Pill Whoppers

That respected repository of medical wisdom, the British Medical Journal, has devoted it’s current issue to the vexed question of doctor/drug company relationships. One side of this eternal argument insists that the creme de la creme of our great teaching hospitals are but putty in the well-manicured hands of some mid-range drug company rep when she pops into the surgery with a bunch of freebie pens and news of a fabulous new bum ointment – that goes where no other bum ointment has gone before. Fifty pens and a Hungry Jack’s voucher later and our easily duped medico is just a bum ointment script producing machine for Intimidatapharma Inc. Lots of seniors are phoning each other with their latest “under the doctor” news, recommending that older less efficacious bum ointments be abandoned in favour of the superlative new product and authorisation clerks at the Health Insurance Commission are wondering exactly why there’s been such an outbreak of bum blemishing…meanwhile the coffers of Intimidatapharma Inc are overflowing with loot sucked from the ever-dwindling pharmaceutical benefits scheme

The other side points to the fact that the great therapeutic advances of the last 50 years have been built on the vast profits of the pharmaceutical industry. They also argue that we don’t spend squillions producing doctors whose ethics can be abandoned for the less than intoxicating allure of marketing freebies.

Confusingly, everyone is right.

The medical and pharmaceutical empires are mutually interdependent and utterly interlinked. Transparency of process, in regard to that symbiosis, is crucial. But we also need to accept that there are good and powerful reasons for that synergy continuing, not least of which is the fact that medical research doesn’t happen without clinical expertise or industry investment.

We also need to recognise that we can get too precious about “morality” in this sphere. It all depends on the strategic context. When the government moved to reform the Pharmaceutical Benefits Advisory Committee a couple of years back, the principals of that august body loudly protested at the inclusion of a pharmaceutical industry representative. The view was that the entire process would be irretrievably compromised by his presence. Given that they themselves, like all senior medicos, had acted as paid principal investigators on clinical trials – presumably without ethical blemish – it was difficult to see how they would be so compromised on this occasion.

I’ve no doubt that there’s a lot of pressure on prescribers to prescribe and a lot of unnecessary prescribing. I just don’t share the mindset that it’s all about the Machiavellian plotting of Big Pharma. Physician heal thyself – preferably with non-PBS therapy – may well be the best diagnosis.