Promotional gift from the pharmaceutical industry

December is a month of reflection. It is also the month of lavish meals and gifts, though. A perfect time for the pharmaceutical industry to send promotional presents to doctors. Ridder Dijkshoorn, a psychiatrist himself, tells us how we can find evidence of this fact in the Chessmen Museum as well and what the consequences are of this type of ´gifts´.

In the collection that I was able to take over from Mr Glotzbach´s heirs, there is a chess game made of synthetic resin (or Bakelite?). The pieces in this set are hollow at the bottom. Originally, it was the space where the capsules of a new antibiotic were stored, a promotional gift presented to doctors by medical salesmen.

The doctors in question would have listened to a fifteen minute talk about the benedictions of the medicine first. Sponsorship, it was called. The offering of this kind of ‘mirrors and beads’ (and diaries, pens, calendars, etc.) were peanuts compared to other ways of pampering: sponsorship of continuing education courses abroad, for example.

Obviously, the pharmaceutical industry applied the ´quid pro quo´-principle in these cases. Their expectations were usually met: the doctor would be inclined to prescribe the offered medication. For this reason, these forms of sponsorship are now subject to restrictions. So if your doctor tells you that he is going for a refresher course to a luxury ski resort abroad, you can -hopefully- assume he has paid for the expenses of the trip himself.

Sponsored scientists
A different case is the sponsorship of studies into the effectiveness of a new medicine. Large amounts of money are often involved in this. Officially, a research team from a university will be hired, for which the university is then paid. This is entirely according to the wishes of governments that praise the concepts of ‘market mechanisms’ and ‘neo-liberalism’: the cost of universities is being passed on to the business community.
The investigators´ independence does get limited this way, though. Furthermore, researchers are supposed to ´produce´: they have to meet a certain number of publications in scientific journals per year.

Danish writer and doctor, Peter C. Gotzsche, claims this is where it all turns sour: often research papers are written by ghost-writers of the manufacturer himself. The universities´ investigators are more than happy to sign their name on such articles, in order to meet the publication requirements.

No better than a placebo
According to Gotzsche this is only one side to these inexcusable practices; another problem is that manufacturers generally tamper with the results of the research to make their medicine seem as effective as possible compared to placebos (fake drugs that are used with half of the subjects of a double-blind trial).

Gotzsche takes it even further: when thoroughly examining research data it frequently turns out that the drug in question isn´t any more effective than the placebo at all. And taking it further still: there are often many side effects to the drug that can sometimes even be fatal. For this reason, antidepressants, for example, should really not be prescribed. Gotzsche is not making any friends among doctors and psychiatrists with these premises (elaborated in two considerably hefty paperbacks).

Gotzsche himself states that he likes debating with these doctors and psychiatrists. Sometimes this happens in organised fashion during conferences, but usually neither side will budge; possibly because Gotzsche defends his opinions tooth and nail, which makes physicians and psychiatrists feel like they are not heard when criticising Gotzsche´s premises. For me it is difficult to choose between the two points of view; perhaps in this case the truth is somewhere ´in the middle´.

Necessary or not?
One thing, however, is very clear to me: true impartial research can only be achieved by entirely independent institutes and researchers. Therefore: we have to return to the times when universities were fully financed by the government and market mechanisms were entirely avoided. That will cost tons of money, but it will repay itself because it will be much more closely studied whether a certain medicine is truly effective. If it isn´t, it is not allowed to brought to market.

It should also be clear whether a drug is really necessary. Gotzsche states that manufacturers make a fortune selling cholesterol inhibitors, when there has also been tampering with the question of when the blood´s cholesterol levels are actually too high. According to Gotzsche the same also applies to antidepressants used in depressions. Again, I think the truth can be found somewhere ´in the middle´. I would like to hear your opinion on the matter.

By Ridder Dijkshoorn
(Director of the Chessmen Museum and psychiatrist)