DOCTORS IN DENIAL Book Review

Vol 2 #12

BOOK REVIEW

Doctors in Denial: Why Big Pharma and the Canadian Medical Profession are too close for comfort by Joel Lexchin MD

James Lorimer & Company Publishers, Toronto 2017. Pages 344.

This is a hard hitting book that names names. The author traces the relationships between the pharmaceutical industry and Canadian Medicine.

He describes the strategies used by industry to influence Canadian Medical and Specialty  Associations, Federal and Provincial Governments, Academic Health Science Centres, the Royal College and the College of Family Physicians of Canada among others.

The pharmaceutical industry has an enormous impact on physician continuing education, research studies and the development of clinical practice guidelines.

Lexchin examines standards developed by various organizations such as the   Canadian Medical Association that have attempted to set limits on the activities of drug companies in determining CME content, advertising copy,  gifts and other funding provided to physicians.  However he finds the enforcement of such policies sorely lacking. He asserts that the medical profession, governments and the industry have failed to protect the public from the harmful fallout of these relationships: poor quality prescribing practices, biased and even “ghost-written” research papers, and inflated health costs to society.

Disclosure of conflict of interest is not enough rather they should be avoided. Disclosure may in fact lull an audience into believing that the conflict of interest has not influenced the content of a presentation or affected the interpretation of research results.

Sales representatives, “drug detailers”,  may provide a rosy picture of a new drug without saying much or anything about potential side effects.

Studies have documented that meeting with detailers, accepting samples, free meals, even inexpensive gifts with company logos does alter physician prescribing practices!

Many physicians may not be aware that drug companies are able to buy from IMS Brogan detailed information about all prescriptions they have prescribed. Thus a company detailer may have statistics on the number of prescriptions issued by a physician for a particular drug. This permits tailoring of the sale’s pitch to the particular physician.

Physicians who believe they are immune to the overt and covert impact of Pharma’s role in all aspects of medicine are ill-informed of the relevant research.

Lexchin concludes with recommendations.

• Academic physicians should not meet with sale’s reps
• The pharma industry should have no role in funding, determining the content of CME or in the selection of speakers.
• All companies should release information on all funding to individual doctors. Funding for CME and research should come from non-industry sources.
• Organizations such as the Royal College of Physicians and Surgeons and the College of Family Physicians of Canada that accredit continuing medical education should report on all sources of funding.
• Medical societies should release detailed financial statements documenting all sources of income and how this was spent.
• Medical journals should require all editors, editorial boards and managers to be free of any conflicts of interest. They should have no financial relationship with any company that advertises in the journals.
• Members of the public should be appointed to editorial boards of medical journals.
• Researchers that have signed off on “ghostwritten” articles should be banned from publishing in journals for several years. Ghostwritten articles should be publicly retracted.
• The selection of individuals to develop clinical practice guidelines should be an open and transparent process. Guideline panelists should be free of conflicts of interest.

This book should be read by physicians, trainees and members of the public.

Alan Eppel