True Colours

Pharma runs a successful and demanding operation, so why are people so often left pondering the lack of defence when it's attacked, or its seeming propensity to fight only those battles it's obliged to? It is the absence of visible labours to deal with unconstructive thoughts, perceptions and rumours that is one of the key criticisms bandied about of the way in which the pharma industry handles its press.

Working on media relations is a key step towards a better reputation, but is there also an opportunity for pharma companies to develop relationships with nascent healthcare professionals? Indeed, what do medical students think of the pharmaceutical industry? What are they taught on their courses, where does the information come from and how is it assimilated?

The Health Select Committee last year warned pharma firms to stay away from newly-qualified doctors with respect to some of the more heavyweight marketing activities, yet with closer NHS-pharma 'partnerships' heralded by experts as the way forward for both parties, is there some value for each side in just, talking?

There is a real gap between industry and med students, and it represents a massive area of long-term potential which is, to my knowledge, currently untapped by the industry, says Julia James, a mature student of medicine studying at a south-west medical school, in England. Before starting a career in medicine, James worked in drug promotion for several years.

I think all med students should be taught about the industry and the ABPI Code of Practice realistically and early. There is nothing in our curriculum that covers any sort of education about the industry, other than a few biased comments here and there from cynical lecturers. This bias - that pharma has tunnel-vision and is interested only in selling expensive drugs - is the majority view and pervades the education of medics.

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She describes the 'pharma content' of her course as comprising frequent derogatory remarks from lecturers and exposure to drug launches at meetings but no guidance whatsoever on the benefits or otherwise of the industry, its representatives, or its public relations/medical information departments.

I am not comfortable; the views expressed by members of the medical profession during lectures and other interactions are individual, there has been no official medical school view given, and no guidance for younger people on the course. They are being swayed very early in their careers by a lot of biased medics.

James wants to see med students learning about the pressure ABPI members are under to comply with good practice: Nobody has ever mentioned how helpful medical information, regulatory affairs or research departments can be. Neither has there been a balanced view of the industry given formally.

If a return to the pharma industry was on the table, she would suggest that a new department be created which would serve to provide med students with educational information about pharma's goals and modus operandi.

I would implement a few different long-term strategies under a separate department from marketing or PR, called something like `Educational Relations' which would have government backing under MMC [Modernising Medical Careers - seeking to develop and implement a better way of training tomorrow's doctors].

How do you feel about pharma?
Printed below are answers elicited from a short questionnaire that was designed to reveal med students' perceptions and understanding of pharma's marketing practices, and circulated by Pharmaceutical Marketing to select medical schools. These are first and second year students, so we cannot expect too much of them in terms of factual knowledge; however, their sentiments towards the pharma industry may prove to be enlightening:

Q: What is the key aim of a pharmaceutical sales rep?

A(1): I'm not entirely sure, but I think it's to try and persuade doctors to make them use their company's drugs/products by giving freebies as incentives.

A(2): To promote drugs and products to doctors; to promote the company that makes them; to get people used to trade names.

Q: What regulates the way in which pharma companies can market drugs to doctors, and who is responsible for enforcing it?

A(1): NICE?

A(2): English law, the BMA and other drug companies.

Q: The UK's pharma industry generates significant profit and there is strong rivalry between companies. Would you be surprised to hear of employees at drugs companies pushing the boundaries of a) what could be ethical, b) what could be good practice, or c) legal, or other binding regulatory frameworks, if it meant achieving greater commercial success?

A(1): I know that pharmaceutical companies have a reputation for being ruthless and that must have come from somewhere, so I wouldn't be surprised by any of it. If they have found a drug that is revolutionary, then they are going to make sure they market it first, before anyone else, so that might mean cutting corners on trials, meaning that they market the drug before they really know its side effects.

A(2): Like all companies, drug firms have to make money, and all companies push boundaries. Good practice continues to change, as does what is considered to be `ethical' - things may not be ethical today, but which were considered to be so ten years ago.

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Clearly, the question above was phrased in such a way as to elicit opinions that may lurk a little way beneath the surface, yet from these few responses it seems that there may well be work to do in straightening up, rounding off and fleshing out some pretty censorious views of pharma - an industry that does much good; and that prompts another question.

As these early-stage students progress through their course, will university medical lecturers strive to impart knowledge and training that ensures doctors-in-waiting form balanced, well-supported opinions of their biggest supplier? Indeed, would they even value some direct input from pharma firms?

A spokesperson for Oxford University, Ruth Collier, comments: How much does the pharmaceutical industry come into medical teaching? Not much is the answer, but it's a very interesting question. Pharmacology certainly does, but with regard to understanding the finances and working of the industry as a commercial operation, I don't think it does come much into our degree.

The University provides limited information about pharma's thinking as part of a lecture series which, though not compulsory, seeks to satisfy the curious med students.

Oxford, in particular, has quite an academic approach to medical teaching. Obviously there is an element in that we're training people to be doctors, but lots of med students go on to become clinical researchers. So, if people are interested in pharma, they can go to that lecture but that's really the main provision. It may well crop up in tutorials, as there's close one-on-one teaching at Oxford, so if people are interested they'll always have the opportunity to ask about it in the tutorial situation.

The approach to explaining pharmaceutical business varies between the Oxford tutors, though Collier believes that any lack of content in this respect is not in any sense that we don't want you to learn about this, it's just that the people who teach the medical course are themselves clinical researchers and so will teach what you need to know in terms of understanding drugs and how they work.

At Birmingham University, there is, perceivably, a stronger sense that med students are under enough pressure to learn their course material as it is, without their focus being diluted by incorporating extra information about how, for example, drugs are marketed and how regulation of pharma is effected.

Would I have any wishes to exclude this information from the course? Yes, sort of. I haven't really considered it, but if we're talking about pharma companies coming in to lecture to students - it's just a case of wanting to sell things to them earlier on, says director of teaching for the division of neuroscience and senior lecturer in pharmacology, Mary Keen.

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It depends on how it was pitched, obviously, and I see that pharma is clearly a very important part; students need to know how to deal with the information they get from drugs reps etc... but I see what we're trying to do as getting them to look at it objectively.

Given that the pharma marketing machine is a powerful, effective force, does Birmingham consider its stance to be in some way protective? Is it helpful to instil in students a critical, or even cynical, view of pharma's promotional practices?

To be aware that their agenda is not necessarily the same as yours? Sure. Yes, I do think that's important. We're also trying to get them to think more about evidence-based medicine now, so being able to weigh up the information for themselves, and not just to take everything at face value, is important.

More information
One initiative underway regarding pharma's 'educational relations' takes the form of the Faculty of Pharmaceutical Medicine (FPM), a body that seeks to provide 'add-on' modules to medical courses, providing information about drug development, promotion and regulation (see www.fpm.org.uk).

'Educating medical students about the pharmaceutical industry and the standards expected of its employees can bring many benefits to both sides,' writes Dr Jackie Napier, on the FPM website. 'Hopefully some myths about the industry will be dispelled, these having arisen largely through ignorance and the historical lack of openness within industry itself.'

Dr Napier says that such interaction at an early stage can only stoke constructive dialogue for both parties, and maybe even encourage medics to view pharma as a potential career path (as is one aim of Pharmaceutical Marketing Limited's own Breakthrough publication, see www.breakthroughlive.com).