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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 24; 335(7629): 1098.
PMCID: PMC2094158
From the Frontline

The bitterest pill

Des Spence, general practitioner, Glasgow

In 2004 I attended a parliamentary subcommittee meeting and sat with stars of the medical firmament such as Andrew Hexheimer, David Healy, and Ike Iheanacho. I was there simply as an honest witness to the excesses I had seen and to express support for the No Free Lunch group ( I was a mere pimple on an ailing and delirious drug industry being dragged down by a virulent infection called marketing.

After all its high living, huge profits, and dancing provocatively on the tops of stock market tables, the drug industry is now hung over and depressed and needs to sort its life out—there are no magic pills any more. Once the darling of the stock exchanges it is now receiving dire reports on its future profitability and witnessing a steep fall in the number of new drugs being approved. And under the attention of the media it is experiencing drug induced flashbacks to the night of excess before: lap dancing clubs, Wimbledon tickets, accusations of research manipulation, class actions, jibes about disease mongering, and funds slipped to medical experts and charities.

But all this is a painful and long overdue correction—the bursting of the bubble that is the notion that societies' social sicknesses can be cured by pills. Can we doctors help the industry? Yes: we must stop seeing pharmaceutical representatives. This is a logical move on several levels. Such contact increases costs and exposes patients to the dangers of new drugs, and the associated hospitality is inappropriate for public servants, undermining the status of doctors in the eyes of the public.

There is also, however, a new economic argument. The open doors to doctors' surgeries have allowed drug companies' marketing departments to gain a stranglehold over business plans and stifle true innovation. It is estimated that the companies spend a third of turnover on marketing but only a fifth on research and development. Worse still, most of this research is not innovative but centred on pointless “me too” preparations that seek merely to increase companies' foothold in profitable established markets. But a “me too” strategy doesn't even cut costs through true competition, for there is an unwritten agreement in the industry that undercutting of prices merely erodes overall profitability.

Preventing access of drug company representatives to doctors would help stop drug companies putting marketing above innovation and force a change in the business culture. This might result in much screaming and blood on the carpets of corporate boardrooms, but a return to innovation offers the only hope of a cure to the industry's illness.


Competing interests: DS is the UK spokesman of No Free Lunch.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group