Physician, heal thyself

Observations on Big Pharma

A study published in the United States at the end of last month should worry all concerned about health care. It detailed the deep financial ties between the pharmaceutical industry and the academics who educate medical students. The study, by Eric Campbell of Massachusetts General Hospital in Boston, a leading expert on health care, has exposed the extent to which drug companies buy influence in medicine and precisely how extensive are the links between America's medical schools and drug companies.

Some sit on boards of directors. Others have stock options. Grant money for research is commonly accepted, as are fees for giving lectures about a company's drugs. Of the 460 departments surveyed, only a third operated independently of industry influence. Five department heads admitted that drug company reps had given them gifts such as tickets to sporting events, prohibited by industry and academic guidelines. And the reaction from doctors? Almost nothing.

It is not that the results lack significance, nor that doctors are unconcerned about the influence of the big pharmaceutical firms.

Hundreds of studies have shown that industry money corrupts other areas of medicine, from the distortion of clinical trials through to the financial kickbacks that doctors receive for prescribing specific drugs. Drug companies spend more than $1bn a year on continuing education for doctors, for example, and such investments are not made without an expectation of a return.

Academics are well aware of the industry's dubious record and that drug companies have faced plenty of negative publicity in recent years. Pharmaceutical sales reps are known to have given doctors misleading information. Patients have died because drug-makers were not honest about side effects. Overall, the scandals have cost the industry billions and wrecked its reputation.

Each successive revelation prompts calls for reform from doctors. But the latest drugs bill, passed by Congress last month, contained little to trouble the industry. Big Pharma makes big donations to politics, too.

One reason for the muted response to the revelations of new links with academia is fatigue. Hundreds of studies have revealed the corrupting influence of industry, and the law of diminishing returns is at work. There is another reason, too. The doctors who accept industry funds know all about the studies that show the corrupting influence of money.

Psychological research suggests they continue to cash the industry's cheques because each believes he is incorruptible while believing that others would be influenced by gifts. The same thing happens among academics. Many medical school heads who took part in the latest survey said they believed large grants from drug companies could indeed cause bias in teaching or research.

Yet, in clear contradiction, most medical schools routinely accept the grants. The answer lies in human nature. While hundreds of studies show that pharmaceutical money distorts almost every aspect of medicine, each chair of these medical schools believes that he or she is personally immune to such persuasion.