Industry influence in healthcare harms patients: myth or maxim?

Abstract

Healthcare is a major global industry accounting for a significant proportion of government spending. Drug and medical device manufacturers are publicly traded companies with a responsibility to their shareholders to maximise profits by increasing sales. In order to achieve this, industry exerts influence over every part of healthcare including academic research, medical education, clinical guideline development, physician prescribing and through direct interactions with patients. In contrast, healthcare services seek to provide effective, safe and evidence-based treatments. This article examines interactions with industry across these domains and seeks to identify mutually beneficial relationships and potential conflict leading to patient harms. Case studies are used to illustrate these interactions.There is no single solution for improving healthcare's relationship with industry, although increased transparency has raised awareness of this issue. We briefly discuss some successful interventions that have been tried at national and regulatory level. While industry influence is widespread in healthcare and this has benefits for shareholders, healthcare practitioners have an ethical obligation to prioritise their patients’ best interests. Industry interactions with healthcare professionals have a valid role in product development and distribution, but industry sponsorship of healthcare education and practice, guideline development or regulatory decision-making can have harmful consequences for patients. Healthcare practitioners need to carefully consider these issues when deciding whether to collaborate with industry.Educational aimsTo explore the many areas where industry influences healthcare and the subsequent effects on patient care. Case studies are used to illustrate examples of beneficial and harmful effects of this influence.To raise awareness of the effects of industry influence and for readers to consider their own potential conflicts of interest.To suggest potential ways to improve the current system with a focus on solutions which have successfully been trialled already.

Mapping the Donations of Pharma Companies in Greece: The Case of Scientific Societies

“…The same problem can be found in Greece too, where there is no consistency in what is announced on the pages of donors, recipients and SFEE's database. A similar picture is presented in the international bibliography, reflecting the current situation in Europe, with the need for a central regulatory authority being imperative (Trayer et al, 2022).…”

“…This registry should be publicly available, easily accessible and all donations should be registered in a timely manner, allowing the scientific community, the authorities and the public in general to see where the funding is going and how it is being used. The funding of these groups should continue and be supported under conditions of control and transparency, to ensure that their actions are not commercialized (Sidiropoulos, 2023;Trayer et al, 2022).…”

The role of spinal surgery in the treatment of low back pain

“…Such associations are common across modern health care, but the central role of implants and instrumentation in many contemporary spinal operations heightens the risk of industry influence 79 . Furthermore, while financial association alone does not prove that an individual surgeon's practice has been unduly altered, the impact of financial support on guideline formation, clinical decision making, and prescribing is well documented in other areas of medicine 80‐82 . A review of articles published from 2002 to 2003 found that 15.9% reported industry funding (57.9% of articles did not disclose a funding source) 83 .…”

“… 79 Furthermore, while financial association alone does not prove that an individual surgeon's practice has been unduly altered, the impact of financial support on guideline formation, clinical decision making, and prescribing is well documented in other areas of medicine. 80 , 81 , 82 A review of articles published from 2002 to 2003 found that 15.9% reported industry funding (57.9% of articles did not disclose a funding source). 83 The same study noted industry‐funded trials were 3.3 times more likely to report a positive outcome compared with other trials ( P < 0.001).…”

Impact of the ventral hernia working group’s publication: a bibliometric analysis

“…It is well established that medical drug and device industries can affect national research agendas through subtle influences at various levels across the healthcare marketplace [1][2][3]. These include evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluation, clinical guidelines formation, healthcare professional education and direct influences on healthcare professional decisions [3].…”