Faith and knowledge ... in the practice of medicine

One of the sentences in Michael's report that the editors highlighted was:

Over-prescribing expensive medicines to uninformed patients is nothing new to observers of Indonesia’s graft-ridden health system

There is no doubt that this is a problem. But a recent report, The Neurontin Legacy — Marketing through Misinformation and Manipulation, in the New England Journal of Medicine (free to those accessing it from Indonesia) shows that, once again this is not a field in which Indonesia leads.

The report makes use of thousands of documents covering a case of illegal marketing in the US by a subsidiary of that giant of Big Pharma, Pfizer. The drug concerned doesn't matter much; the fact is that the company was peddling it for conditions for which it had not been approved, and persuading doctors to up the doses well above the approved level if the treatment appeared to be less than successful. Doctors were recruited, trained and paid to serve as speakers. The company sought "strong Neurontin advocates and users" to promote the drug. They made "unrestricted educational grants" to support Continuing Medical Education. They highjacked research to ensure that reports which did not support their interests were not publicized. And so on.

All very concerning. But worse is that these marketing methods are not illegal; what was illegal was just promoting the drug off-label (to treat conditions for which it was not approved). Apparently there is no law in the US (much less here) which forbids these marketing strategies as long as you are promoting the approved use of a drug.

There have been many reports from around the world of patient groups being highjacked to promote certain drugs. Is that happening with HIV? We'd be stupid if we assumed not. That is one reason why we in Spiritia (and most developing country peer support organizations) refuse to accept money from pharmaceutical companies. On the other hand, many groups in the west rely almost totally on such funding, maintaining that they are 'mature' enough to ensure no conflict of interest. Oh ya?

Back to the doctors here. With such an example from their colleagues in the West, and clearly in much greater need to 'support', who can blame them for jumping on the bandwagon?

Babé