Visiting the doctor can be an anxious process. The patient is in a vulnerable position, being already sick or nervous or uncertain. They will need a prescription or a referral, something only the doctor can give. Then, of course, the doctor has more knowledge than the patient. Some fools may think they know better, having done some skimmed research on Wikipedia but, unless the patient is clinically trained, then the doctor holds all the power in the consulting room. We have no option but to trust our doctors and assume that the treatment they prescribe is the best one for us.
Thankfully, our fine NHS means that trust is almost always repaid, but Panorama raised questions about the influence drug companies may have over our doctors.
They sent reporters undercover to secretly film medical conferences and found that these events are often sponsored by pharmaceutical companies who will pay doctors large sums to promote their drugs. It can cost £800,000 to sponsor a typical four-day conference so the companies expect to make a return on that investment.
These events resemble trade fairs, said one doctor, and you must be wise to the sleek sales techniques the companies employ. There is advertising everywhere. Even the wi-fi password at the centre where the BBC filmed was the name of a new drug and so would have to be spelled out and memorised and typed repeatedly, and when you step into a conference hall to hear a speech about a new wonder-drug, there may be an NHS doctor up on the podium waxing lyrical about this drug. Of course, he is no evangelist; he is being paid to say it.
Panorama secretly filmed Professor David Nutt as he gave a remunerated speech in praise of a new drug. It is perfectly legal to deliver such a talk, but medical ethics - and plain common sense - dictate that the speech should be fair and balanced but Professor Nutt, in this particular talk, failed to mention that the drug he was praising must be paired with long-term psychological care if it is to be safe and effective, so the BBC asked how objective is the information these doctors are paid to deliver?
The programme then focused on the gigantic pharmaceutical company of GlaxoSmithKline and a former employee in Poland said the company would whisk doctors off to tropical beaches and Madonna concerts and then track their prescribing record to ensure they were issuing their particular drugs. It was simply a case of making sure there was a return on the investment, he said. After all, those Madonna tickets don't come cheap!
Thankfully, the company is now under investigation in Poland but this hardly matters; GlaxoSmithKline is so wealthy that any resultant punishments will scarcely be noticed. They make more profit in one year, said the BBC, than the cost of all their fines over the past two decades.
Watching this programme it would be easy to be disgusted. Here is yet another example of big business shouldering its way to the front; another example of a company too fat and too rich to be controlled; a company wielding their power so that they can decide which pill you swallow with your tea and toast each morning. However, I don't blame these companies. They are simply doing what they're supposed to do: make money. After the recession and the banking crisis showed the true ugliness of capitalism is anyone out there genuinely surprised that these companies are doing all they can to turn a profit? The NHS drug bill totals £10 billion each year and there is serious money to be made, so who can blame them? Big companies have no decency or conscience and they take no oath.
But doctors do and their duty is to their patient. Medicine is a vocation, so why then are so many of them scrabbling for money with Big Pharma?
NHS doctors are well-paid, despite the background moaning from the BMA. An NHS Consultant can earn as much as £100,000 but this is simply his basic salary, and in my long years working with the BMA I rarely encountered a doctor who earned simply the basic rate.
The NHS offers myriad ways for a doctor to draw in additional income. Remember this was the only way the BMA could be made to support the creation of our NHS: by ensuring the doctors mouths could be stuffed with gold.
That gold still exists. A newly graduated junior, in his first day on the ward, can double his basic salary because if his working hours break the rules on rest requirements then the Health Board are compelled to offer him a 100% salary supplement. So, from day one, our doctors are already learning that the basic pay scale is meaningless; there is always more to be earned.
As they continue up the ladder there are more opportunities for hard cash: banding supplements, locum payments, discretionary points, clinical excellence awards, recruitment and retention bonuses, QOF payments for GPs, as well as spectacular fees from private practice.
I'm not saying doctors don't deserve this money, because they do. They deserve every penny, but there is no need for them to sniff around the drug companies for more.
The NHS offers substantial financial reward to its doctors and well it should. In my years working with doctors I'd often sit back in my chair after a conversation with one of them and be absolutely speechless and troubled and - if I can admit it - admiring after hearing their incredible stories, but if they simply want more money they shouldn't be in medicine. It is a noble profession and there are jobs in banking for those few who want to amass wealth at the expense of dignity.