The imminent paradigm shift toward the relationship between pharmaceutical industry and medicine

LETTER TO THE EDITOR

The imminent paradigm shift toward the relationship between pharmaceutical industry and medicine^*

Ricardo Costa–Val

MSc. and PhD in Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. Member, SBACV. Professor, Health and Society, Undergraduation and Graduation, Universidade Vale do Rio Verde (UNINCOR), Três Corações, MG, Brazil. E–mail: [e-mail]

How many times, after having attended a fine medical conference on a given theme or after having read a scientific paper in a journal (especially in those that do not require declaration of conflict of interest), have you suspected of a bias behind the indications and conclusions due to a possible relationship between the authors and the industry manufacturing the product under investigation and/or between the authors and the sponsor of the event?

It is undeniable the fact that the relationship between the pharmaceutical industry and medicine (therapeutic, work–up or similar) is not only important, but crucial for the advancement of medical science itself. The history of medicine shows that several serious and methodologically correct studies and research projects were sponsored by the pharmaceutical industry. Actually, without its economic power, large studies would have always remained research projects.¹

It is also important to stress that the relationship between the industry and physicians is not always pernicious, and an ethical behavior by all enterprises should be the rule. Therefore, we cannot start suspecting everything or everyone in a condemnatory fashion. In fact, there are currently many researchers participating in clinical studies in varied areas (such as the new anticoagulants), whose studies are judiciously carried out and inspected by the Food and Drug Administration (FDA) and by the Brazilian Commission on Research Ethics (CONEP), with no restrictions or problems. In addition, the industry has sponsored many events and publications in the area, and without this support it would be impossible to perform them. The relationship between those two parties is not being questioned. What is questioned is how such relationship should be established.

This theme has been increasingly approached, very seriously, by different trends and in different areas, such as sociology, bioethics, philosophy and even law. Thus, it must be deeply analyzed by medicine. Only to give an idea of the problem dimension, the final report issued by City University (United Kingdom) and published in 2006 classified as pathetical the commitment of most food industries around the world concerning the preventive measures established by the World Health Organization (WHO) against obesity, cardiovascular diseases and diabetes.²

Another study, sponsored by the European Commission and published in England on July 2006 by the lobby group Consumers International not only criticized the behavior of the main pharmaceutical laboratories in Europe, but also questioned their ethics after revealing that the investment in marketing in 2005 was R$ 133 billion, which is twice the amount allocated for resources to researches to develop new drugs.²

Nevertheless, more discomforting than that was the publication made by the investigative journalism in Portugal by revealing that the mean participation of a group of Portuguese physicians at a congress in a tourist town was only 13%, although these physician had won registrations, plane tickets and reservations in five–star hotels, under the claim that this investment was fair, since it would return to society as acquired scientific knowledge.³

Moreira Filho sensibly discussed this theme, stating that it is difficult for the physician to be exempt from economic interest in a society that makes money into a factor of prestige and that allows the commercialization of health.⁴ Velloso (former dean of Universidade Federal de Minas Gerais and former president of the Medical Association of Minas Gerais) has recently warned to the fact that physicians should be alert and exercise their critical spirit regarding the use of drugs.⁵ The Brazilian Council of Medicine itself prohibits, in its article 9, any form of commercialization during the practice of medicine.⁶

Among the several factors that influence medical prescription is intense, partially scientific and frequently distorted advertisement, which is performed by some pharmaceutical industries.^7–9

Within the bioethical sphere, we have new proposals on how the relationship between those two sectors should be. Both in Europe and in the USA, there already are restrictions and guidelines concerning this theme, such as the European Industry Code of Practice for the Promotion of Medicines, whose main objective is to assure that pharmaceutical companies perform their activities reliably, thus avoiding deceitful practices and conflicts of interest. There is a movement called PharmFree Campaign, belonging to the American Medical Student Association, which deals with and warns future professionals about the possible ethical conflicts.^9–12 In Brazil, the National Health Surveillance Agency (ANVISA) prohibits the pharmaceutical industry from offering or promising awards or advantages to health professionals able to prescribe or dismiss drugs.¹³

Therefore, we should not question or criticize the past relationship between medicine and the pharmaceutical industry, since it takes a critical and mature analysis of previous attitudes to make some progress. However, a new paradigm is inevitable, centered in a more ethical, more coherent and especially more fair attitude. It has been suggested that future investments by the industry, direct or indirect, should be destined to scientific societies and/or institutions, which have a commitment with continuous education and scientific research, to the detriment of the individual. The new order, therefore, should be based on rationality, responsibility and resistance, because, as in any paradigm change, discussions arise. As has been said once, "it is harder to crack a prejudice than an atom" (Albert Einstein).¹⁴

References

1. Margotta R. The history of medicine. London: Smithmark; 1996.

2. European Public Health Alliance. Marketing practices and accountability of drugs questioned. Disponível em: http://www.epha.org/a/2336. Acessado: 30/10/2006.

3. Marina A. Gentilezas suspeitas. Jornal Estado de Minas. Sessão Cultura; publicado em 15 de março de 2006. p. 2.

4. Moreira Filho AA. Relação médico–paciente: o fundamento mais importante da prática médica.2ª ed. Belo Horizonte: Coopmed; 2005.

5. Velloso C. Medicação banalizada. J Estado de Minas. 2007 fev 10;Sessão Opinião:11.

6. Conselho Federal de Medicina. Código de ética médica. 3ª ed. Brasília: CFM. 1996.

7. Béria JU. Prescrição de medicamentos. In: Duncan BB, Schmidt MI, Giugliani ERJ. Medicina ambulatorial: condutas de atenção primárias baseadas em evidências. 3ª ed. Porto Alegre: Artmed; 2004; p. 143–9.

8. Victora CG. Statistical malpractice in drug promotion: a case–study from Brazil. Soc Sci Med. 1982;16:707–9.

9. European Federation of Pharmaceutical Industries and Associations. Promotions of medicines. Disponível em: http://www.efpia.eu/Content/Default.asp?PageID=150. Acessado: 10/02/2007.

10. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000;283:373–80.

11. European Public Health Alliance. Gifts from the pharmaceutical industry: to accept or not to accept? Disponível em: http://www.epha.org/a/2112. Acessado: 15/02/2007.

12. American Medical Student Association. National Pharm Free Day. Disponível em: http://www.amsa.org/prof/ pharmfree.cfm. Acessado: 15/02/2007.

13. d'Avila RL. Conflito de interesse no relacionamento entre médicos e indústria farmacêutica. J Med. 2007;161:23–4.

14. Drummond JP. Bioética e medicina baseada em evidências. In: Drummond JP, Silva E, Coutinho M. Medicina baseada em evidências: novo paradigma assistencial e pedagógico. 2ª ed. São Paulo: Atheneu; 2004; p. 159–70.

Manuscript received September 18, 2006, accepted March 5, 2007.

*

The authors' opinions do not necessarily reflect those of SBACV and/or of the Editorial Board of Jornal Vascular Brasileiro.

Publication Dates

• Publication in this collection
  19 July 2007
• Date of issue
  Mar 2007