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Healthy Skepticism Library item: 18774

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Henry D
Doctors and Drug Companies: Still Cozy after All These Years
PLoS Med 2010 Nov 2;


The relationships between doctors and drug companies are controversial and have long been scrutinized by researchers, ethicists, professional bodies, and legislators [1]. In recent years, growing concerns about these ties, and allegations of some corrupt practices, have engendered a large amount of coverage in the media and professional journals [2]–4.

In my experience, the main concerns about close ties between companies and doctors are that 1) they lead to inappropriate prescribing that can harm patients; 2) they create divided loyalties for doctors between the health system, their patients, and manufacturing companies, which is a conflict of commitment as well as a conflict of interest; 3) they lead to use of unnecessary and expensive medications with consequent costs falling on health care systems and patients; 4) they may lead to medicalisation of human variation, i.e., “disease-mongering”; and 5) they diminish the professional standing of doctors in the eyes of the public and governments, which leads to a reduced ability to advocate for the health of patients, for the public, and on behalf of the profession.

In response to community concerns, legislators have tried to improve the transparency of the relationships between doctors and drug companies-for example, the recently passed Physicians Payments Sunshine Act in the United States, and mandatory disclosure requirements for companies in Australia [5],6. These require public reporting of certain types of industry-sponsored activities; in Australia this includes the nature of the sponsored meetings, the venues, any hospitality provided, and overall costs [6].

In response to widely voiced concerns, professional bodies around the world have tightened their codes of conduct, and the state of Massachusetts passed legislation banning gifts from drug and device manufacturers [7]–9. Drug companies are trying to reduce some of their more egregious activities, such as provision of lavish gifts and entertainment, and overly generous travel support. Recent revisions to the Code of Practice of the Pharmaceutical Research and Manufacturers of America specifically prohibit these activities [8]. Such activities have long been the focus of those who have questioned the relationships between doctors and drug companies. They have also been the main target of the legislative responses in the US and Australia. But, open-ended activities such as “unrestricted” research grants, “educational” grants, membership in speakers’ bureaus and advisory panels, consultancies, and stock-holding could be of greater concern, through an insidious blurring of professional boundaries and obligations [10]. There is evidence that these types of ties are common among specialist physicians [11]….


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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909