This issue of the International Journal of Clinical Practice includes two strikingly different perspectives regarding the interactions between healthcare professionals and pharmaceutical companies [1, 2]. The first , regarding drug promotion tactics, is similar in tone and conclusions to other antipharma perspectives, as oft-heard in the lay press and at national and international congresses where this topic has been heatedly debated. The second , gives an overarching viewpoint of how antipharma biases have developed over time but how the strength of the evidence, one way or another, has been set aside in favour of distortion and lack of acknowledgement that major changes have taken place, rendering many arguments moot. It is clear that relationships between healthcare providers and pharmaceutical companies remain a ‘hot button’ issue.
Often painted with the same brush, criticisms are often levelled at those physicians who work for, or collaborate with, pharmaceutical companies. The term ‘pharmaism’ (or ‘pharmism’) has been used informally by two of us (JK and LC) and we were both surprised and pleased that another person has used it in an editorial , and to the best of our knowledge, marks 2013 as the year that this word has first been used in a scholarly publication. We offer a more formal definition in Box 1. Strong antipharma 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.
Box 1. Pharmaism, definition
noun \ˈf är-mə-izəm\
: discrediting health care providers because of their association with a pharmaceutical company
: the belief that people associated with pharmaceutical companies are more likely to be intellectually and morally dishonest than others
Full Definition of PHARMAISM
: a belief that being associated with a pharmaceutical company is the primary determinant of human traits and capacities regarding scientific discourse and that not being associated with a pharmaceutical company produces an inherent superiority regarding moral and intellectual standing free from bias
: prejudice or discrimination
—pharma·ist noun or adjective
Examples of PHARMAISM
- The pharmaism that was the basis of requiring additional independent statistical analyses for manuscripts of clinical trials submitted by a pharmaceutical company.
- The singling out in the lay media of healthcare professionals who earn money by contracting with pharmaceutical companies for professional services as an indication of a lapse of professional ethics is an example of pharmaism.
First Known Use of PHARMAISM
Variants of PHARMAISM
It is ironic that many of the same physicians who advocate for evidence based medicine are quick to generalise and jump to conclusions. These are two well-characterised cognitive distortions that any scientist ought to be able to recognise as common forms of bias. Normally in scientific discourse, a writer will try to be conservative and refrain from the use of emotion in presenting a perspective. Yet, when the topic pertains to pharmaceutical research, publications or education, the first volley fired is almost invariably dismissive of any positive value or any ethically sound motives from those who are employed by or associated with pharmaceutical companies' scientific pursuits. The critics' blind spot into their own bias is remarkably consistent and persistent.
One of us (JK) was employed as a clinical research physician for a pharmaceutical company for 8 years, working with some of the best scientific minds he has ever met during his career as a psychiatrist. These were people who were motivated by wanting to do what was best for patients. His job included designing and running scientifically sound clinical trials, writing up the results for publication, coordinating scientific publications and doing educational lectures and workshops. He also reviewed marketing materials to ensure they were scientifically accurate, with no inappropriate claims. At all times, his team would strive to present information in a balanced way that not only discussed positives but also the potential negatives. Knowing how he did his work, it was very difficult to be frequently faced with prejudice in how he was perceived by outside physicians, and in particular academics. The medical team was often accused by audiences and writers of doing unethical things, snubbed, sneered at, dismissed, etc. The worst experiences came from anonymous peer-reviewers of journal articles, and where the sponsoring pharmaceutical company disapproved responding to the allegations because it was not considered strategically wise to do so.
Part of the academic–industry divide may lie in the differences in how accomplishments are valued. Independent investigators are judged on the basis of their grant support and are subsequently rewarded by academic promotion and tenure. Obtaining external grant support is highly competitive and intellectually demanding. Designing and executing clinical trials supported by pharmaceutical companies may on the surface yield similar-appearing publications to those produced via externally funded research grants, but have, by their nature, commercial goals, and thus are perceived differently. Moreover, academic–industry relationships have not been free of tension. There are instances of pharmaceutical company executives not being particularly respectful of their academic collaborators; anecdotes include arrogance of the pharmaceutical company scientists who were unwilling to engage in academic discussion and refusal to listen to anything that they interpreted as criticism, taking ideas presented by others and later presenting them as their own, and breaking promises regarding authorship of clinical trial results where the academic had a substantial role. Although such behaviours are not unique to company employees and can be encountered among academic researchers, they fit a stereotype and reinforce antipharma attitudes. But, to be fair, this variation in pharmaism may be elicited by the behaviour of a few pharmaceutical company executives, and sadly, subsequently poisons the well for others seeking to collaborate on scientific matters.
Academia once served as the leader in developing novel translational strategies for improvements in patient care. Unfortunately, with the divide self-imposed by academia from industry, one has observed a transition of clinical trial and pharmaceutical development away from medical schools to private organisations. Such a shift has also led to a detrimental effect on residency education programmes where the trainees are no longer exposed to the latest advancements in clinical care. Unless academia can re-engage with industry in open, ethical relationships, patient care will continue to suffer from a lack of knowledge and innovation. Fortunately, at some institutions such as UC Irvine, where one of us is employed (GM), faculty are permitted to engage with industry in speaking, consulting, clinical trials and other appropriate interactions. With such, one still has some semblance of ‘trickle-down’ knowledge of new interventions in the training programmes.
Ultimately, we need to ask if the restrictive and burdensome policies of academic medical centres that limit faculty interactions with industry have been in the best interest of patients. Academics consult to and collaborate with industry to facilitate drug development – good or bad for patients? Academics with skills in teaching can inform practitioners about new treatments – good or bad for patients? Academics help industry conduct clinical trials – good or bad for patients? Academics get paid for their time and expertise – good or bad for patients? Regulations about academic–industry interactions are lengthy, burdensome and take an inordinate amount of time to learn and implement along with severe penalties that steer many academics away from any relationship with industry – good or bad for patients? The time seems right to rethink the benefits, costs, and risks of restrictive policies that, in aggregate, may have the unintended consequence of hampering progress in therapeutic development. Ultimately, discouraging academics from interacting with industry may be bad for patients.
Our belief is that the recognition of the existence of pharmaism is a prerequisite to having an honest discourse on the facts. In sharing this commentary and the two perspectives [1, 2] included in this issue of the International Journal of Clinical Practice with our team of Associate Editors, several other related issues were raised and are deserving of further discussion. These include the need for accurate and consistent reporting of conflicts of interest in scholarly publications, the presence of inadequate transparency with regard to study protocols and clinical trial reports, the potential impact of the Sunshine Act in the US and similar initiatives elsewhere, confusion by the general public regarding personal financial interests with work done on behalf of employing organisations, studies designed for regulatory purposes being difficult to appraise regarding their relevance to clinical practice, and the experiences of scientists dually employed by both an academic institution and a pharmaceutical company simultaneously. We anticipate further comments from our readership. Where do you stand on relationships between healthcare providers and pharmaceutical companies? Where do you stand regarding pharmaism?