The relationship between doctors and drug companies continues to draw scrutiny, skepticism, and suspicion, despite the absence of proof of harm. The rhetoric and conjecture are not merely false, but corrosive of medical professionalism and toxic for patients.
This sanctimony continues, unchecked, thanks to the efforts of a small cohort of anti-relationship puritans who seem oblivious to three simple facts.
First, we live and work in an era of “consumer conversation” in which top-down marketing is increasingly outdated. Thanks in part to the user-generated power of the Internet, there has been an unprecedented rise in the demand for product and company transparency in all business sectors: it is now the customer (physician, patient, the public) who is in charge, and that customer wants insights on existing and future products. Consumers are adept at distinguishing between overt brand promotion and useful information that helps them to live longer, healthier, and happier lives. The pharmaceutical industry is struggling to adapt to this new environment because its activities are already so heavily policed that attempting to participate in the conversation leads into a regulatory minefield.
Second, medical and pharmaceutical professionals aspire to the same goals. It is in everyone’s interest that medicines are safe and effective. Physicians who collaborate with industry are not simply duped—and many, rightly, find the implication offensive. Instead, they see an opportunity to help patients through an ethical exchange, and they don’t allow sensationalized media scare stories about fraudulent trials, dangerous drugs, and corrupt doctors to sway them.
Since the medical community recognizes the value of knowledgeable engagement with industry, it has begun to incorporate education geared toward responsible cooperation. New courses and codes of practice at a number of American medical schools teach students how to interact with the pharmaceutical industry, and similar efforts are being considered in the United Kingdom.
In February 2009 the Royal College of Physicians (RCP) in London published recommendations from an eighteen month-long review of interactions between the pharmaceutical industry, physicians, academia, and the National Health Service that argues for a more collaborative culture between industry and physicians. The review points out that more funding from industry would allow medical students better training in prescription, a process marred by high error rates in the first few years after graduation from medical schools. The distrust of industry means that education is persistently underfunded. The RCP reviewers seem to have no trust deficit. “Industry has a distinctive voice that students deserve to hear,” they contend.
The failure adequately to train medical students in the workings and literature of pharmaceutical development persists into the professional ranks. A 2008 study in Psychological Science in the Public Interest points out that “many doctors . . . do not understand what health statistics mean.” Prescribers misunderstand efficacy and safety reports about pharmaceutical products, and the resulting excesses in enthusiasm and concern surrounding drugs can have devastating consequences for patients. Harmonious physician-pharma interaction demands a clinical community that comprehends data. Physicians’ statistical illiteracy is not the fault of the drug industry, but drug industry money could help mitigate it, if we gave it a chance.
The third fact that anti-relationship advocates miss is that a better-educated patient population expects its physicians to engage in a dramatically altered physician-patient dialogue. Again thanks in large part to the Internet, doctors no longer hold a monopoly on medical information. Patients research symptoms and semi-self-diagnose ahead of their initial meeting with their physicians. They also research therapeutic recommendations and include peer-recommendations in their decisions to embark on courses of treatment, pharmaceutical or otherwise. Patients review products, rate doctors, and rank companies as part of a process of managing their conditions.
We are witnessing patients assert a consumer-like approach to medicine, with pioneers such as the community members at PatientsLikeMe.com. In exchange for expedited solutions to the challenges their conditions pose, they willingly abandon confidentiality and openly deliberate about medicines not necessarily licensed for those conditions. These patients thereby support the aims and intents of industry and are even starting to influence the direction of research.
Doctors should be involved in this new frontier of medicine, but opponents of physician-industry collaboration need to appreciate that the arguments purporting bias and influence by pharma are outdated. They are yesterday’s news. The balance of power over company and product transparency has shifted significantly to patients, who have been efficiently using social-media tools to aggregate their voices and expand their influence. Critics and commentators on directional influence are, quite simply, looking in the wrong place.
Ultimately, the anti-relationship puritans, in ignoring these three facts, are stifling the translation of scientific innovations into health gains. Their concern is for medical professionalism and academic integrity, yet those will more likely be compromised if we stymie interactions between industry and academy by attempting to enforce draconian rules of engagement. Tomorrow’s medical experts will not understand the drug development pipeline, and patients will suffer physicians’ and academics’ commercial illiteracy. Medical innovation may be hindered if we further limit interactions, and medical professionals and industry researchers may find it equally frustrating if restrictions on interactions limit their professional aspirations. If pharma-sponsored education, interaction, and strategic alliances are vanquished, we may witness tomorrow’s doctors practicing yesterday’s medicine.
Accordingly, Web 2.0 tools, which rely on “user-generated content,” should be part of the infrastructure to develop more, not less, collaborative communities. The popularity of patient forums (which outnumber brand/industry-sponsored forums by five-to-one), established physician-only network sites such as Sermo, and pharma-physician conduits is overwhelming evidence that we are online, we want to engage, we need to connect. As co-founder of the new site MedPharmaConnect, I have seen that desire in action: I was compelled to create the site by physicians, academics, and patients who have repeatedly sought an environment in which they can expand their professional alliances with pharma and engage confidently and openly. Pharma is not influencing these experts—these experts are seeking to align with equanimity.
Loathe it or love it, this connected generation will continue to insist that the immediacy of blogs, podcasts, and discussion boards usurp the dinosaur of the medical journal, and physicians and academics will have more and more complex relationships with industry. We must embrace the value of these relationships rather than seek to stop them. Because—headlines, bickering, and utopian ideals aside—patients and the public simply want relationships that generate results.