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First published: Friday, August 11, 2006

We have seen sufficient evidence in The Age this week that many within and outside the medical profession are concerned about the effects on our patients of the marketing efforts of the pharmaceutical industry. From the industry’s influence on the direction and publication of research, through its support for patient lobby groups and its indirect advertising in the infotainment media, to its influence on opinion leaders and ultimately on the prescribing patterns of doctors at the coalface, this is an issue well recognised by professional colleges and sadly rejected by the largest medical political lobby, the Australian Medical Association.

Having documented the problems, we have heard little about what might be done. There is no easy solution. There is an almost total reliance on self-regulation, and the evidence suggests that this has failed dismally to minimise the negative influence of the pharmaceutical industry.

Self-regulation can be improved. The industry writes its own code of conduct and effectively administers it itself. The Australian Competition and Consumer Commission must authorise the code but has admitted it is not its role to improve the code itself. The ACCC’s recommendation that the industry publish on its website details of financial dealings is designed to improve this self-regulation through shaming both doctors and the industry. It could be useful but is simply tinkering at the edges.

The professional colleges have their own guidelines for members, and the most recent set released by the Royal Australasian College of Physicians goes a long way to addressing the problem. Most members of the college will not have read it, and many would not adhere to its constraints if they did read it. The professional colleges have no power to compel any adherence to such guidelines. Despite their limitations, guidelines are worthwhile for education.

For every small success against any particular marketing strategy, however, any good industry will find an alternative. Over the past decade there has been a huge growth in funding for patient support groups and in pseudo-advertising on infotainment shows.

To seriously address the total problem, two broad areas need to be considered. These are funding and regulation. The industry is powerful, first because of the limited regulation of the conduct of the industry and of doctors, and second because there is a huge funding gap in medical education, research, and patient support. The industry fills the gap. Medical conferences, seminars, and training courses would be decimated without industry funding. At many such events funding from industry is pooled and the agenda of the meeting is determined independent of industry. The industry is then given the marketing opportunities around such meetings. At many such events, however, the industry has a much bigger input, setting the agenda and providing the speakers. In the research field, 80 per cent of drug trials would cease without industry funding. Many patient support groups would struggle to stay afloat without industry funding.