Dr Ken Harvey, Adjunct Senior Research Fellow, School of Public Health, La Trobe University, has written a long comment on my post below, and it is well worth a read. He also advises that he is putting in a complaint to Medicines Australia about the Sanofi-Aventis campaign.

Meanwhile, here are some other comments on the deal:

Dr Stacy Carter, Senior Lecturer, Qualitative Research in Health, Centre for Values, Ethics & the Law in Medicine and the School of Public Health, University of Sydney:

The naivety – or wilful ignorance – that Melissa describes is both critical and incredible. Doctors and research institutes entering into such deals with pharmaceutical companies are like pantomime characters: the wolf is approaching, the audience is shouting ‘look behind you’, they keep eating their ice-cream.

My colleagues and I have been engaged in some qualitative research around these issues for a while. Get a group of consumers into a room and ask them about drug marketing, and they will soon begin trading stories from their own experience that demonstrate how susceptible to influence many doctors are. Consumers are also under no misapprehensions about the power of corporate profit motives.

Meanwhile, one of the most consistent patterns in research is this area is that most doctors think they (and presumably their reputations) are impervious to influence. I suspect this is the same for many medical researchers.

Consumers look for independence in their medical practitioners and in research: they want to be able to trust. But trust demands trustworthiness, and ties to industry inevitably undermine this trustworthiness. One has to wonder why some doctors and researchers refuse to look up from their ice-cream and face the wolf.

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Michele Kosky, Health Consumers Council WA:

Some health consumers will feel a real sense of disappointment that a distinguished research institute like the Baker has to engage in this kind of fundraising venture which appears to potentially compromise the independence of the research and influence medical practitioners’ prescribing habits once again.

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Dr Alasdair Millar, physician:

I worked at the BMRI for 6 months in the late eighties and support its work.  Your article and the one in The Australian do make it clear that the funding to the BMRI is unconditional, and if that is true it is an important fact: the BMRI can do what it likes and no doubt good research will be done with it, and that could benefit medical practice.

Any dubiousness in the arrangement is in the link with prescription volume, in other words the involvement of the BMRI in a marketing effort of a single pharmaceutical company.  The marketing aspect is doubtless the reason Sanofi did not just give a grant of $500,000 to the BMRI.

I presume that the 25c gift will be conditional on prescribing clopidogrel as Plavix, rather than Iscover or simply as clopidogrel, and that in future, when the patents for clopidogrel run out, the BMRI funding will fall unless the trade-name prescribing continues; so in the long run it will have problems.  However, by then a generation of doctors will be used to prescribing clopidogrel as Plavix and the impact of loss of patent protection to the company will be blunted.  Perhaps this is the strategic objective.

It’s also worth pointing out that the 25c per script to be paid to the BMRI will in fact be paid for by Australian taxpayers directly, because clopidogrel is subsidised by the PBS.  The cost of clopidogrel to government via the PBS is substantial and is a legitimate source of concern.

One could make the case that more public good would be gained if the company simply cut the cost of Plavix by 25c per prescription, and that given the subsidy, the Australian government might feel it should have been consulted, especially given that it probably provides substantial funds to the BMRI through the NH&MRC.

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Dr Ian Haines, Melbourne cancer specialist:

I basically agree with Ken Harvey that the fundamental problems are:
1. The Baker Institute lending its logo to the sanofi advertisements which is indefensible and appears intended to deceive people that the Baker endorses the product Plavix.
2. Donations from Sanofi to the Baker being tied directly to scripts written.

Most health professionals would strongly endorse philanthropic donations from pharmaceutical companies to our leading research institutions which are fully transparent. However, do highly respected and prominent key opinion leaders such as Gary Jennings expect us to seriously believe that next time they are giving a major presentation to doctors, or involved in writing clinical guidelines related to these agents or reviewing journal articles that may be critical of or negative about Plavix or reviewing research grants looking at questions that may favour a rival product that they will be able to be totally disinterested and dispassionate?

If so, their behaviour would be almost unique in human history and they would be potentially reducing their own research funding.

Even if they are truly unique in human history, the perceptions of doctors at their presentations or doctors whose grants are turned down or researchers whose manuscripts are declined will still range from significant scepticism to profound cynicism to outright anger.

The only proper course of action now is for any researcher associated with the Baker to decline to do any presentation, manuscript review, review article or guideline that was in any way related to Plavix or any competitor product. There is no alternative action that would preserve the perceived credibility or integrity of the Baker in the public mind.

Alternative means of funding our major research institutes are urgently needed.
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Dr Jon Juredini, Healthy Skepticism:

The dangerous thing about this piece of marketing is its plausibility. Most readers will see it as an act of philanthropy, albeit one carried out in a way that will enhance the image of the company. Until I read Ken Harvey’s posting, I didn’t see all the dangers.

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