Letters
Ethics
Volume 190 - Issue 8

Patients expect transparency in doctors’ relationships with the pharmaceutical industry

Author:  Catherine H Cole

Med J Aust 2009; 190 (8): 459-461. || doi: 10.5694/j.1326-5377.2009.tb02505.x
Published online: 20 April 2009
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To the Editor: Two articles in the 19 January issue of the Journal1,2 and an article on the involvement of pharmaceutical companies in studies of their own products published in The Australian on the same day3 impel me to relate my own experience of attempting to influence my colleagues’ attitudes toward transparency in relationships with the pharmaceutical industry, and my good fortune to be working in a 21st century oncology clinical trials unit.

The relationship between the science of pharmaceutical development and the science of oncology is robust and fruitful. While intending to be only mildly controversial, I caused great offence in my opening address to the Australian and New Zealand Children’s Haematology and Oncology Group annual meeting in 2008 by suggesting that it is no longer acceptable for any of us at the coalface of oncology to deal directly with pharmaceutical salespeople or for medical education to be directly funded by industry.

I note the view of Tattersall and colleagues that “... sponsoring doctors to attend independent conferences is recognised as facilitating continuing medical education ...”.1 In my view, financial support for medical education should come from unaffiliated sources — perhaps competitive grants from the government, who may in turn raise funds from industry.

Similarly, we must be able to deny (not just declare) a conflict of interest in our activities in clinical trials and practice, and teach the difference between clinical trials (phase III cooperative group randomised controlled trials of multidrug treatment, with wide eligibility criteria to benefit as many patients as possible) and drug trials (phase I or II single-agent trials with narrow eligibility criteria, such that adverse effects of new drugs are found quickly). Both groups of trials are essential for the benefit of patients with cancer and leukaemia, as is the need for clinicians to be — and to be seen to be — at arm’s length from industry.

I have been fortunate to work in a clinical trials unit that is supported by a wise medical administration and an ethics committee devoted to the practice of clinical trials as the best evidence-based medicine for patients. Our unit has clinical research associates on staff, is an active member of the United States-based Children’s Oncology Group, and does not partake in trials directly sponsored by industry. Indeed, after 20 years in the field, I know the trade names of less than 10% of the drugs I prescribe. I decline invitations to see pharmaceutical representatives or to attend industry-sponsored events. I followed the leadership of my mentors and senior clinicians. Can I convince today’s trainees to follow suit?

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