"Hey girls! Do you believe in love? Because I've got something to say about it,
and it goes a little something like this..."
Madonna, "Respect Yourself"
Break ups are always horrible. They cause pain, recrimination and, at the very least, regret and wondering how you could have made it work. They're even worse when they're public, of course, and here I put on my Agony Aunt hat and offer my sympathy to the disillusioned healthcare members of the Ethical Standards in Health and Life Sciences Group (ESHLSG), who are rumoured to have split last week.
1) "This could be the start of something beautiful"
Oh honey, we've all been there. You really hope, you really think this could be the start of something good. So in 2011 when the Association of British Pharmaceutical Industry (the ABPI) joined forces with you all, some of the biggest names on the healthcare side (various Royal Colleges, government health departments, the British Medical Association.. Shall I go on?) it really seemed like the start of a new collaboration that could make sweet guidelines together. Guidelines about pharma transparency in its collaborations with Healthcare staff. You were excited, you couldn't wait to tell your friends all about your togetherness and your plans for the future.
But you need to be honest with yourself, even at this stage, does it not seem in retrospect that something wasn't quite right, that the ABPI were leading you on? Did you really put your organisation badge on that document without thinking some of the claims were a bit, well, off? Did you even read it properly? Freedom of Information requests lodged by researchers David Carroll and Beth Hall seem to show that the government departments involved caved to endorsing after late-in-the-game, persuasive phone calls from the ABPI. Rather than wholehearted support, a couple of email exchanges are more along the lines of "are we sure everyone on the front has actually signed up? If so it would look weird to be left out". Hardly ringing praise.
2) You tell the world... But your friends aren't so happy for you as you'd hoped
You've schmoozed, you've attended the committees and gotten to know each other better.... It's time to announce your togetherness. You decide to go for it and make that grand gesture - you publish a report.
But your friends and workmates aren't as happy for you as you'd hope. In fact they start picking holes in your relationship and claiming pharma has lead you on. Can't you see? Untrue claims have been put in your mouth, sweetheart, see it for what it is.
Bad Guidelines did, in fact, warn you. The whole group started because they could see the way you'd been manipulated, that the report contained untruths. There were claims that Pharma investment in medical education was a good thing, when in fact, it leads to issues such as more expensive prescribing. There were claims that a "robust framework" for clinical trial transparency was already in place and did not need to be overhauled. The whole picture was that everything in pharma is hunky dory okey dokey, when we know perfectly well it's not. (If you want a fuller picture with citations here's the Bad Guidelines breakdown of the reports).
One of your friends even goes further. They put their stamp on the guidelines but publicly withdraw their support and write an editorial saying they were disappointed. None of the claims the ABPI make in their defence really ring true. They claim they neither produced the document, nor led the way for it, yet that's impossible to tell because all of the proceedings have been held in secret.
That's right. There are no public minutes of meetings, no list of representatives at the meetings or their conflicts of interest, no information about who was funding the whole shebang. Members are reluctant to come forward with information about just how much they were involved and how the documents were drafted. Some of this information came out in bits and pieces in the last few months, but all has now disappeared again with rumours of the break-up. Pharma has always liked being secretive that way, honey, it would be hard to change them overnight whatever the smooth talk they give you. But really, wasn't that secrecy another warning sign to you?
3) Update Facebook status to "It's Complicated"
You start to see that your friends might have a point, maybe you're just too much of a romantic idealist at heart and you need to slow things down, talk things through a bit. For months and months, you keep the documents up on your website with a red "under review" notification. A "radical rewriting" is put on the cards for you to thrash out on September 25th 2013, but that meeting is cancelled after you have a heart to heart with your other friends on the "healthcare" side of the fence.
And you realise those two guideline documents are unusable. Nonsense. It's over. Time to admit it and move on. You put on a brave front. You tell a BMJ journalist you're through and put a joint statement up on your site:
"ESHLSG members have decided that in order to enable further progress and focus on these key issues, as well as involve other key stakeholders, the group will be evolved into a forum, led by the healthcare professions – our previous guidance is therefore being retired and the results of our survey work published in full, to inform ongoing debate. The format and name of this group will be announced within the next couple of months, as well as future events or work-streams.
Professor Tim Evans, co-Chair of the ESHLSG and Professor of Intensive Care Medicine, confirmed “Just as the debate around ethical standards has evolved, so to must the ESHLSG and the way in which it contributes to our understanding of these standards. We hope that future meetings provide an open forum for debate on key issues which can inform and inspire the relevant policy making bodies and stakeholders to continue to work together to drive standards and collaboration.”"
But even with the brave smiles and talk of moving forwards, those first policy documents that you had so much faith in seem to have disappeared from the site. Are you pretending it never happened, too embarrassed? Don't feel bad, we've all been there and it's nothing to be ashamed of.
Now some people would say that your relationship could never be, and will never happen. The people who look after the healthcare of patients and the people who need to make a profit from it for shareholders? Fuggedaboudit! But I'm here to tell you I'm not one of those people. I think as long as you take it slow, are cautious and insist on complete honesty and transparency then there are good people on both sides who want to make it happen. Just take it at your own pace and don't feel pressured into doing stuff you're not ready for. Don't be manipulated. Listen to your friends when they tell you someone is up to no good.
Then hopefully, one day soon we'll see the start of a beautiful relationship. But no whitewash. Honesty is the basis for all the best romances.