one or two fingers. But, at the same time, if doctors interact with industry and don’t recognize the results of those interactions then they’re putting the interest of the industry above the interest of their patient. Doctors, and the medical profession in general, are in a conflicted situation. The way to get out of that is to create a firewall between medicine and industry.
What are some key changes that should occur between how the two interact?
First, there needs to be clear leadership from the top of the medical profession that certain practices are not acceptable. Second, both levels of government need to recognize this is a real problem. Government should provide more money for medical research to decrease the need for doctors to turn to industry and become more aggressive in dealing with the ways industry promotes its product.
You support the Open Pharma campaign calling on government to compel drug companies to reveal payments to doctors. In June, we got a first glimpse at how much physicians get, when the Canadian branches of 10 drug makers voluntarily revealed they paid $48 million in 2016 to doctors for work such as sitting on advisory boards and attending conferences. Critics say more transparency is needed, but do you think we’re at a tipping point?
What’s being done in Canada is minimal compared with the U.S., Australia and European countries. I think the industry is going to be embarrassed into being more transparent about the interactions it has with doctors. They may do that because they don’t want to be regulated into doing it. And I think Health Canada is moving in a direction where it’ll be releasing more information about clinical trials that drug companies submit so people can reanalyze the data to see if the purported benefits and safety is what they are claiming. But transparency is only the first step. Transparency alone isn’t going to change what’s going on.