A doctor tells you why you can't trust your doctor again

When you visit the doctor,it's probably with a sense of trustand hope. You're at your most vulnerable, but you trust the doctor, and you know he wants to do the best for you.

Unfortunately, the relationship isn't quite so straightforward for the doctor. Of course he wants to do the best for you, and that's why he joined the profession in the first place.

But increasingly he is being pulled by powerful forces that affect his decisions and the way you will be treated.

'The dark heart of medicine'

These unspoken pressures are so strong that they've been described as the 'dark heart of medicine' – not our expression, but that of a doctor who has been practising medicine for the past 20 years.

Finally, after watching his beloved profession being manipulated to such an extent that the patient comes second, he felt he had to write down his feelings in an extraordinary letter that arrived at our offices a few days ago.

After years of exposing the dangers and shortcomings of medicine in our monthly journal What Doctors Don’t Tell You, for the first time in more than 16 years it was a case of 'what doctors DO tell us' .

'Doctors are becoming pawns of a system'

The doctor, who we'll refer to as 'Dr D', which is the first letter of his last name, wrote it because he wants you – someone who may visit his doctor in all good faith – to understand what's happening.

"I believe it is time that more people were made aware of this dark heart of current medicine which is turning doctors into pawns of a system that dumbs down the real issues to a bewildering degree", Dr D writes.

This dark heart has been created by the pharmaceutical industry, which sees the doctor as nothing more than the deliverer of its expensive, and sometimes dangerous, drugs. To get the doctor to prescribe their drug, which may not be appropriate for you, the drug salesmen will cajole, bribe – and even threaten – the doctor. Threaten? Yes, and we’ll explain how a little later.

Doctors form pressure group against drug companies

This state of affairs has now got so bad that Dr Bob Goodman, an internist in New York, and Dr Des Spence, a general practitioner in Glasgow, have formed themselves into an action group they're calling 'No Free Lunch'. Like our doctor who wrote to us, they have become sick and tired of the way that medicine’s ambitions have become distorted by drug company pressures. They want to put a stop to the overt, and covert, ways that drug companies pressurize doctors into prescribing their drugs.

As Goodman and Spence point out, drug companies are even paying for staff canteens at hospitals – and their colleagues aren't even batting an eyelid. Sadly, most doctors view these subtle forms of 'support' as their right, and one that doesn't need to be questioned.

Of course, this support goes way beyond the free lunch. There's the 'educational' trip to the Caribbean, the free computer that’s an important 'information aid', and the sizeable 'research funds' that are paid to doctors who are prepared to put patients on a new drug – just to see what happens. And then there are the free lunches. We reported one such free lunch for cancer specialists in Australia where $1,000 bottles of wine were being served with the equally expensive food.

Those are some of the overt ways that drug companies encourage doctors to prescribe a particular drug to you.

How drug companies know about every drug you take

But the covert ways are rather more sinister. Very few people realise that the details of the prescription that the doctor writes out for you are passed on to the regulators. They, in turn, sell on the information to commercial data companies that, in their turn, sell it on to. . .the drug companies.

And it's big business. In the States, the American Medical Association earned $44m for the sales of prescriptions information last year alone. It was sold on to companies such as IMS Health, which, in turn, sold on the same information to the pharmaceutical industry for $1.75bn, making a profit of $284m on the sales last year.

This means that within months the drug company representative knows exactly what drugs any particular doctor has prescribed. Yes, that doctor who came along with his wife to the 'conference' in the Caribbean , and yet didn't write one single prescription for the new arthritis drug the salesman had been pushing so hard. Now, if that doctor wants to come to the Caribbean again next year, guess what he’s got to do?

Such are the covert ways of the drug industry.

How drug companies control the patients' groups

Well, you might think, if I can't trust my doctor as an impartial source, I can go to the patient support groups. If so, it's time to introduce you to the techniques known as 'astroturfing'. This is a term coined by drug companies to describe methods they use to influence seemingly impartial and independent support groups that supply helpful information and advice on specific diseases, such as arthritis and asthma.

The drug giant GlaxoSmithKline (GSK) was recently caught out 'astroturfing' a patients group called Ekbom Support Group, which helps advise people with restless legs syndrome. GSK had helped the group set up its website – and the group was actively promoting GSK's drug for restless legs syndrome, Adartrel. Unfortunately for everyone concerned, GSK was promoting the drug up to eight months before it had been approved.

The GSK case is far from being an isolated incident. When the British Medical Journal investigated 28 other support groups, they found that 27 were being funded by drug companies, and were presenting information that was, at best, 'partial'. They all seemed to be pushing specific drugs for treating the condition, and were downplaying the risks, the journal found.

How you don’t have to be a pawn in their game

This headlong dash by drug companies to make ever bigger profits has a tragic consequence, one that Professor Ian Roberts at the London School of Hygiene and Tropical Medicine recently described as 'industry slaughter'. Every year an estimated 100,000 Americans and 30,000 Britons die from an adverse reaction to a drug prescribed by their doctor – and those are the deaths that are identified as being the result of a drug.

We know the true figure is far, far worse, but we will probably never know just how bad it really is.