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  • 1
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    answered Jul 29, 2010 at 02:23PM
    I think that while most doctors are 100% committed to patients, there are some that are 100% committed to their own pocketbooks and self promotion, and thus will write a prescription that promotes the pharma industry he or she is being paid by. Also, the pharma industry often provides vacations, meals, money, junkets, and all expenses paid conferences, rather than merely pens or a cup of coffee. Perhaps blocked access is due to the fact that pharma isn't unbiased, and hospitals are trying to provide an ethical service to patients as well as promote ethical practices by their staff. One can always access the pharma websites on one's own.
  • 0
    Votes
    answered Jul 29, 2010 at 10:43PM
    Kim

    Thanks for taking the time to join the debate and give your viewpoint. Recently I gave a talk in a hospital and all of links to pharmaceutical companies sites were blocked by the hospital server.
    Since the talk was about new drugs in Phase III trials, it was a real setback. Industry has been rightly criticized for its controversial promotional and marketing practices resulting in PHRMA guidelines.

    Contrary to popular impression, pharmaceutical and biotechnology industry websites and new drug information is closely monitored by the FDA and EMA. Industry has to comply with all the rules, regulations and guidelines issued by the regulatory authorities. I think institutional blockage of industry websites deprives healthcare professionals and academics of the only source of information about new drugs in development.

    On the other hand there are websites promoting and selling unapproved, untested and fake remedies and cures under various attractive names and labels (alternative, complementary, natural, traditional, bio, non GMO etc). These sites do not follow any rules and frequently change or migrate to other domain names. Access to these sites remain open to hospital staff?
  • 1
    Votes
    answered Jul 30, 2010 at 09:15AM
    Thank you as well for a reasoned follow up to my commentary. I agree that there are many bogus or untested remedies out there, even masquerading as legitimate treatments or cures. These sites take advantage of the anxiety or even desperation of individuals to help his or her medical condition. I am particularly concerned about sites that target cancer patients. I also agree that it is the drug companies that are often funding important research and bringing drugs, chemotherapy, or other types of therapy such as genetic manipulation, viruses, or monoclonal antibodies, to treatment phase. At least the latter is legitimate and tested, and may or may not prove beneficial to patients. So many treatments are a result of pharma's investment in R&D, and they are saving lives. It is vital that both doctors and patients know about the clinical trials. The problem lies in pharma industry having the perception of bias and profit regarding one treatment over another one, regardless of what is actually best for the patient. One sees this most of all in TV ads, which are developed to sell a product. An ethical doctor must place the patient first and have full information about a treatment, and not just hear or read "the rosy picture" as is often the case on industry websites. On the other hand, FDA does regulate, and provides a usually comprehensive list of side effects as well as benefits. I must add though that in recent years even the FDA has been perceived as not always doing their job and even having bias, what with the cross hiring between FDA and big pharma. Can the FDA be completely trusted? Hopefully so. This is a tough question, I don't believe in censorship of any kind. However, medical and hospital ethics can create such dilemmas.
  • 0
    Votes
    answered Jul 30, 2010 at 10:34AM
    Thanks once again for expressing your views. FDA remains and retains all the data about drugs safety and efficacy. No other individual healthcare professional opinion can match the experience and collective expertise of the FDA. In the past FDA has disciplined even Nobel prize winners. Its shortcomings stem from lack of funds and resources which must be increased to make it more proactive and productive.

    Kim, you are talking about approved and marketed drugs, the adverts for these are once again approved and cleared by the FDA and EMA in Europe, it includes direct to consumers spots on TV. Fear of class action, product injury litigation and punitive damages insures that industry has interest in analyzing adverse drug reactions in time and inform regulatory authorities. Remember the vaccine industry bail out of US market and manufacturing during 1998-2002 period resulting in vaccine shortages and resulting in dominance of European pharma companies. Similarly industry bail out of anti infective research has resulted in lack of new antibiotics and anti fungal agents and increased cases of MRSA. Antibiotics instinct to reserve new antibiotics for rescue use and restrictions means that it is difficult for companies to recover R&D investment? Free samples given to GPs and doctors were often passed on to poor patients or without health insurance.

    My query was mainly about new drugs in development where due to lack of publications in peer review journals, companies are the only source of information. Institutional restrictions in such cases deprive doctors access to valuable information about new drugs.
  • 1
    Votes
    answered Jul 30, 2010 at 10:59AM
    Perhaps by allowing doctors access to pharma iindustry drugs in the developmental phase, the industry is hoping doctors will lobby for their clinical trials. Until a drug is shown to be efficacious in clinical trials, is there much point having access to the information? The drug may be proven to be worthless or even dangerous, or it might be lifesaving or even a cure. FDA approval and peer review journals vett the whole process so it is not the company that is the sole source of information, which is the case in the developmental phase. Yes, it would be interesting for doctors to know about drugs in research, but until it is approved and vetted, are they (the drugs) really going to help their patients who are in the hospital anyway? Doctors can still find out on their own time, if hospitals don't wish to faciltate the linkage.
    I am curious about how this question is handled in countries such as India, although I realize that Indian pharmaceutical companies are regulated by the FDA and European standards when seeking to market to the USA and Europe. What about when the Indian market is involved?
    I am a layperson, and so my knowledge is limited. Perhaps a doctor will comment.
    Iit is such an interesting topic.
  • 0
    Votes
    answered Jul 30, 2010 at 09:20PM
    Kim, your point is well taken. I have done recent multimedia review of new drugs in clinical trials and many drugs have shown dramatic results in incurable diseases and conditions. Top medical journals compete aggressively and offer fast track peer review (to pharma biotech firms) to publish the results of such trials. Patient advocacy groups campaign for faster testing and approval of new life saving drugs. The Indian market is undergoing a period of double digit growth during the past 10 years and regulatory oversight is still weak. Thus some of the worst marketing practices of the pharma companies may still be there. There are moves to eliminate and follow model code of marketing. There are attempts to make the regulatory system in India open and transparent on the model of FDA/EMA
  • 1
    Votes
    answered Jul 31, 2010 at 11:25AM
    I think that we can and will argue the question from our own point of view. Each of us look at the question from our own perspective and that is understandable. As a "conservative" physician (I have never had to discontinue prescribing a drug from a patient which was subsequently taken off the market by the FDA since I never prescribed it in the first place), I am satisfied that I have treated my patients appropriately using an"old established drug" rather than a more expensive, newly marketed one.

    There is ample access for physicians to learn about upcoming drug research in our journals, CME sessions (where conflict-of-interest delivery is surveyed) and on our own access to the internet, that if a hospital decides to block access to such pharmaceutical sites on their own computer systems it shouldn't substantially diminish our potential education nor represent a "freedom of speech" Constitutional issue. ..Maurice.
  • 0
    Votes
    answered Aug 01, 2010 at 02:06AM
    Maurice,

    Thanks for sharing your viewpoint and experience on this issue. I can understand your conservative approach to new drugs. I believe that you are open to new drugs and start using them when you decide that there is sufficient and substantial evidence of safety and efficacy. In my experience, top medical journals and CME courses are few years behind latest development in new drugs and rely mostly on funding, advertisements and sponsorship by the industry. So it has become difficult to create a real firewall on conflict of interest issues. Visiting
    industry stands during medical meetings to get literature/brochure or getting a coffee during session breaks is not needed in a conflict of interest declaration IMHO?
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