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

To the Editor: The Journal recently published three interesting articles on the relationship between the medical profession and the pharmaceutical industry.1-3 With Medicines Australia (the pharmaceutical manufacturers’ association) setting up a strict code of conduct (tighter than for any other industry I know), a better balance seems to be on the horizon. Breen reminded us of our responsibilities to protect ourselves and our patients from slick marketing by pharmaceutical companies.1

One technique our surgery has found useful is to have a personal code of conduct. Our surgery has a guide for pharmaceutical reps (copies available from the author). It advises reps that we are not interested in seeing their promotional material, especially those useless coloured graphs. However, we are very happy to look at published trials regarding their product and associated diseases. Personally, I have found the resources available from many reps useful and time-saving.

Breen is concerned about our professional leaders being in denial about the influence of the pharmaceutical industry on doctors’ prescribing habits. If this is so, then the same leaders have complete amnesia and catatonia about another influence that potentially threatens to engulf us.

The sale of supplements and complementary medicines in Australia is a billion-dollar business now. Every month I receive more requests to use supplements for conditions varying from heart disease, cancer and fatigue to non-specific therapies such as detoxification, immune support, metabolic enhancer and anti-ageing. I can sell all these products directly to consumers (patients) at a mark-up I consider reasonable. Alternatively, I can recruit patients to become sellers in a multilevel marketing scheme (similar to pyramid selling). One doctor who practises nutritional medicine full-time has told me he buys $10 000 worth of vitamin E at the start of the year and manages to sell it over the ensuing 12 months for $100 000. I imagine most of that doctor’s patients are recommended vitamin E for their health complaints or health maintenance. This is entirely legal, although there are major ethical concerns about conflict of interest.

To date, there has been little debate among our leaders regarding proper guidelines and regulation of this behaviour. With the enormous potential of the complementary industry to be a useful partner in health management, this needs to be sorted out sooner rather than later.