Blog originally posted at http://www.mastersystematicreviews.com/theres-no-such-thing-as-a-free-lunch/

There’s no such thing as a free lunch

I first started working as a junior doctor in 2001 and there was enormous clamour for getting freebies. I was sucked in. Drug reps would come around, chat away to all doctors, provide pens, sticky pads and all of us would go away happy. If someone mentioned any conflict of interest, it was brushed aside saying surely having a pen is not going to influence my practice. I will always prescribe what I think is right for my patient.

I went to a few dinners sponsored by drug companies. There were experts in the field speaking eloquently about selected cases and demonstrating how the drug manufactured by the company had produced wonderful results. Everyone was in a jolly mood and went away happy.

Over the years, things gradually changed. I got introduced to the world of Cochrane and began to look at drug company funding in a different light. I completely stopped going to any drug company funded events and refused to eat lunch provided by them at journal clubs in hospitals. The trend appeared to have caught on around the country (in the UK) and co-incidentally the major manufacturers were running out of new and interesting drugs on the market. The financial crash did not help either I guess. As the drugs began to go off patent one by one, I heard stories of reps being sacked, their catchment area increased to cover larger areas for colleagues who had been let go and increased pressures to meet targets. They were now up against a skeptical audience, reduced funding and increased pressures and stiffer targets to achieve.

“Companies still try to buy free food and I see eager young eager faces like how I used to look like in the audiences.”

This was also the era of talking therapies and more and more trials coming out. Interestingly, majority of the trials were being published by those who had a vested interest in conducting a particular type of therapy – they themselves were practitioners of it or worked in centres that introduced them. The conflict of interest columns were left with nothing to declare. Curiously talking therapy trials never reported the outcome of side effects that by now drug companies were mandated to do. No one spoke about worsening of anxiety or jitteriness or suicide in such trials. Are we not going through the same cycle now, all over again. Have we learnt anything at all from our previous experience?

Companies still try to buy free food and I see eager young eager faces like how I used to look like in the audiences. The companies are not charities, they have a product to sell. However part of the profits do get reinvested into drug development and we do need new drugs.  The talking therapy people so far have not provided lunches. However, by not adequately addressing adverse events are we being sold something that is not entirely accurate? As I have aged, my views on these things have become more measured. We need drug companies to manufacture new drugs. We need new talking therapies evaluated in trials that have the same standards that the industry is required to do now so patients can have access to the best and most effective talking therapies. We need to look objectively at the evidence before deciding what we prescribe or discuss as options with our patients. If there is no evidence to back us up, we need to acknowledge the uncertainty.

Perhaps there is no free lunch anywhere, there never was.

I'd be interested to hear your view on this, please leave comments below, I will reply.