The pharmaceutical industry is starting to lose the confidence of its delivery system-doctors-after it paid out record fines of $11 billion for criminal wrongdoing over the last few years.
Doctors are becoming sceptical about 'scientific trials' that demonstrate the effectiveness of drugs because vital-and sometimes inconvenient-data are left out, researchers have found.
This could mean that doctors may stop prescribing new drugs, say researchers at Brigham and Women's Hospital in Boston-and with it would go a major source of profits for the pharmaceutical industry.
In one example, GlaxoSmithKline (GSK) promised to make available the safety data for its diabetes drug Avandia, but the final version still has "disturbing exceptions", says Boston University's Kevin Outterson.
GSK was handed out the largest fine-$3 bn-for criminal behaviour and was one of 26 drug companies fined by US regulators for dishonest conduct. Close behind GSK was Pfizer, which was fined $2.3 bn, and Abbott Laboratories, fined $1.5 bn for promoting its Depakote drug despite "inadequate evidence of its effectiveness".
But even given the size of the fines, drug companies view them as just the collateral damage of conducting business, as they represent only a tiny fraction of their annual sales, said Mr Outterson.
N Engl J Med, 2012; 367: 1082-5, 1119-27