How do pharmaceutical companies influence doctors

At first the campaign was like a call for freedom, the woman should finally get a chance, even in bed. If Viagra and similar accomplices in love play had been available to men for years, it was high time to bring a female sex pill onto the market as well.

Feminist groups demanded it, and sex medicine specialists also supported the initiative for the introduction of the drug Flibanserin. "That helped get the controversial drug approved in the US," said Lisa Bero, a pharmacologist at the University of Sydney. In August 2015, Flibanserin was launched in the USA with a lot of noise.

"Patient organizations are playing an increasingly important role in healthcare"

What looked like a feminist campaign, however, turned out to be the marketing strategy of the company Sprout Pharmaceuticals - the manufacturer of the drug. The company had cleverly brought well-known women's organizations on board in order to influence the public and ultimately the FDA.

"Patient organizations are playing an increasingly important role in healthcare," writes Lisa Bero in JAMA Internal Medicine. The journal has just published a series of articles on conflicts of interest in medicine. In it, experts describe how the pharmaceutical industry influences the prescription of drugs through doctors and patient organizations.

For example, two thirds of 289 patient organizations in the USA were co-financed by companies, and almost half of the funds came from the pharmaceutical industry or biotech companies, according to one of the studies JAMA. Ten percent of the organizations surveyed received more than $ 1 million annually. "Large organizations in particular can have a significant impact on the industry they receive funding from," writes Susannah Rose, director of bioethics at the Cleveland Clinic and lead author of the study.

The Centers for Disease Control (CDC), for example, felt powerful headwinds last year when they looked for ways to reduce the abuse of strong painkillers - opioids - in the USA. 165,000 people died there from an overdose from 1999 to 2014, including the pop singer Prince last year. The CDC had therefore published a draft for new guidelines to curb the abuse.

38 percent of those patient organizations that were co-financed by the opioid manufacturers were critical of this. Among the pharma-independent groups, however, it was only six percent, reports the epidemiologist Caleb Alexander of Johns Hopkins University. None of the 45 pharma-related patient groups had mentioned their relationships with industry in their comments. "We need much greater transparency," demands Alexander.

15,000 pharmaceutical representatives visit German practices and clinics 20 million times a year

But even when doctors report on their proximity to pharmaceutical companies, this has hardly had any consequences so far. In the USA as well as in Germany, medical professionals have had to disclose conflicts of interest since 2011, for example when working as experts on new therapy guidelines. "Those affected still vote on the new treatment in the commissions," says Christiane Fischer, managing director of Mezis, the "Initiative of incorruptible doctors".

Only a few specialist societies in Germany insist on independent experts for their guideline commissions, for example the German Society for General Medicine. And the drug commission of the German medical profession established the rule in 2014 that, if possible, only independent experts are allowed to evaluate new drugs or therapies.

However, around 15,000 pharmaceutical representatives still visit German practices and hospitals around 20 million times a year. "There is still a lack of awareness of the problem in Germany," says Klaus Lieb, chairman of the specialist committee for transparency and independence of the drug commission of the German medical profession.

This is especially true for doctors who share health advice on Twitter. In another JAMA study, researchers report that 80 percent of the 634 American hematologists active on Twitter receive money from the industry. However, their followers do not know about this.