Dear colleagues,
after having sent out Fran Baum's assessment of the Jakarta Conference, I
received the following e-mail.
My response will be sent out after this mail.
Eberhard
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------- Forwarded Message Follows -------
Date: Fri, 01 Aug 1997 11:35 +0200
From: [log in to unmask]
Subject: who letter
To: [log in to unmask], [log in to unmask]
Dear Eberhard,
I recently saw a letter distributed by you to the health promotion group
expressing concern about the pharmaceutical industry involvement in the WHO
WHO conference. I felt I must make some respone.
I am associate director of clinical epidemiology with Hoffman La Roche
Canada. Personally, I find the concept that anyone with an industry
label is to be excluded from the cause of promoting health a difficult
one - I would have thought that anyone who can make a useful
contribution should be welcome. I find it particularly difficult given
my own background - I am a UK General Medical Council certified
physician, and accredited specialist in public health with with
memership of the UK Faculty of Public Health Medicine, several years
training in public health, an MPH, and several years training in
research and health policy in academic departments and health
authorities. I would think it rather sad if I were to be excluded from
any further endeavours to improve the public health, and an unecessary
waste of my training.
Perhaps I can deal with some of the concerns raised. It is true that
pharmacuetical companies are businesses and need to make profit rather
than financial loss to survive. I suspect it is also true that many of
the people who read your letter have themselves benefited from
advances in therapeutic research. Have none of your family or personal
friends ever benefited from a drug - whether it is an antibiotic (used
appropriately), a beconase spray for hay fever (which I use myself),
an aspirin for a headache, or a drug to treat hypertension resistant
to conservative means and required to reduce the risk of stroke or
myocardial infarct. My own father developed angina a few weeks ago,
and personally I am immensely grateful that it appears to be well
controlled on a calcium channel blocker and he is getting back to
normal life. To suggest that we have no contribution to improving
public health, including through health promotion seems to me to be
incorrect. We would never suggest that a drug such as an
antihypertensive should be given in isolation and without proper
adjustments in liefstyle where indicated. We need help from groups as
yourselves to ensure such matters are addressed appropriately. Should
we not be collaborating to ensure such things occur?
I think some of the misconceptions arise out of a misunderstanding of
the process of new drug development. A drug is carefully assessed
before being brought to the market - if it not clear that it will
bring genuine benefits to patients, my role as an advisor would be to
advise abandonment of further development. I personally find no
professional conflict in these decisions, and promised myself I would
change jobs if I did. Thjere is a natural concern about the proper
assessment of new drugs and their safety, and I can assure you that
that is the foremost concern of anyone involved in industry
development. Why on earth would we develop a drug we did not believe
was safe? The regulatory mechanisms now in place ensure that such care
is taken on a global basis. Generally, if something is not in the
interest of the public health it will not be a good business
proposition, the two coincide. Why would anyone invest the enormous
amount to develop and launch a drug that did not meet a need? From
the business perspective we would never be able to sell enough to
recoup our development costs (quite rightly). If it not safe we will
be sued and our credibility will be rightly damaged. Without this sort
of investment in research, when will there ever be hope for the often
exhausted families of people who develop Alzheimer's disease - is
their well being not an issue for health promotion? Of course drug
therapy is only one component of the many ways of influencing the
public health - efforts in the environmental field for example have an
enormous role and I would not wish to unduly medicalise the public
health function, but surely the role of drug therapy should not be
regarded as irrelevant.
Is it not true that decisions about resouce allocation to health
initiatives made by health authorities or public funding bodies are
often influenced by political considerations? My own experiences in
public health in health authorities in the UK lead me to believe that
the restrictions imposed are far worse than those I experience in
industry. Are regional public health directors in the UK also to be
excluded because they are in the department of health, are bound by
the official secrets act, and are legally civil servants entrusted
with implementing as well as guiding government policy? If not, where
is the rationality in such decisions about exclusions? Personally I
would regard it as totally inappropriate that someone who has made a
personal decision about where best they might achieve their impact
should be excluded.
I can well understand that the group wish recommendations they may
make to be seen as credible and to be based on best evidence, and also
to be perceived as such. However, my own experiences in industry
suggests that they draw on such evidence to guide their decision
making rather more than many other bodies operating in the public
health arena. In fact they are extremely sensitive to it - I have no
difficulty in demonstrating to my business colleagues that bad
clinical pratice is bad business.
At a time when public funding in most countries is increasingly
squeezed, it is surely the time when collaboration between sectors is
most required if we are really to take further strides in improving
the public health.
I would be grateful if you would forward my views to whoever you
regard as appropriate. I would be happy to offer my services to
debate this in a public setting.
Kate Lawrence MBBS, MPH, MFPHM
Hoffman-LaRoche Limited
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Eberhard Wenzel MA PhD
Griffith University
Australian School of Environmental Studies
Nathan, Qld. 4111
Australia
Tel.: 61-7-3875 7103
Fax: 61-7-3875 7459
e-mail: [log in to unmask]
http://www.ens.gu.edu.au/eberhard/welcome.htm
Morton's Law:
If rats are experimented upon, they will develop cancer.
(What this country needs are some stronger white rats.)
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