The Review

Outside the Box

No such thing as a free lunch

Ben Goldacre’s : How Drug ‘Do treat staff as Companies Mislead Doctors and Harm partners in health care. In working together, Patients, a decimating critique of the both sides can access a broader range of pharmaceutical industry and the system- knowledge and expertise and ultimately level problems that support ineffective and ensure high quality patient care’ unsafe prescribing, is the new Harry Potter.1 Open it on the bus or tube and people will and: approach you to ask what chapter you’re up to. Scandalous, they say. Scandalous, you ‘Don’t be tempted to accept the negative agree. Those overhearing your conversation myths about cooperating with industry. will peek at the title and scribble it discreetly Undertaken appropriately, working on the back of their ticket. As I write this, with industry will not harm objectivity of Goldacre is narrowly behind JK Rowling on clinical decision making and should not be the climb up Amazon’s top 20 chart. perceived negatively by peers.’3 Deservedly so. Described by as ‘slightly technical, This ‘guidance’ appears to overlook eminently readable, consistently an overwhelming evidence base that shocking, occasionally hectoring, and pharmaceutical sponsorship consistently unapologetically polemical’,2 Bad Pharma distorts the objective assessment of clinical makes three fundamental points. First, that need and increases doctors’ propensity in order to present their products in a to prescribe medication.4 As clinical favourable light, drug companies run their commissioning groups sit poised to sign studies on unrepresentative participants contracts for a veritable smorgasbord of and conceal data on an industrial scale. industry-sponsored care pathways and Second, that the regulatory system chronic disease management support intended to ensure transparent and robust programmes, Goldacre’s latest blockbuster control of drug production, marketing, should be prerequisite reading for their and use is fatally flawed, and furthermore, boards of governors. reforms introduced in recent years have had little impact. Third, that you and I, Trisha Greenhalgh, through our acts and/or omissions, are GP in north London, Professor of Primary Health Care at Barts and the London School of complicit in perpetuating this corrupt and , London. and dangerous system. Cosying up to the industry — either overtly through hospitality DOI: 10.3399/bjgp12X658359 and conference freebies or covertly through ‘free’ educational events — is a deep-rooted REFERENCES part of our professional culture. 1. Goldacre B. Bad pharma: how drug It was ever thus. But as Goldacre points companies mislead doctors and harm patients. London: Fourth Estate, 2012. out, this cosying up has recently taken on 2. Pick your pill out of a hat. The Economist a more corporate flavour. Bad Pharma 2012; 29 Sep: http://www.economist.com/ may be the book on everyone’s knees, but node/21563689 (accessed 4 Oct 2012). you could think of it as a sequel, and an 3. Association of British Pharmaceutical impassioned counter-narrative, to a set of Industry. Guidance on collaboration guidance produced by the Association of between healthcare professionals and the British Pharmaceutical Industry (ABPI) and pharmaceutical industry. London: ABPI, 2012. http://www.abpi.org.uk/our-work/library/ endorsed by a host of medical and nursing guidelines/Pages/collaboration-guidance. Royal Colleges who ought to have known ADDRESS FOR CORRESPONDENCE aspx (accessed 4 Oct 2012). better, proposing closer collaboration Trisha Greenhalgh 4. Spurling GK, Mansfield PR, Montgomery between healthcare professionals and the , Policy and Innovation Unit, Centre for Primary Care and , Blizard Institute, BD, et al. Information from pharmaceutical pharmaceutical industry’.3 companies and the quality, quantity, and Barts and The London School of Medicine and cost of ’ prescribing: a systematic Our own Royal College of General Dentistry, Yvonne Carter Building, 58 Turner Street, review. PLoS Med 2010; 7(10): e1000352. Practitioners has put its logo on a publication London, E1 2AB, UK. that includes statements such as: E-mail: [email protected]

594 British Journal of General Practice, November 2012