Companies are misleading doctors, patients and governments to push their medicines, says a special edition of the 'BMJ'

The "murky" relationships between the world's leading pharmaceutical companies, supposedly independent medical journals and family doctors are exposed in the British Medical Journal today.

A landmark edition of the BMJ is devoted entirely to claims that patients and governments are being systematically misled over the benefits of new treatments and therapies by drugs giants. It is the most comprehensive and damaging dissection to date on the tactics used to promote new drug products, despite supposedly strict guidelines safeguarding the independence of research and a ban on advertising medicines in Britain.

One of the BMJ studies exposes the first weak link in the chain from a company developing a drug to it becoming an international "bestseller". It outlines how pharmaceutical companies increasingly sponsor research into therapies and treatments previously funded by governments. Scientists from York University in Canada found that published clinical studies sponsored by pharmaceutical companies were four times more likely to favour products made by that company. The drugs in question ranged from contraceptives to treatments for depression, osteoarthritis and Alzheimer's disease. In some supposedly independent academic studies, the drug produced by the sponsoring company was compared with an "inappropriate" alternative, or was given at a higher dose, meaning it was bound to be more effective, the BMJ claims.

The next step for the drugs giants is to get their new products approved by govern-ments. Experts for the BMJ analysed the way in which five antidepressant drugs were submitted to the Swedish authorities for marketing approval. As well as submitting "favourable" trials sponsored by the drugs companies themselves, the journal found that some studies were being submitted twice, or even three times, but in different publications so that the pile of evidence looked weightier. "Selective" submissions meant trials that did not strongly support the drugs were left out.

Richard Smith, the editor of the BMJ, analysed the influence drug giants had on the medical newspapers - their shop window for prescribing doctors. Many publications rely heavily on revenue from advertisements placed by the very drugs companies they should be scrutinising - adverts Mr Smith says are often "misleading". Moreover, some companies may offer to buy advertising space on the basis that the paper runs articles favourable to their products.

"Health care, doctors, journals and, I believe, the pharmaceutical industry, would all benefit from relationships being less grubby and kept more at arm's length," Mr Smith concludes.

Yet another study cited by the BMJ found that GPs who regularly spoke to sales representatives from drug companies were more likely to prescribe medicines unnecessarily and in contravention of guidelines. Mr Smith said: "The [drug] industry dominates health care, and most doctors have been wined and dined by it."

But perhaps most worrying is the way that drug companies in Britain now give money to patients' groups - or even set up their own ones - in an effort to promote products directly to the public. Unlike in the US, there is a strict ban in Britain on marketing prescription medicines directly to the public. But patient groups are now relying on drug companies for up to 20 per cent of their funding, says a BMJ article.

The Association of the British Pharmaceutical Industry (ABPI) complained that it had not been contacted for comment by the BMJ. Dr Trevor Jones, the director general of the ABPI, said: "The UK-based pharmaceutical industry strives to maintain the highest possible ethical standards in its dealing with healthcare professionals and other stakeholders." But Ray Moynihan, a pharmaceutical specialist who guest-edited the BMJ issue, told The Independent: "The stakes have been raised recently, because all the big drugs companies are chasing that big blockbuster drug which will keep their shareholders happy."

Rappid campaign group with links to vaccine firm

A new campaign group was launched in the UK last year called Raising Awareness of Paediatric Pneumococcal Infection and Disease (Rappid).

Less well publicised was that Rappid was set up and funded by the drug company Wyeth, which has developed a vaccine against those diseases. It grabbed headlines at the outset with a story linking pneumococcal diseases such as meningitis with the increasing numbers of children in day care. The media reported how 50 children under five die each year from complications caused by pneumococcal diseases.

The media reported how Rappid ­ described as a group of parents and health experts ­ was urging the Government to introduce routine vaccines against pneumococcal disease.

The group now puts out press releases raising awareness of the diseases and its website also features a news archive with headlines such as "Babies with meningitis 'become troublesome teens' ". It also employs a public relations agency, The Red Consultancy, to handle press inquiries. The PR agency told The Independent: "Rappid was set up last year by parents involved in the area and they approached Wyeth."

A spokesman for Wyeth, however, gave a different story. He said: "Wyeth pretty much established the foundations of this group, which is bringing together concerned parents, healthcare professionals and other interested parties to raise awareness of paediatric pneumococcal diseases.

He said: "We make no secret of our sponsorship." But he would not say how much money Wyeth put into Rappid. Asked about Wyeth marketing the vaccine that Rappid campaigns for, he said: "It would be fair to say that any commercial organisation with a new product will seek to build awareness of that product."