Enfrentando las fallas de la medicina – BMJ

The BMJ this week brings together several of the themes that we have campaigned on in recent years: competing interests and the hidden hand of the drug industry in clinical decision making; the quest for open trial data; and overdiagnosis and overtreatment.

Our GP columnist Margaret McCartney has long been a cheerleader for rational and evidence based decision making, free from the influence of pharma and politicking. This week, in addition to her regular No Holds Barred slot—in which she lambasts England’s health secretary, Jeremy Hunt, for wanting drugs costing more than £20 (€29; $31) to display the price (doi:10.1136/bmj.h3929)—she investigates so called partnerships between the drug industry and primary care (doi:10.1136/bmj.h3688).

After filing 186 requests under the Freedom of Information Act, McCartney found that 36 English clinical commissioning groups were involved in drug management programmes paid for, either directly or indirectly, by the drug and devices industry. In some areas she found that industry staff were working in general practices to review patients. In Portsmouth, writes McCartney, general practices wrote to patients with stomas and offered them an appointment with a nurse employed by a stoma company to “optimise stoma care.” In other areas pharmacists who were paid indirectly by a company making calcium and vitamin D products for osteoporosis had access to patients’ records. The practices, however, did not seek permission from individual patients.

McCartney describes a range of models for joint working between the industry and the NHS, including intermediate companies and pharma sponsored nurses and pharmacists in general practices. Although the UK government has been open about its support for closer collaboration, concerns abound about patients giving fully informed consent and the risk of drug switches that are profitable to the industry. “Are we sure we are getting a fair exchange for this intelligence gathering?” asks McCartney.

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