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Healthy Skepticism Library item: 6902

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

Vermeulen L.
Clarification and amplification
BMJ 1999 Aug 20; 319:(7208):525


Dunea has summarized clearly the current state of clinical affairs in the US. Medication prescribing has become an exercise in wanton waste and he certainly did not need to look far to find examples. Others, even more disturbing, were most likely available to him (but might have been less believable?). We need to re-infuse rational therapeutic behavior into our prescribing practices, or face even more onerous restrictions on appropriate medication use by both private and public payers. I would, however, like to clarify the term Dunea used to describe the pharmaceutical industry. He refers to the “pharmacy industry” being concerned about federal regulation which will certainly be needed if a prescription drug benefit is added to Medicare. As a pharmacist, I feel it is important to distinguish the profession of pharmacy from pharmaceutical manufacturers. Pharmacists have repeatedly proven their ability to improve the quality of medication use while increasing cost-efficiency. I’d refer readers to a recent study (Leape LL et al., JAMA 1999;282:267-270) demonstrating our ability in critical care practice. In contrast, pharmaceutical manufacturers engage in various practices that promote inappropriate medication use, including direct-to-consumer advertising. As the US FDA has been forced to lift restrictions on marketing practices, prescribing patterns have clearly changed. A search for “reason” in prescribing habits will not bear fruit in the garden of free enterprise. [full text]

*letter to the editor/United States/quality of prescribing/pharmacists/DTCA/direct-to-consumer advertising/FDA/Food and Drug Administration/INFLUENCE OF PROMOTION: PRESCRIBING, DRUG USE/PROMOTIONAL STRATEGIES: INDUSTRY/PROMOTIONAL TECHNIQUES: DIRECT-TO-CONSUMER ADVERTISING


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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