No Decency? Pharma-UK on How to Collaborate

While attending to events on this side of the ocean, I seem to have been late learning about a kerfuffle set off by the Association of the British Pharmaceutical Industry, which I gather is the UK equivalent of our PhRMA.

The ABPI last year issued a 4-page "Guidance on Collaboration between Healthcare Professionals and the Pharmaceutical Industry":
http://www.rcplondon.ac.uk/sites/default/files/guidance-on-collaboration_0.pdf
On its face this is quite an impressive document--it features the logos not only of ABPI but also such august organizations as the Royal College of Physicians, the Royal College of General Practitioners, the Royal College of Nursing, the British Medical Association, and The Lancet. It claims to have been produced by a conjoint effort of all these organizations "with the aim of promoting positive collaboration between industry and healthcare professionals to support high quality patient care."

Since The Lancet was prominently listed as a collaborator in this effort, several physicians actively critical of Pharma penned a letter to the editor of that journal which was published last July, regretting that the journal had allowed its name to be put onto a document that played fast and loose with the truth. Among the statements contained in the report that we have previously demonstrated to be either blatantly untrue or highly doubtful:

• "Healthcare and industry professionals are able to manage their relationships with each other without compromising clinical decision making."
• "Information about industry-sponsored trials is publicly available."
• "Industry plays a valid and important role in the provision of medical education."
• "[Industry] Medical representatives can be a useful resource for healthcare professionals."
• "The industry takes its responsibility to monitor adverse events very seriously."
• Anything negative about industry behavior in the past is solely due to "historical practices that are no longer acceptable, or the actions of a few individuals that are not typical of the working relationships between healthcare professionals and the industry."

And the report adds a list of "Dos and Don'ts for Healthcare Professionals"--

• "Don't establish blanket policies denying interaction with industry..."
• "Don't be tempted to accept the negative myths about cooperating with industry. Undertaken appropriately, working with industry will not harm objectivity..."

So-- how did The Lancet react to being challenged? Its editor, Richard Horton, published a revealing comment earlier this year, in which he retracted the journal's endorsement of the report: "The statements made in the 'guidance' certainly do not match  the latest evidence about the behavior of pharmaceutical companies today. Indeed, this evidence undermines the principles we originally signed up to, principles that attempted to forge a new and more constructive partnership between medicine and the pharmaceutical industry. It's time for us to withdraw our name from the 'guidance' as it currently stands."

A little bit of between-the-line-reading seems called for here. What I take Horton to be saying (based on past experience of similar efforts in the Pharma world) is that the ABPI invited all these other organizations to come on board by promising them that this time, the industry was really serious about finding new, more positive ways to collaborate, and perhaps indicating that they were finally ready to fess up to past wrongs and turn over a new leaf. Like Charlie Brown figuring that this time, maybe Lucy would actually hold the football for him to kick, those other organizations, all valuing the day (as I do, myself) when a real collaboration might become possible, signed on. And then, ABPI took advantage of its control over the writing process and inserted wording that served their PR purposes splendidly, but that were completely at odds with the cooperative spirit that had caused the other organizations to agree to become a part of the effort--in effect playing all the other groups for chumps.

The title of this post is taken from the incident in the Army-McCarthy hearings of 1954 which is usually cited as the turning point in the infamous career of Sen. Joseph McCarthy. With the nationally televised hearings not going the way McCarthy had hoped, he pulled out his usual trump card and without warning, accused a young lawyer in the firm of the Army's chief counsel, Joseph Welch, of once having been a member of a Communist-affiliated organization. Welch replied in defense of the lawyer and then, when the Senator continued his character assassination, turned on McCarthy with obvious regret, "Have you no sense of decency, sir? At long last, have you left no sense of decency?" It appears that Pharma-UK, offered a chance to finally show a sense of decency and admit that its past behavior has made it impossible for any health professional of integrity to trust them or to engage in any direct financial dealings with them, could not in the end change its stripes, but had to once again demonstrate its lack of decency and its insistence on substituting PR fluff for substantive change.

Braillon A, Bewley S, Herxheimer A, et al. "Marketing versus evidence-based medicine [letter]." Lancet 380:340, July 28, 2012.

Horton R. "Offline: falling out with pharma." Lancet 381:358, February 2, 2013.