Are your pills good for you - or your GP?
by Dr Desmond Spence
Mail on Sunday 4 July, 2004
Can I tempt you with a weekend at a world-class hotel? How about lunch at the most fashionable restaurant in London? A week in California, all expenses paid? Just spend ten minutes looking at these marketing pictures and I'll give you £50 cash right now.
This all sounds too good to be true. Nobody gets perks like these in their job, do they?
Yes they do, and they are the people you would least suspect of being susceptible to bribery: doctors.
The freebies come from the pharmaceutical industry - one of the most profitable industries on earth and one of the most unscrupulous.
Each year the NHS spends £9 billion of your money on medications. In America the drug market is £100 billion and ballooning, with an increase of 19 per cent last year.
Lavish hospitality is offered to doctors to increase sales and maintain huge profits. And the terrifying truth is that the drugs you are prescribed are directly related to this hospitality.
Often it is not the cheapest, most effective, non-branded product you are given - best for the hard-pressed NHS and best for you - but a more expensive variety of basically the same thing.
The problem is global. Italian police are investigating a possible scandal involving 4,400 doctors and a £152 million incentive scheme from the UK drugs giant GlaxoSmithKline.
I am not a bitter Leftie attacking one of our great institutions, but a family doctor genuinely concerned about the relationship between GPs and pharmaceutical companies and the negative impact this is having on patients.
Only a few years ago, like most doctors, I was up to my neck in hospitality and freebies.
One night, however, I returned from speaking at a meeting clutching a large cheque from a pharmaceutical company and feeling rather self-important.
I was up to my neck in freebies
My Glaswegian wife, who does not suffer fools gladly, was disgusted and told me that she preferred the snivelling medical student she had met 15 years before in a pub, pulling pints for £1.80 an hour, to the corporate pawn I had become.
She pointed out that they were paying for my influence, not my wit or charisma. On reflection, I couldn't deny it.
My practice budget was £500,000 a year and the budget in my local area, for which I was partly responsible, was ten times that. A one per cent change in the budget was worth £50,000 a year to the companies, and money spent inflating my ego was small change to them.
Why hadn't I seen it before? As a student I took countless freebies and thought the industry was fantastic.
As a junior doctor I went with my colleagues to some of the most exclusive restaurants in Glasgow and got drunk at the drug companies' expense. In general practice they provided my lunch on a daily basis.
Company representatives sponsored my practice meetings and even paid for, and attended, our Christmas parties.
I also conducted research for which I was paid a great deal of money. All these things influenced which drugs I prescribed to my patients. I felt beholden to the drug representatives and would always prescribe their more expensive medications.
The sales reps preyed on the human instinct to help your friends. In my defence, I can merely say that I was doing what everybody else did. I knew no better. But the industry should.
One of the most frightening strangleholds it has on the medical profession is the invaluable resources it provides for research. This can involve tens of millions of pounds being paid to hospitals that become dependent on this money. The drug companies own the research and control the interpretation of results. A spin is put on positive findings while negative news is suppressed.
Scandals can emerge many years later because of this suppression, as concerns over the side-effects of the anti-depressant Seroxat have shown.
This research is published in leading medical journals which, in turn, depend on drug companies to survive. Both the British Medical Journal and The Lancet receive huge sums from the drug industry in advertising revenue.
When 'research' is published, top NHS doctors and influential journalists are often flown to five-star hotels for international drug launches. These all-expense-paid trips are passed off as 'educational'.
Articles talking about a 'wonder drug' are published and experts appear on daytime TV. Pharmaceutical representatives then start selling hard and direct to GPs.
Drug companies allocate £10,000 a year for marketing their products to each doctor in the UK. The more sales representatives a doctor sees, the more drugs he or she prescribes. Some doctors can spend almost twice as much public money on medications compared with neighbouring GPs. The pharmaceutical industry monitors sales, and areas with high sales receive more visits and hospitality.
Drug giants invest in making us sick
In addition, doctors rely heavily on information supplied by the pharmaceutical industry. But proper research suggests that just six per cent of the information is supported by hard evidence.
In America the situation is even worse because 'direct to consumer marketing' is allowed. Soft-focus TV commercials and celebrity endorsements convince a naive public of a new drug's life-giving properties.
In 2000, the company Merck spent £90million advertising a single an anti-inflammatory used for and bone pain - more than was spent by Pepsi or Budweiser.
This led to a deluge of patients demanding Vioxx at £17 a time other similar products cost a few pence a month.
All this leads to another important issue - we are taking record levels of drugs but our health is not improving. I see some patients who take more than ten medications a day, and I feel that these multiple drugs cause a lot more harm than good.
The pharmaceutical industry invested a fortune in making us sick and neurotic.
Consider Prozac. We were all to become happy all of the time. Unfortunately this has convinced a generation that being unhappy is not natural and can be 'cured' by medication. Life isn't that simple, thank God.
Put bluntly, the profit motive of the pharmaceutical industry is corrupting doctors and destroying society's sense of well being. The medical profession continues to be in denial over the influence of the pharmaceutical industry. Many doctor addicted to its hospitality and freebie culture, so beware: your prescription may not have been issued for all the right reasons.
• Dr Desmond Spence is a full-time GP and a tutor of medicine at Glasgow University. He writes for several medical publications and is founder of the No Free Lunch organisation.