Rupert Cornwell: The vast cost of drug promotion puts judgement in doubt

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The Independent Online

Links between the big drug companies and doctors have become increasingly controversial in the US, as the pharmaceutical industry showers physicians each year with billions of dollars in the shape of free samples, speaking fees and perks like all-paid conference trips, to help promote their products.

Most doctors play down the risks, insisting that whatever they receive from the companies has no effect on their judgement. But critics say the system creates dangerous conflicts of interest.

According to a January 2009 article in The New England Journal of Medicine, evidence indicated that "drug promotion can corrupt the science, teaching, and practice of medicine".

The issue is anything but straightforward, as some kind of relationship between the companies and individual physicians is inevitable – indeed necessary – for doctors to have access to the latest drugs and see which ones work best on their patients. But the money involved is huge.

According to a recent study by the University of Quebec, drug companies spend an astronomical $57bn in the US annually promoting their products to doctors – more than they spend on conventional advertising.

And much of the money goes on pushing new drugs that are no better, merely more expensive, than the ones they are designed to replace. "We should pay for innovation," says Dr Joel Lexchin, one of the authors. "Too often we are paying for the promotion of new drugs that offer no new therapeutic value."

No less open to abuse are the financial links of drug companies with some of the country's best known academic physicians. On Capitol Hill, Charles Grassley, senior Republican on the Senate Finance Committee, has investigated some 20 top medical universities, including Harvard and Stanford, for under-reporting the income their leading researchers get from the drug industry.

Doctors downplay these and other practices. "I take such endorsements with a pinch of salt," one Washington-area GP said. But many say the drug industry has gained wide control of how doctors evaluate its products. These ties, according to The New York Review, "affect the results of research, the way medicine is practised, and even the definition of what constitutes a disease."

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