The
Canadian Journal of Psychiatry
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| Volume
47 |
Ottawa,
Canada, May 2002 mai
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Number
6
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Editorial
The Role of Pharmaceutical Companies in Research and Development
— Plaudits and Cautions
Quentin Rae-Grant, MB, ChB, FRCPsych, FRCPC
Editor-in-Chief
Over the last several years, pharmaceutical companies have continued
to market their specific products with ever increasing diligence
to physician prescribers. These companies make a great contribution
but also challenge the boundaries of balanced information-sharing.
With this issue, the Journal introduces new procedures to address
this situation.
The knowledge and practice of medicine has changed immensely over
the last 60 years. We can now treat illnesses that were only subject
to alleviation. Nowhere has this been greater than in psychiatry.
While many areas have made significant contributions, the area of
psychopharmacology has been in the forefront since the introduction
of chlorpromazine for schizophrenia.
While the progress has been impressive, the downside is the decrease
in medical-psychiatric use of forms of psychotherapy, which have
become the territory more of other mental health professionals,
some of whom have been campaigning for prescription rights. Some
would go so far as to claim that psychiatry has become a less caring
profession and that this may partly account for recent reduction
in the number of medical students enrolling in psychiatry, a trend
that seems to have been reversed this year.
The research to develop these drugs is long, complicated, and often
without result. But where there is evidence that the drug works
better than placebo, attention and funding flow into development
and promotion. Particularly where there are competing compounds
in the same group, the struggle for attention and prescribing choice
is intense. More recently, the funding of many of these studies
has come from companies who are brokering them. This is in no way
to imply that there is anything wrong with this activity as it is
quite in keeping with the mandate of these companies.
Journals everywhere are committed to keeping their readers acquainted
with the latest developments and how to make choices for the individual
patient and to provide a framework within which to consider the
information and promotion by the representatives of the firms. There
have been strenuous efforts to combat direct interference in the
conduct, preparation, and dissemination of results. There is even
more bias if the firms can stop research before it is completed
or even censor the results published. There have been a number of
prominent cases of just such occurrence.
However, reality is that there are many ways of influencing the
prescribers, such as the teaching events at annual meetings, advertising
in the journals, and frequent mailings. Organizations have been
happy to accept these influences provided there has been preliminary
review of the intended general material and clear declaration of
sponsorship.
Journals are now accepting this reality, and the distinguished
New England Journal of Medicine has announced that it will no longer
insist that authors of review articles be unattached to any of the
manufacturers. The argument is that those best able to articulate
a review today seem to be involved in funded research of this nature.
What is now being emphasized is the clear declaration of any funding
received for the research submitted in a paper and any affiliation
with the activities of these firms. The purpose is to provide readers
with enough information to assess the quality of the research for
themselves.
Accordingly, each Journal paper will state any affiliations of
the authors—academic, financial, or employment—and specific
information as to any and all sources of funding for the work and
research being reported. Broadly, the Journal will make the presentations
as transparent as possible.
Another issue that has come up recently is the inclusion of already
published work as an insert in the Journal package. These inserts,
for which the CPA is paid, will now have a facing sheet indicating
that the item is a paid insert and that its distribution with the
Journal in no way implies the endorsement of the content either
by the Journal or the CPA. The Journal will not allow the pharmaceutical
firms to influence what is published in the Journal or, on the contrary,
to impede publication of articles, review papers, inserts, or the
choice of guest editors for a specific topic in the In Review series.
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