BMJ columnist holds doctors to a higher standard over industry payments

Here in the UK the on-going ‘Leveson inquiry’ has been investigating the practices of the press, as well as its relationship with the police and politicians. It is alleged to have revealed illegal undisclosed payments made by the press to public officials. This is clearly intolerable and wrong but results from a cultural change. In the latest edition of the British Medical Journal, columnist and general practitioner Dr Des Spence draws parallels between this wholly unhealthy situation and a very similar situation that exists in the medical profession [1].

Here’s some excerpts from Dr Spence’s column:

…thousands of pounds and other large payments in kind have been made to doctors in the past few decades. These payments continue and are widespread and undisclosed. This is clearly intolerable and wrong.

The paymasters have been Big Pharma and device manufacturers.

The smell of improper behaviour didn’t come just from Big Pharma but from doctors too. Without the collusion of doctors, Big Pharma would never have been able to operate its corrosive marketing and hospitality culture. We are just as much to blame, for often our behaviour was inappropriate. I believe that doctors should cease to receive all payments from drug companies. Any external witness would find it unacceptable that highly paid public servants accept large undisclosed payments and hospitality (however this might be dressed up as “advisory fees” and “educational support”) from private companies. Some doctors suggest that we are professionals with a higher code of ethics than others, so these payments do not affect our judgment. This is not true.

Dr Spence makes the point that there is talk of disclosure of payments to doctors which, he suggests, is a bare minimum even if these payments are not stopped. He then goes on to take a swipe at the General Medical Council – the organisation whose job it is to regulate doctors and maintain professional standards. Dr Spence continues:

To make this work the industry needs the cooperation of the General Medical Council, a flatfooted institution that has repeatedly failed to acknowledge, deal with, and protect the public from potential conflicts of interests of doctors. In this time of social change we must work with the industry to establish a new working relationship. Medical regulators need to wake up and smell the public mood, for undisclosed payment to NHS public servants stinks.

It’s good to see a doctor stick his head above the parapet and ‘do the right thing’. I think in this column Dr Spence holds us doctors to a higher standard, and many in the profession might do well to take note.


1. Spence D. Medicine’s Leveson BMJ 2012 (Published 7 March 2012)

6 Responses to BMJ columnist holds doctors to a higher standard over industry payments

  1. tom scott 15 March 2012 at 7:50 am #

    You might find this article from Boise, Idaho (U.S.) to be of interest.

  2. Tom McAnea 16 March 2012 at 9:36 pm #

    Des Spence is a brave and honest GP, working in one of the most deprived areas of Glasgow (and thus, the whole of Europe). As a GP who also recognises the corrosive effect that big pharma has on the profession, and our complicitiy in this process, I commend his article.

  3. Cybertiger 18 March 2012 at 12:13 pm #

    Last year, GSK was fined nearly $3 billion for various development and marketing offences in the US. Then Andrew Witty, the CEO was awarded a knighthood in the New Year’s honours. Reward for failure: that’s what I call corrosive.

  4. Deborah 18 March 2012 at 3:43 pm #

    Yes, well done Dr Spence, wish there were more such brave docs around.

  5. Cybertiger 18 March 2012 at 8:59 pm #

    The GMC is an embarrassment. I’m registered with the GMC and I feel deeply embarrassed. The GMC purports guide the profession and protect patients: it does neither. In January 2010, after the longest trial in GMC history, Professor John Walker-Smith was convicted of serious professional misconduct and his name erased from the medical register. On 7 March 2012, Mr Justice Mitting at The Royal Courts of Justice overturned both the conviction and the erasure. The GMC’s failings were stark,

    Paragraph 150 states,

    “It is in its findings on the clinical issues in the individual cases of the Lancet children that the most numerous and significant inadequacies and errors in the determination of the panel occur. In no individual case in which the panel made a finding adverse to Professor Walker-Smith did it address the expert evidence led for him, except to misstate it. The issues to which this evidence went were of fundamental importance to the case against him. Universal inadequacies and some errors in the panel’s determination accordingly go to the heart of the case. They are not curable. Unless the remainder of the panel’s findings justify its conclusion that Professor Walker-Smith was guilty of serious professional misconduct, its determination cannot stand.”

    … and then the judgement finishes at paragraph 187 with,

    “The panel’s determination cannot stand. I therefore quash it. Miss Glynn, on the basis of sensible instructions, does not invite me to remit it to a fresh Fitness to Practice panel for redetermination. The end result is that the finding of serious professional misconduct and the sanction of erasure are both quashed.”

    Sadly, this was not just an isolated example of GMC judicial incompetence, inadequacy and general uselessness. However, the Mitting judgement also demonstrates that the GMC can behave not only unfairly, with unkindness, but with actual malice too. And acting maliciously towards retired doctors of the exemplary calibre of John Walker-Smith does nothing to protect patients – quite the opposite in fact. The GMC stinks.

  6. Cybertiger 18 March 2012 at 9:23 pm #

    I agree that Des Spence is a good and brave doctor. However, he writes for the BMJ and can only go where the BMJ will let him. And the BMJ uses him as a fig-leaf to cover the enormity of the BMJ Group’s ethical deficiencies when it comes to declaring conflicts of interest with Big Pharma. Des Spence is kept on a tight leash and there are certainly places that the BMJ will not let him stray.

    The following two links may be instructive,


    The BMJ stinks too.

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