Dear Editor

We read with great interest the report by Raftery et al on Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness. The authors raise the very pertinent point in respect to a single company owning two competing drugs and the inherent cost to tax payers. The authors conclude their abstract with "Public pressure may be the most potent weapon in persuading Genentech to license bevacizumab for AMD". We would like to suggest what forms this public pressure may take. The pharmaceutical industry claims to educate the medical profession on conditions and its drugs to treat them. Should we be relying on a business to give us unbiased evaluations of products it is selling? Most doctors who accept free lunches and merchandise will claim to be unaffected. However, doctors who have frequent contact with drug representatives are more willing to prescribe new drugs, do not like ending consultations with advice only, and are more likely to agree to prescribe a drug that is not clinically indicated. [1] Doctors are now dependent on drug companies for education and funding for research. Research funded by drug companies has been found to be less likely to be published than research funded by other sources. Studies sponsored by pharmaceutical companies were found to be four times more likely to have outcomes favouring the sponsor than were studies with other sponsors. [2]

We have an unhealthy relationship with the pharmaceutical industry which undermines our ability to make patient centered decisions. To prevent more profit centered drugs coming to market rather than patient centered drugs, we as a profession must take responsibility. When published financial reports indicate pharmaceutical industry spending in marketing is three times that of Research and Development, alarm bells should be ringing.

To reduce this influence we must no longer accept free lunches, merchandise or holidays, look for alternate means of funding research and educational meetings and most of all become educated on the role drug companies play in our decision making. Accepting our need for the pharmaceutical industry should not mean accepting dependence upon them, if we wish to see drugs such as bevacizumab being licensed it is time we make our boundaries clear.

Suggested reading: The Truth About the Drug Companies by Marcia Angell (Former Editor of the New England Journal of Medicine) www.nofreelunch.org

References

1. Watkins C, Moore L, Harvey I, Carthy P, Robinson E, Brawn R. Characteristics of general practitioners who frequently see drug industry representatives: national cross sectional survey. BMJ 2003;326: 1178-9

2. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326: 1167-70