Is Bias Against Pharma-Funded Research Fair?
Anti-pharma prejudice may have a detrimental effect on drug discovery, clinical research, and physician education.
Is Bias Against Pharma-Funded Research Fair?
Pharmaism — a type of prejudice or discrimination practiced against people associated with pharmaceutical companies, whether it be employees or medical professionals who are engaged as independent consultants — was the topic of a recent editorial published in the International Journal of Clinical Practice.1
Pharmaism includes the implicit belief that people associated with pharmaceutical companies are more likely to be intellectually and morally dishonest than others.
Medical journals insisting that additional, independent statistical analyses be conducted for manuscripts of clinical trials submitted by pharmaceutical companies, and the lay media singling out health-care professionals who earn money by contracting with pharmaceutical companies for professional services are both examples of pharmaism.
The latter will no doubt be even more common once public access to data regarding payments to physicians from pharmaceutical and device manufacturers are made available through the Open Payments program provisions of the U.S. Physician Payments Sunshine Act.2 Public disclosure is expected to begin on Sept. 30, 2014.
Some of the attitudes behind pharmaism have origins in the sins of the past. This includes the deliberate withholding of data, questionable promotional tactics, and rewarding high-volume prescribers. Despite substantial changes in how pharmaceutical companies do business, there is much in the way of lingering suspicion that deceptive practices continue unabated.3
Separating the facts from the rhetoric takes some effort, and an excellent summary of the issues can be found in a commentary by Tom Stossel, MD, of Harvard Medical School, and colleagues can be found in the International Journal of Clinical Practice.4
They provide an overview of the issues surrounding costs, ‘me-too' drugs, disease mongering, unknown risks of new agents, detailing, gifts, advertising, peer-to-peer speaking, CME funding, lawsuits and settlements, ghostwriting, publication bias, and financial conflicts of interest.
The authors observed that since they first started writing about the topic in 2005, there has been a shift from a narrow focus on decrying physician-industry research collaboration to demonizing all physician–industry interactions, with some commentators calling for a complete apartheid between physicians, researchers, and the medical products industry.
Of concern is that it has become “respectable to ignore the epistemological foundations of medical science, diverting attention away from the scientific merit of the information presented and focusing it instead on the identity and motives of those who present the information,” Stossel et al noted.
Strong anti-pharma biases in the form of pharmaism actually can be harmful to patient care, drug discovery and development, clinical research, resident training, physician education, and innovation.
An example is how academia had once served as the leader in developing novel translational strategies for improvements in patient care, but with the divide self-imposed by academia from industry, there has been a transition of clinical trial and pharmaceutical development away from medical schools to private organizations.
Such a shift has also led to a detrimental effect on residency education programs, where trainees are no longer exposed to the latest advancements in clinical care.
“We need to ask if the restrictive and burdensome policies of academic medical centers that limit faculty interactions with industry have been in the best interest of patients,” the editorial's authors authors wrote.1
"Consulting for and collaborating with industry to facilitate the development of new treatments, informing practitioners about new treatments, assisting in conducting clinical trials are all activities that can ultimately benefit patients."
Leslie Citrome, MD, MPH, is Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, New York, and a member of the Board of Directors of the American Society of Clinical Psychopharmacology.
Disclosures: In the past 36 months, Citrome has engaged in collaborative research with, or received consulting or speaking fees, from: Alexza, Alkermes, AstraZeneca, Avanir, Bristol-Myers Squibb, Eli Lilly, Forest, Forum, Genentech, Janssen, Jazz, Lundbeck, Merck, Medivation, Mylan, Novartis, Noven, Otsuka, Pfizer, Reckitt Benckiser, Reviva, Shire, Sunovion, Takeda, Teva and Valeant.
- Citrome L, Karagianis J, Maguire GA, Nierenberg AA. Pharmaism: a tale of two perspectives. Int J Clin Pract. 2014;68:659-61.
- Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 402 and 403 [CMSY5060YF] RIN 0938-AR33. Medicare, Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests. Agency: Centers for Medicare & Medicaid Services (CMS), HHS. Action: Final rule. Rules and Regulations. Federal Register 2013;78(27):9458-9528. Accessed July 25, 2014.
- Tagore A. Drug promotion tactics-yet another pharma deception? Int J Clin Pract. 2014;68:662-5.
- Barton D, Stossel T, Stell L. After 20 years, industry critics bury skeptics, despite empirical vacuum. Int J Clin Pract. 2014;68:666-73.