The medical profession and the pharmaceutical industry: when will we open our eyes?

To the Editor: Thank you for publishing the Viewpoint by Breen regarding pharmaceutical industry relationships with the medical profession1 — but please do not coin the word “pharmaproof”. This word unintentionally casts aspersions on fellow clinicians — pharmacists — who share the dilemma of aggressive pharmaceutical marketing influencing professional decisions.

The relationship between the industry and pharmacists is actually more complicated, as we are not only advocates for patients and advisers to doctors on the safe and evidence-based use of medicines, but also the buyers of the pharmaceutical products. This last function means that most pharmacists cannot be removed from the business side of medicine supply and must work with the manufacturers to obtain supplies in a timely fashion and at the best price.

In my work as a hospital pharmacist, the pharmaceutical industry helps in planning financial aspects of medicine supply, sponsoring various activities that the public health system and universities are unable to, and providing specific product information — be it for marketed, unregistered or trial medicines.

Most pharmacists cannot choose to not see industry representatives. The formation of such relationships can indeed insidiously affect our clinical decision-making, as outlined by Breen. Unfortunately, the issue of industry’s influence on pharmacists’ decision-making has only rarely been discussed in the pharmacy literature.2-4

Both medical and pharmacy clinicians must be aware of this influence and act accordingly. Peter Mansfield’s Healthy Skepticism (www.healthyskepticism.org) is a good starting point to increase this awareness. However, the movement must include physicians and pharmacists on the same side. I have often been told that we must have the latest new drug on the hospital’s formulary because . . . and have been given a hefty manufacturer-prepared dossier as the sole reason for the request.

I urge physicians to work with pharmacists and be “pharma(cist)friendly”, yet also “industryaware”.