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Is the ABPI code too restrictive? I ask this question because I never imagined it was, particularly when, several years ago with Richard Smith (who this month laments the failure of medical leadership over the MTAS issue: JRSM 2007;100:486), I edited a BMJ theme issue on the relationship between doctors and the pharmaceutical industry (www.bmj.com/content/vol326/issue7400). At the time the issue created a storm, not least because of its provocative cover depicting pharmaceutical representatives as lizards, but mostly because many readers misinterpreted the message of the theme issue as being an urgent need for doctors to cut ties with industry. The myriad entanglements between doctors and industry were vividly discussed, but the central argument of the issue was subtler than most people had patience for.
The pharmaceutical industry had delivered many benefits, we readily agreed, and would continue to do so with its research acumen and commercial clout. Doctors were required to engage with the information received from companies, and learn from and contribute to the development of new products as well as the safety and efficacy of established ones. But the myriad entanglements between doctors and industry had become a problem. What was the real purpose of gourmet meals, all-expenses paid travel, and an evening of lap dancing? The time had come, we argued, not to sever ties with industry but to disentangle and forge a new relationship with patient care as its focus.
Since that edition of the BMJ, the medical mood has appeared to swing further against industry. The rise of doctors supporting ‘No Free Lunch’ (www.nofreelunch-uk.org) has contrasted neatly with the industry's pain over drug scandals such as the one surrounding Vioxx. Drug representatives are finding it harder to see doctors and the good old lunchtime meeting now requires other means of sustenance. The industry watchdog, the Association of the British Pharmaceutical Industry (ABPI), has even brought in more stringent guidance around gifts that doctors can receive from companies. Companies themselves are fearful of breaching the ABPI code and public punishment.
You might then argue that this is the correct balance of forces: a clever industry intent on selling, controlled by a regulator intent on ensuring that the quality of the product is what counts and not the brilliance of the marketing, and doctors disentangled from anything worth more than £6.
Yet I guess the debate is not yet done, and my reasons are based on feedback I hear from doctors. Some are furious at the hypocrisy of journal editors who fund their million pound publications from industry sponsorship and advertising but spend their time preventing practising doctors from enjoying an evening pizza. Others believe that they should be allowed to interact freely with industry to gather as much information as they wish in whatever way they wish, since they are smart enough to make their own clinical decisions. More still are angry at their inability to organize educational meetings and conferences because the climate of fear on both sides means that funding is next to impossible to obtain.
These sentiments come from presidents of Royal Colleges and full-time clinicians at the ‘coal face’. The line in the sand, many doctors believe, has been drawn in the wrong place. Can this be true? Has disentanglement been misinterpreted for intolerance? Or is it just that the silent majority are quietly content? I remain of the view that the relationship between doctors and industry must be transparent, disentangled, and focused on patient care. But there is also a genuine debate waiting for a home, and the JRSM is willing to consider contributions to this important and fascinating discussion. Is the ABPI code too restrictive? Is the current relationship between doctors and industry another manifestation of the infringements on the clinical freedom of doctors? You tell us over the next few weeks and the best contributions will be published in the January issue.
Competing interests KA is Editor of JRSM and editor-in-chief and CEO of onmedica.com. Both publications receive revenue from the pharmaceutical industry and are read by doctors, which was also the case at the BMJ.