If we conclude that a change in attitude on behalf of the company or academic department could be a key to success in combating fraud the obvious question to ask is "Why hasn't this happened before?"
To understand why the pharmaceutical industry has been loath, until relatively recently, to tackle the problem of fraud, one has to understand the unique relationship that exists between the pharmaceutical industry and its customers.
In the normal relationship of a company carrying out a process, a supplier of goods, and an end user or customer, the supplier supplies the raw material, which is then processed by the manufacturer and sold to a customer. The transactions are one way. In this scheme the customer can impose standards on the manufacturer and the manufacturer can impose standards on his supplier.
The situation that the pharmaceutical industry finds itself in with regard to clinical research is that our suppliers - in this case clinicians - are normally our customers, prescribing doctors. This has been one of the prime reasons why the pharmaceutical industry has been loath to take an aggressive attitude to clinical fraud.
A case study might make the problem clear.
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