Doctor—patient relationships in China are in crisis. Doctors have been injured or even killed by patients at work. One of the major drivers might be the unhealthy and unethical relations between many doctors and some drug companies.
On July 8, GlaxoSmithKline (GSK) said that they were investigating allegations that its staff had improperly used cash and other incentives to encourage the prescription of onabotulinumtoxin A (Botox) in China. The company added that “inquiries to date have found no evidence of bribery or corruption in relation to our sales and marketing of therapeutic Botox in China.”
The Lancet has no evidence to suggest that the allegations against GSK in China are true. However, some observers claim that bribing doctors to boost drug prescriptions by some drug companies is an open secret, and that this alleged practice has compromised the public’s trust in doctors. The varieties of unethical relationships that exist between some doctors and some of the drug companies in China are said to range from cash kickbacks, lavish gifts or entertainment, ghost writing services, sponsored supplements in journals, and all-expenses-paid trips. There is real concern that doctors’ prescriptions are therefore not based solely on patient need and clinical evidence, but may be biased by commercial interests.
The perceived unethical association between physicians and industry in China is worrying, because it inevitably harms patients as well as doctors. It damages the doctor—patient relationship and, ultimately, China’s whole health system. The GSK China allegations, although unproven, have clearly rung an alarm bell for China’s regulatory authorities to ensure the drug industry promotes products in a responsible, ethical, and professional way. Chinese doctors should rely on evidence-based clinical guidelines to inform their practice, and are in urgent need of guidance on their collaborations with the drug industry in various areas such as patient care, professional education, and research. Furthermore, training for doctors in China on managing their relationships ethically with the drug industry and other organisations should start at medical school and be part of continuing professional education.