Why the GMC should set up a central registry of doctors competing interests
Hole Ousia Blog Post 16 January 2014
Open Letter to the General Medical Council:
Trust between patients and doctors is critical to good medical practice, and doctors are still highly trusted by the public. But we should ensure that we deserve it. The Association of the British Pharmaceutical Industry has estimated that the drug industry pays £40m (€48m; $65m) a year to doctors for speaking fees, flights, hotels, and other travel expenses.
Yet who is being paid what is opaque. It is clear that exposure to pharmaceutical advertising adversely affects future prescribing. There is also evidence that if doctors accept gifts from the drug industry, patients trust doctors less. Citizens can access MPs' central register of their financial conflicts of interest, yet patients cannot find out whether their doctor has a financial conflict of interest.
The vast majority of doctors will be receiving no payments from any organisation other than their employer or the NHS. Some will receive fees for their expertise from NHS or non-NHS organisations. Others will be receiving some pharmaceutically sponsored education. A few will be receiving large amounts for assisting pharmaceutical or other companies with their profile and sales of their products ..."
Read complete letter
FOI Request Response from NHS Lothian re Register of Payments
I made an FOI request to NHS Lothian on 30 April 2014, asking if there was now a Register of Interest for all employees, in particular to find out if any psychiatrists in this health board area, where our Scottish Parliament sits, receive payments from drug companies.
Here is the FOI Request Response from NHS Lothian.
The gist of which is that NHS Lothian "do not maintain a standing register of interests for all employees".
'Who's Paying Your Doctor?' Panorama, Monday 14 April 2014
Panorama on Monday 14 April 2014 at 8.30pm asked the questions 'Who's Paying Your Doctor?':
"With the NHS drug bill topping £10 billion in 2013, this investigation examines the tactics employed by drug companies to tap into that lucrative market and influence which medicines your doctor prescribes.
Strict rules govern drug company spending in the UK, but still they pay out millions to doctors to attend and speak at conferences. Panorama goes undercover to see this subtle persuasion at work and asks whether you should have the right to know who is paying your doctor.
And as Britain's most profitable drug company, GlaxoSmithKline, waits to hear whether it will face criminal charges following allegations of bribery in China, the programme reveals new evidence that GSK was recently paying doctors to boost prescriptions much closer to home, in Europe."
I've set up two new blogs on Big Pharma topics
'Do we underestimate the benefits of antidepressants?' Lancet April 2014
Authors: Mazda Adli, Ulrich Hegerl
"In the past 5 years, doubts have been raised about the
therapeutic eff ectiveness of antidepressants in patients
with depressive disorders, because of the small diff erences
in symptom improvement between antidepressants
and placebo recorded in randomised controlled trials
(RCTs). With the recent debates about lowering of disease
thresholds in the Diagnostic and Statistical Manual of
Mental Disorders, fi fth edition, and the medicalisation
of normal bereavement, this scepticism has increased."
Read complete article
'Challenges in rolling out interventions for schizophrenia' Lancet April 2014
Authors: Derrick Silove, Philip B Ward
"The Global Mental Health (GMH) movement has played
a pivotal part in bringing to attention the unmet needs
of patients with mental disorders, particularly in lowincome
and middle-income countries.1,2 Sch izophrenia
is of primary concern in view of the high level of
associated disability and stigma, and the risk that,
without treatment, patients will experience prolonged
institutionalisation, neglect, and abuse.
Sudipto Chatterjee and colleagues' multicentre,
randomised controlled COmmunity care for People
with Schizophrenia in India (COPSI) trial,6 in The Lancet,
represents a milestone by showing the benefi ts of
a collaborative community-based care plus facilitybased
care model compared with conventional
facility-based care alone for treatment of moderate
to severe schizophrenia. However, implementation of
collaborative community-based care in low-income and
middle-income countries has several issues that need
further consideration, such as ensuring continuity in
supervision of community workers, safeguarding the
physical health of patients, and embedding services
within the local context and culture."
Read complete article
'US doctors earn speaking and consulting fees from
drug companies that sponsor their research' BMJ 27 March 2014
by Michael McCarthy, Seattle
"Medical researchers in the United States often accept thousands
of dollars in speaking and consulting payments from drug
companies that also sponsor their research, the investigative
journalism nonprofit organization ProPublica reported on 25
In their investigation Charles Ornstein and Ryann Grochowski
Jones, reporters for ProPublica, used a searchable database
called Dollars for Docs, which tracks payments made to doctors
by 15 drug companies."
Read complete article
Is GSK's move to employ doctors as medical educators more transparent than paying external speakers?
BMJ polls 2014 selection
Yes 225 (53%)
No 198 (47%)
Total votes cast: 423
Should medical journals publish sponsored content?
Yes 244 (32%)
No 521 (68%)
Total votes cast: 765
Would you be comfortable declaring your competing interests on a central database?
Yes: 417 (81%)
Total votes cast: 515
Should medical journals stop publishing research funded by the drug industry?
Yes: 786 (55%)
No: 631 (45%)
Total votes cast: 1417
I believe that taking money from Big Pharma is ethically wrong
[a statement written for ALLIANCE event 'A Question of Ethics: Members discussion on the ALLIANCE's relationship with the pharmaceutical industry' on 7 February 2014]
Psychiatric drugs are used in psychiatric settings to coerce and control psychiatric patients. The drugs alter brain chemicals and cause debilitating side effects which result in more psych drugs being taken to control the effects. In my case the anti-psychotics agitated and depressed me. I was given the anti-depressant venlafaxine which depressed me more, gave me suicidal impulses, I took an overdose. Then I was given the "mood stabiliser" lithium, a toxic drug that requires monthly blood tests. None of these drugs worked to lift my mood. I had to take charge of my own mental health, go against the advice of psychiatrists, to recover and survive.
At least 50% of people are unhappy that they were forced to take psych drugs against their will. All of my close family members have engaged with psychiatry. Half of us stayed in the system, the other half went our own way. Of the half who stayed in the system and on the drugs they all lived with physical disabilities. My mother walked with a stick from her 40's onwards, she was on a 3wkly depot injection until she died aged 68. If you go into a mental health day facility you will see many older women walking with sticks. My youngest sister, now in her 40's walks with a stick, her balance is effected, she is on clozapine ....
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