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Physicians, the industry and population health
  1. Juan Gérvas1,2,3,4,5,
  2. Peter R Mansfield5,6,7,7
  1. 1
    Canencia de la Sierra, Garganta de los Montes y El Cuadrón (Madrid) Spain
  2. 2
    Equipo CESCA, Madrid, Spain
  3. 3
    Department of International Health, Escuela Nacional de Sanidad, Madrid, Spain
  4. 4
    Nogracias, Spain
  5. 5
    Healthy Skepticism Inc, Australia
  6. 6
    Private practice, Willunga, South Australia
  7. 7
    Discipline of General Practice, University of Adelaide, South Australia
  1. Correspondence to Dr Juan Gérvas, Travesía de la Playa 3, 28730 Buitrago del Lozoya, Madrid, Spain; jgervasc{at}

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In the 1840s, many doctors carried out autopsies of women who had died of childbirth fever. The doctors sometimes became infected with bacteria without knowing it. When they delivered more babies, they transmitted the infection to more women, causing more to die. When it was suggested to the doctors that they might be unintentionally carrying harmful bacteria they felt insulted and reacted with angry denials. Fortunately, since then our profession has gone through a paradigm shift based on understanding the germ theory of disease. Initially, it was thought that doctors who deliver babies should never carry out autopsies, but methods of preventing and/or curing bacterial infection such as surgical gloves and hand washing have been shown to be effective.

We now face a similar situation. In 2008, many doctors allowed themselves to be exposed to drug promotion. These doctors may have become infected with bias without knowing it. When they treat patients their decisions are not as good as they could be. When it is suggested to the doctors that they might be unintentionally carrying harmful bias they feel insulted and react with angry denials. Our profession needs to go through a paradigm shift based on understanding theories of how decision-making can be biased, such as the Elaboration Likelihood Model and Cognitive–Experiential Self Theory.1 Unfortunately, at this time, we do not have any proven methods for detecting, let alone preventing or curing, bias.

Currently, many doctors deny that they are influenced by drug promotion, but are not so confident about their colleagues. This “illusion of unique invulnerability” is common and makes people overconfident and thus at higher risk of being misled.2 We …

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  • Competing interests Both authors belong to organisations that promote fair pharmaceutical–physician relationships. Since 2005, JG has been the coordinator of the Seminars of Innovation in Primary Care, organised by Fundación Ciencias de la Salud (Madrid), Fundación para la Formación de la Organización Médica Colegial (Madrid) with support of the Instituto para la Investigación de la Fundación Jordi Gol (Barcelona), and sponsorship of the Spanish Ministry of Health and GlaxoSmithKline.

  • Note: Studies of the impact of drug promotion on the quality of prescribing: references are available on request to

  • Provenance and Peer review Not commissioned; not externally peer reviewed.