How big pharma and regulators fail clinicians.

Generalists daily make poor evidence-based decisions because regulatory and ethics committees fail them and drug companies habitually misrepresent products. The pervasiveness of this perversion – at least overseas – is best illustrated by the equivalent of R131.4 billion in healthcare fraud settlements made by pharmaceutical corporates in the USA over the last 10 years, with the most recent individual company fines breaking all records. Professor Keymanthri Moodley, head of the Centre for Medical Ethics and Law in the Faculty of Health Sciences at Stellenbosch University, revealed this while discussing challenges in the ethics of medical generalism at the 16th National Family Practitioners conference in Observatory, Cape Town, on 11 May this year. She said that one of the significant challenges in generalism was the growing base of easily accessible scientific data, of which a significant proportion is unreliable. The ability to critique this data was vital to evidence-based medicine, and doctors/ clinicians faced a major dilemma in sifting out what was falsely presented to them. Citing what she termed 'a favourite book of mine' (Bad Pharma by epidemiologist Ben Goldacre), [1] she said that positive findings were twice as likely to be published as negative findings, which Goldacre describes as 'a cancer at the core of evidence-based medicine'. She said Goldacre outlined the myriad ways in which regulatory and research ethics committees let the profession down, while numerous studies involving routine treatments (she singled out antidepressants and statins) were deeply flawed and 'presented in a skewed direction'. Goldacre estimates that 25% of the massive global turnover of the pharmaceutical industry goes to advertising and promotion, which translates inter alia to incentives to doctors in the form of gifts, promotional meetings and conferences, overseas travel expenses (including spouses and partners), sponsored hospital grand rounds and other clinical meetings, and even holidays.