Journal lifts lid on drug industry

By MAXINE FRITH

The "murky" relationships between the world's leading pharmaceutical companies, supposedly independent medical journals and family doctors are exposed in the latest British Medical Journal.

A landmark edition is devoted entirely to claims that patients and Governments are systematically misled over the benefits of new treatments and therapies by drugs giants. It is the most comprehensive and damaging dissection yet on the tactics used to promote new drugs, despite supposedly strict guidelines safeguarding the independence of research.

One of the studies exposes the first weak link in the chain of events from a firm developing a drug to it becoming an international "bestseller". It outlines how pharmaceutical firms increasingly sponsor research into therapies and treatments previously funded by Governments.

Scientists from York University in Canada found that published clinical studies sponsored by pharmaceutical firms were four times more likely to favour that firm's products over others. The drugs ranged from contraceptives to treatments for depression, osteoarthritis and Alzheimer's disease. In some supposedly independent academic studies, the drug produced by the sponsoring firm was compared with an "inappropriate" alternative, or was given at a higher dose, meaning it was bound to be more effective, the Journal claims.

The next step for the drugs giants is to get new products approved by Governments. Experts for the Journal analysed the way in which five anti-depressant drugs were submitted to the Swedish authorities for marketing approval. As well as submitting "favourable" trials sponsored by the drugs firms themselves, the journal found some studies were being submitted twice, or even three times, but in different publications so the pile of evidence looked weightier. "Selective" submissions meant trials that did not strongly support the drugs were left out.

Journal editor Richard Smith analysed the influence drugs giants had on medical newspapers - their shop window for prescribing doctors. Many publications rely heavily on revenue from advertisements placed by the very drugs firms they should be scrutinising - ads Mr Smith said are often "misleading". Moreover, some firms may offer to buy advertising space on the basis that the paper runs favourable articles.

"Healthcare, doctors, journals, and, I believe, the pharmaceutical industry, would all benefit from relationships being less grubby and kept more at arm's length," said Mr Smith.

The Journal claimed international public relations firms were then brought in. They were found to pay "opinion leaders" - doctors and other experts - to promote products as independent experts.

Yet another study found GPs who regularly spoke to sales representatives from drugs firms were more likely to prescribe medicines unnecessarily, in contravention of guidelines. Mr Smith said: "The [drugs] industry dominates healthcare, and most doctors have been wined and dined by it."

But perhaps most worrying is the way drugs firms in Britain now give money to patients groups - or even set up their own ones - in an effort to promote products directly to the public. Unlike in the US, there is a ban in Britain on marketing prescription medicines directly to the public. But patient groups now rely on drugs firms for up to 20 per cent of their funds, says a Journal article.

The Association of the British Pharmaceutical Industry (ABPI) complained it had not been contacted for comment by the Journal.

ABPI director general Dr Trevor Jones said: "The UK-based pharmaceutical industry strives to maintain the highest possible ethical standards in its dealing with healthcare professionals and other stakeholders."

But Ray Moynihan, a pharmaceutical specialist who guest-edited the special Journal issue, said: "All the big drugs companies are chasing that big blockbuster drug which will keep their shareholders happy."

- INDEPENDENT