Memorandum by "NO FREE LUNCH UK"
(PI 05)
We are a group of medical practitioners who
seek to challenge the current relationship between the pharmaceutical
industry and the medical professions. We have had direct contact
with industry and its representatives in the front line of the
NHS. We are aware of widespread conflicts of interest in medicine
that both undermine confidence in the professions and have a direct
detrimental impact on patient care. We are concerned by the increasingly
medicalisation of society which in turn is undermining societies
sense of well being. We accept that the industry has a legitimate
right to pursue profit but equally we have a professional obligation
to protect our patients from organisations whose motivation is
profit.
No other public servants would be allowed the
level of hospitality enjoyed by the medical professions. We are
calling for a compulsory register of contact, hospitality, fees
and gifts for medical professionals. This would be open to peers
and the public.
Lastly the current voluntary code of practice
through the ABPI is inadequate and we call for more robust regulation
of this £9 billion industry that so directly affects peoples
lives.
We have no conflicts of interest in this campaign
and merely seek to protect the profession and our patients.
TERMS OF
REFERENCE
Drug innovation
We share concerns that much research is not
"innovative" but focussed on "me too" preparations
which seek to gain market share in established profitable markets.
The diseases of the developing world which kill many millions
prematurely receive limited interest or funding from an industry
fixated with the "risk factors" of first world populations.
The conduct of medical research
We echo the widely voiced concerns over "ghost
writing", suppression of results, "Scientific imperialism"
, publication bias and the use of editorial "spin".
We question why results from the industry are more likely to show
a positive outcome than those sponsored by no profit organisations.
More specifically in the UK we are concerned
by the practice of "research for profit". This is often
conducted in General Practice where patients agree to be included
in research for altruistic reasons yet the doctors can receive
thousands of pounds profit per patient enrolled into the study.
This constitutes a direct conflict of financial interest and is
widespread in the UK with some practice making £50,000+ in
profit per year from this work.
The provision of drug information and promotion
A widespread hospitality culture exists in the
NHS focussed mainly at doctors but also other health care professionals.
The hospitality engenders "goodwill" and allows the
industry to gain access to health care professionals. Minor promotion
hospitality involves the provision of pens, mugs, lamps and sandwiches.
This minor hospitality is a daily occurrence for many doctors.
More troubling and inappropriate hospitality
involves expensive lunches (£50 plus) and the use of exclusive
hotels (Gleneagles, Turnberry etc). This is common practice. The
most important opinion leaders may be involved in hospitality
that involves international flights and provision quality hotels
abroad. These opinion leaders may in addition be offered lectureship
fees and consultancy fees. This hospitality is undeclared and
local registers of financial dealing are not kept by hospital
or general practitioners.
The ABPI code is broken on a daily basis but
both sides have strong vested interests in not reporting these
breaches. We argue that doctors are no different from other public
servants and these levels of hospitality would not be tolerated
in other public sectors. This hospitality culture is highly effective
at changing prescribing habits and raising drug costs.
The pharmaceutical industry currently employs
"third party" agencies to deliver care widely across
the NHS. This might involve drug "switching" on general
practice databases or offering direct face review of patients
by industry sponsored agents. A potential financial conflict exists
with all this activity.
Professional and patient education
"Promotional hospitality masquerading as
education" is the best description of the current provision
of education by the industry to the NHS. Education is the "foot
in the door" pretext of much of the contact and the hospitality
between the NHS and the industry. Unfortunately this education
for professionals is skewed with agenda setting by the industry
and with speakers paid directly by the industry. Quality independent
education could be provided at a fraction of the cost through
the NHS.
The written material provided by the industry
that is relied upon by many doctors is promotional and lacks a
strong evidence base.
The pharmaceutical industry directly and indirectly
has influence over patient education. Education is delivered through
the media either by the use of advertisements in "disease
awareness campaigns " or the use of industry friendly journalists.
Past examples of industry sponsored campaigns include conditions
like depression, anxiety and obesity. Distorted messages bombard
the public and serve to undermine our collective sense of well
being. The industry and its commercial interests are perhaps the
single most powerful force in setting health agenda.
We are concerned about motivation of the pharmaceutical
industry involvement with patient advocacy groups.
Regulatory review of drug safety and efficacy
No comment.
Product evaluation, including assessments of value
for money
No comment.
SUMMARY
We welcome this opportunity to provide a brief
memorandum and would be happy to expand on this if called to give
oral evidence. This inquiry is timely as there is a pressing public
interest to challenge the relationship between health care professionals
and the pharmaceutical industry.
We recommend at the very least a compulsory
and open register of contact, hospitality, fees and gifts for
medical professionals.
29 July 2004
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