Doctors as lapdogs to drug firms

Fugh-Berman is correct that we need to bite something tender and to get out of that lap.¹ But we are fighting the wrong beast. The beast is not the pharmaceutical industry—it is ourselves.

Pharmaceutical companies sell products under the banner of science. But their only raison d'être is to make money. Industry has to balance genuine hypothesis testing and transparency against commercial interests and the financial consequences of dishonesty. This is not in itself a criticism—it is a simple fact.

It is also of course true that the industry provides products which are often beneficial to our patients. It is equally evident that many actions of industry have not resulted in benefit, and have instead caused harm. More importantly, we are often completely unable to assess the degree of harm, because information is hidden by gag clauses, the threat of litigation, and cosy commercial arrangements between the regulators and industry.^{1 2}

We, as doctors, have created the atmosphere which has allowed companies to malfunction. We have allowed industry to subvert the rules of science.³ We have watched quietly as governments and academics have colluded with industry to hide information critical to our patients. We have remained silent as our medical schools have churned out graduates who have no knowledge of the dilemmas and scandals of medicine. We have allowed many of our medical journals to become corrupted and timid. The soft parts that need biting may well be our own.