Last month, the CEO of Medicines Australia, Brendan Shaw, launched a strong attack on industry critics, and singled out journalist and author Ray Moynihan for special mention.

According to the online industry news publication, Pharma in Focus (sub only), Shaw described accusations that companies “brainwash doctors into over-prescribing medicines” as “not fully conversant with reality”.

He reportedly dismissed allegations that the industry is involved in disease-mongering, and said Moynihan’s criticisms of the industry were “out of date” and don’t recognise the changes the industry has made”.

The timing of his comments is most interesting, given a few recent developments which tend to undermine his arguments.

Pharma promotions a negative for health care

As per the previous Croakey post, a new systematic review raises serious concerns about the impact of pharma promotion to doctors. The editor’s summary, in PLoS Medicine, concludes: “The findings support the case for reforms to reduce negative influence to prescribing from pharmaceutical promotion.”

I regret to report that pharma-funded education/promotion is not only an issue for doctors and other health professionals. This week in Washington, the National Press Foundation is running an educational event about cancer for journalists. It is funded by Pfizer. The arrangements have drawn heated criticism from a number of leading journalists (more here).

It’s a bit tricky for journalists to critique pharma funding of medical education when we’re supping from the same gravy boat.

Pharma pays doctors millions for promotions

News has also just broken of a major journalistic investigation into pharma payments to doctors in the US. ProPublica compiled a “Dollars for Docs” database out of disclosures by seven companies, some as the result of legal settlements. The database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties.

The investigation – a collaboration involving six news organizations – also found that hundreds of doctors paid by pharmaceutical companies to promote their drugs have been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.  The investigation includes a section with advice for public and patients about how to use the database.

The US advocate for quality health journalism, Gary Schwitzer, has described it as “an historic piece of journalism”. (Update: Another interesting overview of the story from the American Association of Health Care Journalists)

(Update, 22 Oct: this article reveals how the investigation used the Google Refine tool in establishing the Dollars for Docs database. ProPublica also has a free widget that people can use on their website to enable readers to search by name for doctors in their state who’ve received money.)

Disease-mongering happens

As for Shaw’s suggestion that disease-mongering is a construct of journalists, there is plenty of evidence otherwise amongst the presentations to the First international Selling Sickness conference held in Amsterdam recently. Have a look for yourself.

Shooting the messenger

History shows that when powerful industries are under attack or facing regulatory pressure, they often aim their fire at the messenger/s.

Moynihan (who, as I’ve previously declared at Croakey is a friend and colleague) is a powerful messenger and it’s not surprising the industry might want to undermine him. His investigation of the industry’s marketing practices have had an international impact. If you follow him on Twitter, you will know that in recent weeks, he has been giving talks to the Selling Sickness conference in Amsterdam, the Cochrane/Campbell Collaboration meeting in the US, and to various media outlets in North America.

But what really matters here is not so much the messenger, but the message. It’s getting ever more difficult for the industry  and the professions to dismiss the evidence about the costs of entanglement, whether it comes from academic or journalistic investigations.

It’s also getting more difficult for regulators and institutions to ignore these investigations, especially in the light of legislative moves in the US to force a more open disclosure of the ties between industry and health care.

In this recent article in Australian Prescriber, I noted that Australia lacks a systematic mechanism for ensuring full and open disclosure of financial ties between industry and researchers/clinicians/policy makers, despite concern that self-regulation by the profession has been largely ineffective and that “medicine is facing a credibility problem of unheralded proportions”.

Some authors have argued, however, that encouraging greater transparency is the wrong solution, and is comparable to asking doctors in the 1800s to declare whether they washed their hands between doing autopsies and delivering babies. A better solution, they argue, is to end the financial entanglements between industry, research and practice.

I know of others who have reacted negatively to that analogy and, when I first heard it, I must admit that it took me aback.

But the longer I think about it, and the more evidence that emerges in this field, the more it starts to seem appropriate.

If entanglement with industry biases research, clinical practice and policy, isn’t it better to get rid of the bias than simply to assume that disclosure is the fix?

Easier said than done, of course.

But history shows that seismic shifts can happen. It’s a point was made by the economist and blogger Nicholas Gruen, after reading this recent article in The Atlantic about misleading medical research.

He says, for example, that in 1968 the Australian economist Max Corden said that free trade was a nice idea but a political impossibility.  By 1988 it was pretty much all over (though it took till 1990 for the final announcement to be made).

As Gruen emailed Croakey: “I guess as an economist watching economists do the impossible by doing no more than being united in their vision of what to do – for instance tariff or tax reform – I’m more optimistic that if a group of respected people come to a clear well understood and argued view, that it can happen. Indeed, I’d say that if one could get a degree of uniformity of what to do, it would be denounced as impossible and within ten years it would have become seriously contested and within twenty, it would have become inevitable.”

We shall see…

Update, 21 Oct:
Brendan Shaw’s response to the PLoS review, reported by Pharmacy News

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Peter Fray
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