David Gillen asks 'How did it get to this?'

After a brief introduction, Dr David Gillen, UK Medical Director for Pfizer, provided the context of the discussion: Medicine is being challenged by the media and the focus of much of this debate is the relation between pharma and opinion leaders. By way of illustration, he cited Alexander Fleming. Although instrumental in the discovery of penicillin, Fleming needed input from Howard Florey in Oxford and assistance from Pfizer to turn an unusual petri dish into a mass-produced, lifesaving medicine.

How did the relationship between academia and pharma sour? How did it slip from such positive beginnings to its present low point, where a recent issue of the BMJ resorted to caricatures of puppets to illustrate an article on opinion leaders? More important still, Gillen asked, what impact is this deterioration of relations having on human health?

Gillen's position is clear. Without a private independent pharmaceutical industry, there would be no drugs. State-owned pharmaceuticals, such as the model developed in Russia in the past have not been effective. 'In 30 years I think that they developed about one medicine' Gillen said. He sees industry-funded research as pivotal to the reductions in many common diseases over the last 40 years and reminded the audience of George Merck's maxim that profit is a follower not a leader of innovation.

KOLs are a part of that research and come from many sources. Gillen lists medics, scientists, government representatives, patients, and the media as possible KOLs, but does not subscribe to the 'Orwellian view of an opinion leader as a drug representative in disguise'.  He attributes the poor public perception of pharma to two main reasons - institutional short termism and a failure of the current industry R&D model.

Short-termism is driven by shorter patent lives and the need to support investors. Drugs need to make money more rapidly. Higher regulatory hurdles and increasingly complex disease conditions have led to a failure of industrial R&D to deliver. Despite increased year-on-year research spending, the number of new FDA drug approvals continues to fall. Collectively, these factors have engendered suspicion of the motives of the pharmaceutical industry.

Placing doctor-industry relations in a historical context, Gillen illustrated the decline in relations from the mutual respect of the 1940s to the current position of mistrust and the need for rebuilding. Key landmarks were the erosion of trust by the thalidomide disaster and a perception of manipulative marketing, leading ultimately to the present nadir where all academic-industry relations are viewed with suspicion. 'The media absolutely hound all of us' Gillen says ' all they want to talk about is a miracle drug or a killer drug'.

Gillen is nonetheless optimistic - he sees the present standoff as an opportunity to redress the balance and re-establish a proper distance between academia and industry but emphasises that this requires action by physicians as well as pharma to rebuild a mutual and respectful working relationship based on transparency and regulation as necessary.