"Yes, I am a doctor and I am quite often approched by the pharmaceutical industry in different ways, (in fact in the US industry spends about 100 000 USD on me), I get some small gifts with names of drugs, I participate on conferences sponsored by the pharma industry but I am sure I am in no way influenced by these practices. I prescribe what I find the best for my patient, and I get this medical information from objective, peer-reviewed studies and professional guidelines. Clinical studies are very strictly monitored and FDA looks after what is approved for the market." If you think you or your doctor agrees with the statements above, it is high time to read Brody's book and lose your illusions. We still have too many doctors and patients who may be aware of some of the deviances of the pharmaceutical industry, however, consider these to be exceptional and of marginal importance. In fact, if someone reads Brody's book she will learn that fraud, malpractice and lying is an inbuilt phenomenon in the system of clinical research, drug regulation, scientific publication, medical training and drug advertisements. This is certainly disturbing, worrisome and frustrating.
Fortunately we have already seen dozens of books from Marcia Angell, Carl Elliott, Sheldon Krimsky and others on the ugly practices of pharmaceutical industry; however, we must confess too little has changed to leave this topic rested. Novel and well written books are permanently needed to keep the interest on these issues awake so that a critical mass of information and motivation for change reach the public and the medical profession.
In his book Hooked, Brody has a systematic overview on the specific issues and problems in the relationship of medicine and industry. We read and reread the classic stories of Vioxx and antidepressants, we rethink the whole system of medical education, the reanalyze the different catches of clinical research, we relive the complicity of FDA in this corrupted enterprise. What Brody adds to our present knowledge is a systematic collection of recommendations for changing the present malfunctioning status quo. His most revolutionary recommendation of is a National Institute of Pharmaceutical Development (NIPD) to overcome many of the obstacles commercialized clinical research possesses nowadays.
With regard to the proposals I would have two questions for the author: in his recommendations he is mainly focusing on the US. Given the globalized nature of drug research, is it possible to change present practices without having collaboration with the rest of industrialized world? I doubt his answer would be yes.
As for the second: Brody is not a radical, as he does not challenge the basic capitalist norms and option in drug research. Although his idea of NIPD seriously restricts completions and the realization of profit-interests, the question is whether we can achieve an affordable and sustainable drug research within our present framework, or we should abandon for-profit research for the welfare of patients in a long term? I do not have a precise answer for this question nor does Brody in his book.
It is good to read Brody's book, it is good to have his reflections in our mind. To have them realized would be in the best interests of all of us.
© 2009 Imre Szebik
Imre Szebik received his MD and PhD from Semmelweis University of Medicine, Budapest, Hungary and his M.Sc. Specialization in Bioethics from McGill University. He now works as a research associate at the Bioethics Department of the Institute of Behavioural Sciences of Semmelweis Medical University.