GlaxoSmithKline broke a shameful record this week with a $3bn fine from US regulators for marketing medicines beyond their authorised uses. It would be comforting to believe the action was an exception by a few individuals in a single company, in one country, and in a past era. The evidence is not so reassuring.
The punishment is the latest levied on a series of large pharmaceutical companies employing aggressive tactics in the US. Pfizer was fined $2.3bn in 2010, and Abbott $1.5bn in May this year. Several other cases have already been concluded, and still more are pending.
Many of the events took place a decade ago, and the US seems to have had a particularly aggressive commercial culture that put sales before patient safety or value to healthcare systems. Yet some of the accusations against GSK date as recently as 2010. Furthermore, legal actions elsewhere, including against Servier in France, suggest overly cosy links between drug companies and doctors are not simply an American problem.
While the drug industry has introduced tougher ethical codes in recent years, almost every reform companies have taken has been a response to litigation and regulatory action, notably in the US. It is these threats which bring the greatest chance of an improvement in ethical conduct. There may yet be a case for a tougher threat of criminal action against the individuals responsible for abuse.
Greater transparency is necessary, with more disclosure on clinical trial design and results, as well as side effects, payments and entertainment from industry to all those with influence over prescribing decisions. Medical education in particular should be more firmly separated from corporate funding. Marketing can have a place in medicine, but it should be evidence based.
It would be dangerous to entirely isolate doctors from drug companies. The best researchers and clinicians need to engage with industry to develop and assess new treatments. But doctors have sometimes appeared as willing to take money as companies have to give it. They should be subject to more scrutiny and controls on financial support they receive.
Prescription medicine producers like to describe themselves as the ethical pharmaceutical industry. To deserve that label – particularly at a time of growing pressure on margins – they will have to redouble their efforts to recognise that drugs are not simply a commercial product.