So I don’t like drug companies. Well, specifically, I don’t like their marketing departments, or their data suppression departments (they must have these, right? They’re awfully good at it). I’ve signed the all trials petition, and won’t allow a drug rep across the threshold of our team’s base, for which I am pleasingly notorious amongst them. I’ve stopped all drug sponsorship of meetings I am involved with. So this post is about how easy it is to become compromised, even for a firebrand like me.
It started with an email from a researcher. Would I like to participate in some research into prescribing attitudes among clinicians in the ADHD field? Actually, I’ve always wanted to look into this myself, because I find the way professionals import their own prejudices into these decisions fascinating, so I said yes partly to see how they were doing it. I should have been alerted by the lack of a university affiliation, and when they arranged an interview in an office in Soho, I probably should have cancelled. It was of course marketing research for a new drug that one of the pharmaceutical giants were bringing to market, and these researchers were the outriders of the subsequent pushing of Lisdexamphetamine (which is a decent 3rd line agent). I was a bit startled to be handed £100 in cash after a 30 minute chat with a charming researcher, and I’ve since given the money to an open access kick starter, but what interests me is what had happened since.
Every week I get more emails, asking me to participate in this seminar, that round table, have this interview, to discuss advances in medical treatment. There is never any NHS affiliation, nor university, but the language is deliberately non-commercial. They can be flexible, work round my busy schedule (a form of flattery to which I am not yet immune), and the money…
In 2013 I could have made more than £4000 helping the drug companies with their marketing. That’s not an atypical figure. I’m not publicising this to display my moral fibre- I can’t make any great claim there, but multiply these sums over all 37,000 NHS consultants and 43,000 GPs and the figures are staggering. The point is that they are buying something, more than my time, they are buying influence. I’m continually staggered by the protestations of colleagues that yes, they regularly attend drug-sponsored lunches and presentations but of course they don’t affect their practice, for they, Dr X, are immune to the cognitive biases that plague lesser mortals. Horseshit.
So individual payments to doctors are, at best, suspect, and it’s great news that they will have to be public (sadly with some get-outs) from next year.
But what about support for organisations? In the NHS, medical education is withering, and increasingly dependant on drug money. Most medical charities are heavily funded by these companies. Obviously, if this funding comes with pressure over what is presented, that is straightforwardly wrong, but it doesn’t work like that- quite.
For instance, at first glance, for such an important medical issue, there’s not very much ADHD education out there. But study days happen, fairly often, it’s just that in order to learn about them you have to meet a drug representative, and be invited. So access to education is dependant on exposing yourself to the hard sell.
It’s not always like that, and unrestricted grants are given out for organisations to engage in education projects, which, let’s face it, are not cheap. The drug companies in these cases are discreet: a few logos here and there, a stand outside the lecture Hall… The message is subliminal but powerful: in the hall, messy, nuanced science, dilemmas and unanswered questions; outside the hall, shiny solutions and biscuits.
There’s also a danger of another broader bias: even if we accept that the companies are committed to improving medical education, they will only be interested in areas where more education means more medication prescription- what about areas (I’m thinking of sleep problems and minor infections) where better education will likely result in less prescription?
All of this is by way of explaining my dilemma. I’ve recently joined the board of an educational and advocacy organisation for ADHD that accepts drug company funding, and would argue that it needs to in order to survive. The question is: should I have accepted the invitation? What degree of company involvement should be acceptable if I’m going to remain involved? I honestly don’t know.
So this has ended up less as a broadside at evil pharma and more a confused musing on a tricky subject. I would welcome any views (of the non-extreme kind).