The Polypill doctors' conflict of interest

I wrote yesterday about a website marketing an unlicensed medicine to the general public. I've had another thought about it since then, but first I would like to direct you to another excellent blogpost on the Polypill by Anthony Cox, an academic pharmacist who understands more about the legal implications of selling unlicensed medicines than I do. You should go and read it now. I'll wait.

OK, are you back? Then I'll continue.

Before you can buy the Polypill, you need to have it prescribed by a doctor. The Polypill website offers an online consultation with one of their own doctors. Now, there is probably much to say about the appropriateness of prescribing medication based on an online consultation, but I'll leave that to others. What I want to talk about is the conflict of interest.

There are some who object when pharmaceutical companies give free pens to doctors. They regard this as an unhealthy inducement to prescribe their products. They may even be right about that. I'm not hugely familiar with the literature in that area, but I've read enough of the psychology literature to know that you can influence behaviour in fairly subtle ways, and I don't find it too hard to believe that small gifts such as pens could have an influence.

So if it's bad for a pharmaceutical company to give a free pen to a doctor, what happens when the doctor is directly hired by the pharmaceutical company for the specific purpose of prescribing their own drugs? Doesn't that take prescriber's conflict of interest to a whole new level?

Paragraph 78 of the GMC's guidance on Good Medical Practice states:

You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.

And paragraph 80 states:

You must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients.

It's hard to see how being hired to prescribe a specific product on behalf of the person who hired you is consistent with that guidance.