It is reported that medical students both in the U.S. and Poland have experience of interacting with pharmaceutical company representatives (pharma reps) during their school years. Studies have warned that the interaction typically initiated by the pharma reps’ general gift-giving eventually leads to the quid pro quo relationship between the pharma company and the future doctors, the result of which is that the doctors will prescribe their patients drugs in favor of the pharma company. Built upon (...) the existing finding, this research engages in analysis with three foci. The first is to compare attitudinal differences of the American and Polish medical students as they interact with pharma reps. Second, it investigates the role of the different economic and cultural elements (respectively in the U.S. and Poland) in the students’ attitudinal differences. Last, it suggests that the medical schools in both countries should have strict policies and effective education curriculum to help their students better prepare to interact ethically with pharma reps. Since there has been no direct comparative cultural analysis of this kind which is known in a published literature or report, the authors believe that the paper will serve as a catalyst for further research in the area. (shrink)

There is no lack of criticisms frequently levelled against the international pharmaceutical industry (Big Pharma): excessive profits, dubious or even dishonest practices, exploiting the sick and selective use of research data. Neither is there a shortage of examples used to support such opinions. A recent book by Brody (Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry, 2008) provides a précis of the main areas of criticism, adopting a twofold strategy: (1) An assumption that the special nature and human (...) need for pharmaceutical medicines requires that such products should not be treated like other commodities and (2) A multilevel descriptive approach that facilitates an ethical analysis of relationships and practices. At the same time, Brody is fully aware of the nature of the fundamental dilemma: the apparent addiction to (and denial of) the widespread availability of gifts and financial support for conferences etc., but recognises that ‘Remove the industry and its products, and a considerable portion of scientific medicine’s power to help the patient vanishes’ (Brody 2008, p. 5). The paper explores some of the relevant issues, and argues that despite the identified shortcomings and a need for rigorous and perhaps enhanced regulation, and realistic price control, the commercially competitive pharmaceutical industry remains the best option for developing safer and more effective medicinal treatments. At the same time, adoption of a broader ethical basis for the industry’s activities, such as a triple bottom line policy, would register an important move in the right direction and go some way toward answering critics. (shrink)

ABSTRACT:In 2022, John Abramson published Sickening: How Big Pharma Broke American Healthcare and How We Can Repair It. The book illustrates how large pharmaceutical companies have become misinformation machines that have corrupted peer-reviewed journals, systematic review authors, and guideline committees. Industry influence includes selective reporting of clinical trial results and selection of control groups likely to enhance benefits and disguise side effects. Other documented forms of influence include clear conflicts of interest for members of guideline committees and even direct (...) intimidation. The book concludes with a series of implementable reforms, such as ensuring the accuracy and completeness of evidence, developing an independent National Health Board, designing clinical research to optimize health outcomes, requiring the posting of research data so that independent scholars can replicate analyses, and ensuring the accuracy of direct consumer advertising. Abramson’s book is a must read for students of medicine, public health, and public policy. (shrink)

Researchers, investigative journalists, community physicians, ethicists, and policy makers have voiced strong concerns about the integrity of medicine. Specifically, questions have been raised about the ways in which financial conflicts of interest (FCOI) in the biomedical field may be compromising the integrity of the scientific research process and thus compromising patient care by disseminating imbalanced or even inaccurate information (Angell 2004). Indeed, many of us are no longer surprised when we read about settlements made by pharmaceutical companies—some totaling hundreds of (...) millions of dollars—for withholding information on adverse side effects, overstating the efficacy of medications, or for aggressive .. (shrink)

In this paper, I will argue that the current discussions about regulating certain activities concerning the pharmaceutical industry do miss a crucial point. The Pharmaceutical Industry is a story of success, providing a wealth of new discoveries and applied technologies, which have greatly enhanced our lives. The current call for strict regulation of the Pharmaceutical Industry makes the unwarranted assumption that such regulation will not disturb the mechanisms of the Industry’s success. I will claim that a centralised regulation profoundly transforms (...) the direction of travel. I will also claim that the role of the executive in bypassing regulations creates a parallel industry of subsidiary regulations to counter such bypassing. The predictable consequence is the increasing role of central regulatory control and the progressive slowing down of the success of the Pharmaceutical Industry leading towards an undesirable mediocrity. The conclusion I wish to advance is that our choices are not limited to ‘a wild open market’ and ‘a regulated open market’ scenarios, and the strategy to avoid a robustly regulated but mediocre Pharmaceutical Industry may involve ‘non-open market scenarios’ which have so far been absent from the alternatives discussed. (shrink)

The author of this paper discusses why the issue of financial conflicts of interest in psychiatry has important public health implications for women and why FCOI complicate the informed consent process. For example, when psychiatric diagnostic and treatment guidelines are unduly influenced by industry, informed consent becomes a critical issue, because women may be assigned diagnostic labels that are not valid and may also be receiving imbalanced or even inaccurate information about their mental health treatment options. However, mere disclosure of (...) industry relationships is an insufficient solution. Following Ells, the author offers a more robust account of autonomy, inspired by Foucault, to strengthen informed consent practices. In addition to addressing power relations, this Foucauldian account of autonomy emphasizes the relational and dialogical aspect of the physician–patient relationship. (shrink)

Could an accreditation, certification, or rating mechanism help the pharmaceutical industry improve both its bioethical performance and its public reputation? Other industries have used such systems to assess, improve, distinguish, and demonstrate the quality of their services, processes, and products. These systems have also helped increase transparency, accountability, stakeholder confidence, and awareness of industry best practices. This article explains how market forces can be harnessed to recognize and promote better bioethical performance by pharmaceutical companies when there are good systems to (...) accredit, certify, or rate. It concludes with a review of relevant failures of credit-rating agencies — such as conflicts of interests and revolving-door practices — to illuminate some of the pitfalls of developing a bioethics accreditation, certification, or rating system for pharmaceutical companies. (shrink)

This article investigates the pervasive influence of the pharmaceutical industry in Pakistan and primarily the attitudes of the medical community toward such interactions. We used an inductive approach informed by grounded theory principles to analyze interviews and focus groups with consultants, residents, medical students, and a pharmaceutical industry representative in Karachi and Lahore, and participant-observation data from two biomedical conferences. Data were then analyzed through a deontological and teleological ethical theoretical framework. Findings highlight the reasons leading to the continuation of (...) norms including weak regulations, physicians’ expectations of receiving favors, and limited exposure to bioethics education. Recommendations for practice, policy, and research are discussed. (shrink)

This article explores whether the bioethical performance and trustworthiness of pharmaceutical companies can be improved by harnessing market forces through the use of accreditation, certification, or rating. Other industries have used such systems to define best practices, set standards, and assess and signal the quality of services, processes, and products. These systems have also informed decisions in other industries about where to invest, what to buy, where to work, and when to regulate. Similarly, accreditation, certification, and rating programs can help (...) drug companies address stakeholder concerns in four areas: clinical trial design and management, dissemination of clinical trial results, marketing practices, and the accessibility of medicines. To illuminate processes — such as conflicts of interests and revolving-door policies — that can jeopardize the integrity of accreditation, certification, and ratings systems, the article concludes with a consideration of recent failures of credit-rating agencies and a review of the regulatory capture literature. (shrink)

Doctors in Denial examines the relationship between the Canadian medical profession and the pharmaceutical industry, and explains how doctors have become dependents of the drug companies instead of champions of patients' health. Big Pharma plays a role in every aspect of doctors' work. These giant, wealthy multinationals influence how medical students are trained and receive information, how research is done in hospitals and universities, what is published in leading medical journals, what drugs are approved, and what patients expect when (...) they go into their doctors' offices. But almost all doctors deny the influence and control the drug companies exert. In this book Dr. Lexchin urges the medical profession to make the changes needed to give priority to protecting and promoting patients' health and benefitting society, rather than enabling Big Pharma to dominate health care while raking in billions in profits from citizens and governments. (shrink)

In his carefully argued and extensively researched article “The Implications of Recent Work in the History of Analytic Philosophy” (Preston 2005a) Aaron Preston has raised what should surely be the central methodological issue for Russell studies and the history of analytic philosophy more generally.[1] That is, what are the goals of the history of analytic philosophy and by what means can we best try to meet these goals? Preston’s main conclusion is that historical investigation into the origins of analytic philosophy (...) has made the most common answers to these questions untenable. In particular, we are encouraged to conclude that analytic philosophy is not even a genuine philosophical movement, and is in this sense “illusory”. For Preston, then, the history of analytic philosophy should reconcile itself to this fact and adjust its methods dramatically. Once we see that analytic philosophy, as traditionally conceived, never existed, then we are free to apply tools not usually deployed in the history of philosophy, e.g. memetics (Preston 2005b). (shrink)

The study examines the attitudes among physicians regarding acceptance of gifts, sponsorships, and drug samples in response to marketing efforts of pharmaceutical companies in India. The research also attempts to study physicians’ perceptions of the Medical Council of India (MCI) guidelines on the code of conduct for pharmaceutical marketing practices and the influence of these guidelines on physicians’ actions. A structured questionnaire was developed for collecting primary data regarding exposure of physicians to promotional tools and physicians’ attitudes and practices with (...) regard to various professional ethical issues. One thousand physicians from private and government hospitals located in a metropolitan area were approached personally or through email for getting the questionnaire filled. A total of 189 completed and usable questionnaires could be obtained which is a response rate of approximately 20 %. Respondents in the study indicate being offered samples, sponsorship, and gifts by pharmaceutical companies with a frequency of at least once a month. Thus, many pharmaceutical firms are not following the code of conduct issued by the Department of Pharmaceuticals, Govt. of India. Further, though almost all physicians report being aware of the guidelines issued by the MCI, yet as many as 69 % of the sample admitted to be accepting gifts and sponsorships offered by the pharmaceutical firms. Educational programs were found to be influencing physician prescription behavior to a greater extent when compared with gifts. Frequency of offers made for gifts and sponsorships were found to be dependent upon physicians’ practice (number of prescriptions written) and the type of hospital they are associated with (private or government). The study focuses on sensitive yet critical ethical issues related to the promotional practices of pharmaceutical firms in India and physicians’ responses with regard to these promotional practices in the context of the guidelines of the Medical Council of India and the Department of Pharmaceuticals. (shrink)

The purpose of this paper is to provide a normative model for the assessment of the exercise of power by Big Pharma. By drawing on the work of Steven Lukes, it will be argued that while Big Pharma is overtly highly regulated, so that its power is indeed restricted in the interests of patients and the general public, the industry is still able to exercise what Lukes describes as a third dimension of power. This entails concealing the conflicts (...) of interest and grievances that Big Pharma may have with the health care system, physicians and patients, crucially through rhetorical engagements with Patient Advocacy Groups that seek to shape public opinion, and also by marginalising certain groups, excluding them from debates over health care resource allocation. Three issues will be examined: the construction of a conception of the patient as expert patient or consumer; the phenomenon of disease mongering; the suppression or distortion of debates over resource allocation. (shrink)

From the title, Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare, Peter Gøtzsche makes the thesis of his book very clear. Not only does the pharmaceutical industry contribute to detrimental health outcomes through biased research, deceptive marketing, and disease mongering, but the industry’s business model meets the criteria of an organized criminal operation. Gøtzsche argues for this in two parts. First, he defines organized crime by drawing upon the United States Organized Crime Control Act of 1970, (...) the centerpiece of which is the Racketeer Influenced and Corrupt Organizations Act. RICO prohibits deriving income from a pattern of racketeering... (shrink)

Ghost-Managed Medicine exposes the conspiracy to conceal all of the players in the marketing of drugs, including ghostwriters, key opinion leaders, patient advocacy organizations, contract research organizations, publication planners, and even medical journal editors and publishers. The credibility of the claims conveyed by the industry depends on the invisibility of these players.

Why do physicians have financial conflicts of interest? They arise because society expects physicians to act in their patients’ interest, while simultaneously, financial incentives encourage physicians to practice medicine in ways that promote their own interests or those of third parties. Because physicians’ clinical choices, referrals, and prescriptions affect the fortune of third parties, these third parties may offer physicians financial incentives to make income-driven clinical choices. In the past, physicians and scholars typically conceived of conflicts of interest as an (...) ethical issue to be resolved according to individual judgment or professional and organizational norms. However, society can mitigate or eliminate conflicts of interest by changing financial and organizational arrangements in medicine. Conflicts of interest, therefore, are as much matters of public policy and management as individual choices or social norms. (shrink)

This paper deploys Laclau and Mouffe's discourse theory to examine the dispute over intellectual property protection and global HIV/aids medicines access. Over the 1980s and 1990s, major pharmaceutical companies and minority world governments successfully crafted a strong patent protection regime, institutionalized in the World Trade Organization's intellectual property rules. In the early 2000s, a transnational civil society campaign challenged this regime, positioning patents at the centre of a highly publicized dispute. This dispute has been retrospectively identified as a turning point (...) in medicines access discourse, with the 2001–2003 period dubbed the ‘golden window’ for expanded global HIV/aids medicines access. However, this ‘window’ has also been critiqued as an unsustainable aberration to a continuing hegemonic regime that prioritizes patent protection, to the detriment of equitable global medicines access. This paper draws on both political economy analyses and discourse theoretical concepts to examine the processes of rupture and suture in HIV/aids medicines access discourse. (shrink)

Sue Petrovski’s short book, A Return Journey: Hope and Strength in the Aftermath of Alzheimer’s, is a collection of personal stories as she and her husband cared for her mother during the course of the disease as well as the shared stories of others. A Return Journey provides an insider’s view of the challenges of caring for those with Alzheimer’s and is useful for current and future caregivers as well as those who are studying and working in the health professions.

Since March of 2020, the world has been brought to its knees by unscientific and unethical mandates. These mandates have destroyed the world economy and the lives of countless innocent individuals. The “cure” that has been offered by medical bureaucrats and politicians has been more deadly than the disease (COVID-19). The imposition of ludicrous lockdowns, mask-wearing, coerced vaccination, and vaccine passports have not only proved to be ineffective, but also much more harmful than SARS-CoV-2 and all its variants. COVID-19 has (...) a recovery rate of close to 99% for most of the world’s population, however, despite this, institutions and power-hungry individuals have trampled upon our civil liberties and ignored our inalienable human rights. It is precisely as Thomas Paine famously stated: “The greatest tyrannies are always perpetrated in the name of the noblest causes.” -/- Many lives have been gratuitously lost because of the administration of deadly medical treatments, and the rejection of effective treatments that follow genuine science. In the process, informed consent has been disparaged and desecrated. For over two years, we were instructed to “trust the science,” but the “science” advocated by medical bureaucrats and greedy politicians was the reason why the world was turned upside-down. In the face of these crimes against humanity, justice will only be brought by real courts and real judges, but this will require the awakening of a critical mass. This book serves as an instrument for this awakening. (shrink)

This case study reports an instance of SmithKline Beecham's behind-the-scenes ghostwriting a letter to the editor in a medical journal article in the name of an academic physician. In order to respond to criticism that paroxetine caused severe withdrawal effects, SmithKline Beecham's marketing department hired a PR firm to ghostwrite three separate letters to spin a favorable impression of paroxetine vs fluoxetine and published one in the Journal of Clinical Psychiatry.

In September 2006, a small start-up company in Cambridge, MA called Sermo, Inc., launched a social networking site with an unusual twist: only physicians practicing medicine in the United States would be allowed to participate. Sermo, which means “conversation” in Latin, marketed its website as an online community exclusively for doctors that would allow them to talk openly about a range of topics, from challenging and unusual medical cases to the relative merits of one treatment versus another. “Sermo enables the (...) private and instant exchange of knowledge among MDs,” the company announced in its first press release. Even better, participation was free and the site carried no advertising. (shrink)

Dennis Thompson and Lawrence Lessig are leading thinkers in the realm of institutional corruption, the notion that inappropriate dependencies and conflicts of interest undercut the ethical foundations of institutions on which society relies. Both are particularly known for their work on institutional corruption as it affects government and politics. This essay examines the applicability of their writing to the private sector, particularly as it relates to vital and influential industries like pharmaceuticals.

In 1995, Dennis Thompson, the founding director of Harvard’s program in Ethics and the Professions, authored a book entitled Ethics in Congress. That subject, in and of itself, seemingly was not new. And it undoubtedly inspired a few irreverent snickers. Consider that a Goggle search of “Ethics in Congress oxymoron” recently produced 5.79 million results in just over a tenth of a second.But it was the subtitle of the book — From Individual to Institutional Corruption — that revealed how Thompson’s (...) tome signaled an abrupt departure from the standard paradigms for measuring political corruption. (shrink)

A growing number of doctors in the United States are joining online professional networks that cater exclusively to licensed physicians. The most popular are Sermo, with more than 135,000 members, and Doximity, with more than 100,000. Both companies claim to offer a valuable service by enabling doctors to “connect” in a secure online environment. But their business models raise ethical concerns. The sites generate revenue by selling access to their large networks of physician-users to clients that include global pharmaceutical companies, (...) market research and consulting firms, and hedge funds and other investors. In exchange for a fee, these clients are offered a variety of tools to monitor, analyze, and solicit physicians’ opinions. In Sermo's case, clients are also offered opportunities to conduct “awareness campaigns” on the site that are aimed at influencing physician sentiment about specific drugs and medical devices. In effect, these online networks have created an even more efficient means for the pharmaceutical industry to track physician sentiment, disseminate messages, and cultivate key opinion leaders. This paper argues that the dual nature of these sites (a) undermines their integrity and transparency as forums for the exchange of medical opinion and (b) presents an ethical conflict for the doctors who use them. (shrink)

To be made aware of bioethical issues related to their disciplines, undergraduate students in biology and pharmaceutical sciences at the University of Basel are required to enroll in the bioethics course called “Introduction to Bioethics”. This article describes the chances and challenges faced when teaching a large number of undergraduate biology and pharmaceutical sciences students. Attention is drawn to the relevance and specific ethical issues that biology and pharmaceutical sciences students may be confronted with and to how these could be (...) integrated into ethics curricula. Results from a survey addressing the knowledge and opinion of students taking the course in spring semester 2012, 2013, and 2014 are presented and discussed. Finally, we describe the lessons learned and how we have improved the course based on students’ feedback throughout the following years. (shrink)