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Healthy Skepticism Library item: 20484

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

MaLAM's open letter to industry
Scrip 1989 Oct 20; (1457):22


Abstract:

The international doctor’s lobbying network, MaLAM, asked Scrip to publish the following open letter to the pharmaceutical industry to explain MaLAM’s aims and hopes:
“Every month one of you recieves hundreds of MaLAM letters signed by health professionals from around the world. Our letters quote an advertisement, provide a summary of the scientific literature, and ask questions. Most topics are chosen from a list of complaints received from doctors working in third world countries. However, our letters should not be seen as complaints but rather requests for information. We do not know if you have evidence to supporting the advertising claims are consistent with company policy or resulted from an error made by a subsidiary or distributor.

“MaLAM’s questions are an opportunity for you to promote your products and your company. Our hope is that you will either justify the advertising or tell us that you are going to improve it. We wish to see properly designed, conducted and reported double-blind randomised controlled trials to justify your claims. If the claim was an error, we will be reassured in the future.

“The more responsible companies are developing marketing standards documents. Many are modifying the vague provisions of the IFPMA code. The WHO ethical criteria for medical drug promotion provides a better starting point. To ensure that whatever standards you decide upon are implemented consistently you will need to develop effective international marketing quality control systems (IMQUCS). Otherwise embarrassing errors will undermine your credibility.

“Free flow of information is vital for the advancement of scientific medicine to which your industry owes its profitability. If you opt for secrecy, you bite the hand that feeds you. Refusal to answer questions forces us to conclude that you know your marketing practices cannot be justified. Failure to reply forces us to move from correspondence seeking your point og view, to publishing negative reports in the medical journals.

“We believe that drug companies can develop adequate standards and quality control systems. So as to ‘practice what we preach’ MaLAM has in-built quality control. Not only must the letters pass the MaLAM editorial board, they must also be approved by our subscribers, 95% of whom are doctors. Subscribers will only sign our letters if they are consistent with the consensus of scientific medical opinion. MaLAM is funded by subscription so market forces ensure that we reflect the concern of health professionals. This makes MaLAM more useful to all concerned, including yourselves. You can regard us as a free service identifying some of your problems. MaLAM gives you the chance to remedy problems before further damage is done to your reputation.

“MaLAM is not an anti-industry organisation. By contrast, we are keen to counter the widespread belief that the drug industry puts profits before patient care, by providing that you are capable of reform. Our aims are positive. MaLAM’s aim is to encourage drug companies to provide sufficient, consistent, and accurate information to enable appropriate prescribing, dispensing and consumption of drugs. Open, honest communication between health professionals and yourselves is essential for the advancement of scientific medicine. Scientific medicine aids not only us and our patients but is also the best path to increasing your future profitability.

“We believe that many of you in the industry are working for reform and we hope that our encouragement will help you”.

…company responses

The letter is from Dr Peter Mansfield, a full-time GP who founded MaLAM and is its secretary. He suggested that Scrip might like to publish a response, and we have asked two companies – Ciba-Geigy and Organon – which have been in correspondence with MaLAM for their views on the letter.

Ciba-Geigy responded as follows:

“MaLAM’s open letter is a useful document. It certainly merits careful study, and hopefully a bit more – a positive response from the industry in words and deeds. The chances of that happening are good. The number of pharmaceutical companies committed to the cause addressed by MaLAM is growing. The IFPMA code was a good starting point and helped to pave the way for the systematic development of modern ethical marketing standards. The WHO ethical criteria are a further step in this direction. International marketing quality control systems are being developed and are already implemented by several companies – there will be more of them.

“One can hardly emphasise enough MaLAM’s request for a free flow of information. As each drug is a ‘substance plus information’, patients, physicians, and medical science are entitled to have access to all information concerning the effects of marketed drugs. Data safety and efficacy of marketed drugs cannot be considered as confidential.

“Progress has been made, but much remains to be done. Exaggerated claims, undue secrecy, distrust and weakness in the fulfillment of professional duties have certainly been found in pharmaceutical companies, but are by no means confined to this sector. The remarkable offer of dialogue contained in this open letter may helpful in creating the imagination and courage needed for improvement.

“The medical and other healthcare professions, medical and biological sciences, pharmaceutical industry and health authorities serve a common cause: to protect the health of the patient. We should take the opportunity to increase mutual understanding and co-operation, in the public light, to rule out complicity, suspicion and distrust”.

Organon responded as below:

“We as a company have quite an extensive exchange of letters with MaLAM, which ask about claims, differences in MIMS, HKIMS, publications etc. As soon as these are answered we get more questions , always ending up with requests for ‘properly designed, conducted and reported double-blind randomised controlled trials to justify claims.

“However open we are prepared to be to critics and to questions about our product claims, we do not feel obliged to reproduce our registration files in this way. If doubts exist about the justification of our claims, no-one is prevented from asking the health authorities in the country concerned to investigate the matter. It is to them that we have defended our claims and it is to them that we are accustomed to answer questions and repeat trials, as the case may be.

“As to the hundreds of doctors who sent letters to the industry, in our experience only some 40 of these have reacted positively to our question whether they would like to take knowledge of our reply to their letters. So, without diminishing our duty to inform the health profession properly and to reply in full to questions which may arise in everyday medical practice, we consider MaLAM’s purpose and intention, as spelled out in the open letter, as overshooting and neglecting the role of the health authorities”.

Organon also commented that MaLAM’s is affiliated to Health Action International.

 

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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963