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Healthy Skepticism International News

Newsletter Mar/Apr 1997

April 1997

Vol 15 Issue 3/4

Special edition Improving MaLAM Part 1

    1. Introduction
    2. Finances
    3. Aims
    4. Participants

MaLAM must choose to change significantly or die. This edition is part 1 of a series intended to keep you informed and to give you a chance to influence the choices being made.

At the MaLAM Inc Board meeting in September 1996 it was agreed to commence a process of reorganising MaLAM. This edition follows from consultation involving the MaLAM Secretariat staff, our Board, distributors and voting members regarding our aims, finances and the roles of participants. We are also reconsidering MaLAM's methods which will be the subject of another edition soon.

Improving MaLAM Part 1

1. Introduction

MaLAM must choose to change significantly or die. This edition is part 1 of a series intended to keep you informed and to give you a chance to influence the choices being made.

At the MaLAM Inc Board meeting in September 1996 it was agreed to commence a process of reorganising MaLAM. This edition follows from consultation involving the MaLAM Secretariat staff, our Board, distributors and voting members regarding our aims, finances and the roles of participants. We are also reconsidering MaLAM’s methods which will be the subject of another edition soon. So far there is no consensus on any of the issues.

We would appreciate your comments on the ideas presented below. Your views will be influential. However, the final decisions will be made by the MaLAM Inc Board.

The members of the MaLAM Inc Board for 1997 are: Professor Tariq Bhutta, (paediatrics, Lahore), Associate Professor Les Irwig, (epidemiology, Sydney), Dr Joel Lexchin, (emergency medicine, pharmaceutical issues, Toronto) and Dr Bernard Topuz, (public health, Paris)

2. Finances

For the past 4 years MaLAM’s main source of income has been contracts with the Australian Pharmaceutical Education Program (PEP) for the establishment of the Australian MaLAM edition. We had hoped that funding would continue until we had recruited enough subscribers to cover the costs of our Australian and International activities. We expected that this would take about 10 years as has been the experience with similar organisations.

Unfortunately our contract has not been renewed in part due to a 40% cut to the PEP. Consequently, our income has dropped dramatically from around AUD $ 100,000 per year to AUD $ 18,000 per year coming mostly from Australian subscriptions. All $ in this document are Australian dollars which are usually worth between 75 and 80 US cents.

Currently our distributors in other countries do not send any money to Australia. Our UK distributor kindly pays for our subscription to Scrip (the journal for pharmaceutical industry executives which is one of the most useful sources of information for us). However most distributors only just cover their basic costs. Where there is a surplus we have felt that would be better used locally for recruiting more subscribers.

To reduce costs Agnès Vitry and Peter Mansfield are now working without pay. Both of us have had to find other paid work so the hours available for MaLAM have been dramatically reduced to one day per week each. Even without paying us, MaLAM is far from financially viable as is shown below.

Our estimated financial position for 1997 and 1998 without any of the changes listed below is:

Bank balance January 1997 +AUD $40,000

1997 Income +AUD $18,000

1997 Expenses* -AUD $34,000

1997 Loss -AUD $16,000 -AUD $16,000

January 1998 Bank balance +AUD $24,000

1998 Income +AUD $18,000

1998 Expenses -AUD $44,000

1998 Loss -AUD $26,000 -AUD $26,000

January 1999 Bank balance -AUD $ 2,000

* We have enough stocks of printed stationary to last through 1997. After that we will need around
AUD $10,000 per year for stationary and printing. The estimate includes rent, postage, phone, printing MaLAM editions and pay for Lynn Telfer our administrative assistant. It does not include travel, promotion or capital expenditure (eg computer or software upgrades).

The estimates for 1997 and 1998 make it clear that changes must be made. However as shown in the box above, MaLAM has accumulated sufficient funds during the past 4 years so that subscribers can be confident that we can fulfil our obligations during 1997 even if we are not successful at reducing costs or increasing our income.

Reducing costs

To further reduce costs we have decided to:

 

  • reduce the frequency of both the International and Australian MaLAM editions to once every 2 months until the situation improves. This was necessary anyway because now that we are not being paid we do not have enough time to produce both editions once a month. We did consider ceasing the Australian edition. However we decided that we should continue doing the best we can to build up support in Australia because our best chances for achieving viability in the future appear to be in Australia.
  •  

  • increase the use of E-mail rather than other forms of communication because E-mail is much cheaper for us. If you have an E-mail address then please communicate with us via E-mail rather than conventional mail or fax. Our address is: .(JavaScript must be enabled to view this email address).
  • Increasing income

    To increase income we have decided to:

     

  • increase the Australian subscription fee from AUD $ 45 to $ 65 per year. The student fee will remain at AUD $ 15.
  • The subscription fees in most other countries are determined by distributors. If your local distributor decides to change the fee you pay then he or she will inform you.

    We hope our Australian subscribers will accept the price rise knowing that the price is still below cost and only possible because of work without pay. The results of our questionnaire to Australian subscribers in late 1995 suggest that many people (128 of 312 respondents) were willing to pay over AUD $ 200 for the Australian and International editions even when we had government funding. However we are concerned that if we raised the price to that level, we would not be able to attract new subscribers.

     

  • increase the MaLAM Inc Voting Membership fee for members from Australia, New Zealand, Europe and North America to AUD $ 135 per year with payment direct to Adelaide. Voting Membership for supporters in Asia, Africa and South America will remain free. (The difference between subscriptions and voting membership is discussed in the participants section below.)
  • invite all subscribers to become Voting Members of MaLAM Inc if they wish. (see below)
  • invite subscribers in other countries to subscribe to the Australian edition at a cost of AUD $ 85 per year with payment direct to Adelaide.
  • We are considering the following options:

  • a higher subscription fee for institutions.
  • a “blind bank account”. This is controversial. Such an account would enable drug companies or their individual staff members to give us donations without us knowing who did so. It has been suggested that this would give us money without it influencing us. Drug companies or their individual staff members might give donations if they support our aims or see that they could benefit if unfair competition from misleading promotion was reduced.
  • other sources of funding including research grants, selling educational and advisory services, CD ROMs of past editions and correspondence and even including advertising in MaLAM editions for other organisations that the Board judges to be worthy of support.
  • It appears that many agencies may be willing to fund us to do “other projects” but we have not yet found one interested in funding our core activities. We are concerned that if we receive funding for non-core activities it will only make it even more difficult to keep producing the MaLAM editions. We may need to consider major changes to MaLAM editions so as to meet the requirements of a funding agency. Perhaps we should cease producing MaLAM editions and pursue our aims in other ways. Consequently, it is important for us to be sure about what our aims are. These are the subject of the next section.

    It would be good to find a funding source interested in paying for subscriptions for Third World people. We get requests for free subscriptions almost every week. Our current free subscribers are a major drain on our funds.

    Other drains on our limited resources include frequent requests for free assistance from large numbers of individuals and organisations around the world. Many of these requests are very worthy of our support but until the situation improves we will not be able to answer, let alone fulfil, such requests.

    We may need to suspend production of MaLAM editions for 6 - 12 months so as to have the time required to obtain funding. An alternative is to return to being an unfunded voluntary organisation as was the case from 1982 to 1992.

    3. Aims

    MaLAM Inc is an Association incorporated in South Australia. Our constitution states that:

    This Association is established:

      a. to defend appropriate compassionate scientific medical care, health professionals and the public from marketing practices which may be detrimental to health.
      b. to engage in dialogue with bodies involved in health-related marketing.
      c. to provide a balance of information and practical opportunities for action, which assist health professionals to act for the benefit of the public.
      d. to encourage bodies involved in health-related marketing to provide reliable information to assist appropriate therapy.
      e. to support the development of marketing quality control systems and other methods which enable health-related marketing to become more trustworthy and helpful.
      f. to support appropriate compassionate scientific medical care.
      g. to provide a Medical Lobby for Appropriate Marketing where:
  • Appropriate Marketing refers to “health-related marketing with provision of appropriate information to assist health professionals to provide appropriate compassionate scientific medical care”
  • Medical Lobby refers to “an organisation which conveys the concerns of health professionals in ways that encourage Appropriate Marketing.”

  • Can our aims be improved?

    We propose to expand MaLAM’s aims to include education (for health professionals and the public), research (on the effects of promotion on the use of drugs) and advisory services (eg advising other organisations on how to use promotional methods to improve the quality of health care). We would intend to provide education, research and advisory services as well as (not instead of) our “traditional” activities.

    We propose to include the widely accepted definition of “Marketing” as involving consideration of the Product, the Price, the Place (market segment) and the Promotion. This will clarify that we are concerned with all four aspects of marketing.

    We propose to delete clause (d). The original intention of the wording was to be positive but also convey an aim of discouraging provision of unreliable information. However that is not clear. Also, we have not yet been able to develop methods for identifying more reliable information and then rewarding the provider. Some people feel that that would not be possible or even worthwhile. Others disagree.

    We look forward to receiving comments and alternative proposals for our Aims from subscribers.

    4. Participants

    People may participate in MaLAM via one or more of the following roles. We are concerned that many people are not aware of the difference between “Subscribers” and “Voting Members” and hope the following descriptions make it clear. Please let us know if you are interested in taking a new role in MaLAM in any of the following ways.

    Subscribers receive MaLAM editions. Many subscribers describe themselves as “members” although they are not Voting Members. The difference is similar to the difference between subscribers to a newspaper and its shareholders. Anyone can be a subscriber regardless of whether or not they support MaLAM’s aims. However, the newspaper analogy is not entirely accurate because MaLAM subscribers are not passive. They are invited to participate. Also most do support MaLAM’s aims and many are keen to identify themselves as “members”. It is because many subscribers have such a strong interest in MaLAM’s success that we have decided to be so open about our current difficulties. Others including journalists, industry and government staff want to read our editions but remain independent and so do not want to be regarded as “members”.

    To resolve this problem, and for other reasons explained below, we propose that the MaLAM Inc Board invite all subscribers who wish to identify as members to become Voting Members.

    About 1,000 subscribers receive MaLAM editions direct from a Distributor. In Australia there are over 550 subscribers with over 90% paying the annual subscription fee.

    In addition, 700 subscribers to ACASH in Southern India and 4,000 subscribers to BHODI in Northern India will receive MaLAM editions as supplements during 1997.

    Some people receive pirate copies of MaLAM editions, especially in government departments and pharmaceutical companies. If you are reading this and have not paid for it, then we warmly invite you to pay a subscription fee.

    Voting Members of MaLAM Inc are subscribers who have been invited to become members by the MaLAM Inc Board. In the past the Board has only invited people who have made a special contribution to MaLAM. This ensured industry staff, who are welcome to be subscribers, could not have a position of power within MaLAM Inc. In 1996 there were only 27 Voting Members of MaLAM Inc worldwide. It has been suggested that a take over attempt by industry is unlikely to occur let alone succeed. Meanwhile, we are missing out on the contributions of many good people just because we do not know them yet. Consequently, we propose to invite all subscribers to become Voting Members.

    Voting members are required to support the aims and to pay a membership fee in addition to their subscription fee. Voting Members own MaLAM Inc’s property and elect the MaLAM Inc Board during Annual General Meetings which occur by mail so that all members are equal regardless of where in the world they live.

    If you would like to become a voting member of MaLAM Inc then please let us know using the form at the end of this edition.

    Report readers are informed of MaLAM’s work via summary reports in other journals. Scrip publishes summaries of almost every MaLAM edition. Scrip’s reports probably increase our impact within the pharmaceutical industry dramatically. Other important journals include the Lancet, the BMJ, the WHO Drug Action Program’s Essential Drugs Monitor and many member journals of the International Society of Drug Bulletins and Health Action International.

    Sources around the world inform the MaLAM Secretariat about a promotional items or activities.

    The MaLAM Secretariat is based in Adelaide and now consists of Peter Mansfield, Agnès Vitry and Lynn Telfer. With the assistance of Scientific Advisers around the world the Secretariat produces the International and Australian editions.

    Scientific Advisers check MaLAM editions for quality, reliability and readability.

    National or Regional Divisions of the MaLAM Secretariat are designed to produce MaLAM editions about promotion published in their territory for subscribers in their territory. Currently only Australia has a division but there is strong interest in establishing National Divisions in Eastern Europe. We believe that a project to establish MaLAM Divisions in Eastern Europe would be attractive to several funding agencies. The problem is that just keeping MaLAM going leaves little time for finding funding for the MaLAM Secretariat let alone for Divisions.

    Distributors reproduce (sometimes after translating) the International MaLAM editions and post them to the subscribers in their territory. Distributors set their own fees and many have different fees according to ability to pay.(eg student concessions and free subscriptions for key contacts in poorer countries) Currently MaLAM Headquarters only receives funds from subscribers who pay in Australia.

    Some distributors also recruit subscribers and are active in supporting MaLAM in other ways.

    The MaLAM Inc Board consists of 5 people elected by and from the MaLAM Inc Members. The Board meets twice a year by phone but communicates more frequently by fax or E-mail. Peter Mansfield who until this year has been the MaLAM Secretary did not stand for re-election because we have been advised that it would be better to have a separation between the Board and the staff. Peter can now concentrate on being the Director of the MaLAM Secretariat.

    Ambassadors for MaLAM is a new concept, not yet implemented. The idea is to invite subscribers and voting members to accept responsibility for recruiting new subscribers in their local area professional area or organisation.

     

     

    HS Int News index

     

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    ...to influence multinational corporations effectively, the efforts of governments will have to be complemented by others, notably the many voluntary organisations that have shown they can effectively represent society’s public-health interests…
    A small group known as Healthy Skepticism; formerly the Medical Lobby for Appropriate Marketing) has consistently and insistently drawn the attention of producers to promotional malpractice, calling for (and often securing) correction. These organisations [Healthy Skepticism, Médecins Sans Frontières and Health Action International] are small, but they are capable; they bear malice towards no one, and they are inscrutably honest. If industry is indeed persuaded to face up to its social responsibilities in the coming years it may well be because of these associations and others like them.
    - Dukes MN. Accountability of the pharmaceutical industry. Lancet. 2002 Nov 23; 360(9346)1682-4.