Examination of Witnesses (Questions 140
- 151)
THURSDAY 14 OCTOBER 2004
DR DES
SPENCE, MR
GRAHAM VIDLER,
DR IKE
IHEANACHO DR
PETER WILMSHURST
Q140 Chairman: So this comes back
to the need to make public where money is being received, the
issue that was raised a moment or two ago.
Dr Wilmshurst: Yes, and even if
people declare their conflicts of interest, they do not often
tell you how big the conflict is; they do not tell you how much
they are getting. It is well known that in fact there are lots
of cases where conflicts are not declared. In the majority of
cases they are not declared, and where they are, there is no mention
of the actual sums involved. Some people—this is in some
of the written evidence I have sent—were earning considerably
more from individual pharmaceutical companies by talking for them
every fortnight, twice a month, than they were earning from the
university or the NHS that they work for.
Q141 Chairman: So this is quite a
common practice, you would say?
Dr Wilmshurst: It is very common.
It is the only way that many academics can achieve the salaries
that their NHS colleagues do in private practice, because in cardiology,
if you do private practice, you can earn very considerable sums,
hundreds of thousands of pounds a year. If you did away with it,
you would have no academic cardiologists. It is almost impossible
to appoint academic cardiac surgeons in this country because a
morning's work would earn you £5,000 for an operation.
Q142 Chairman: One of the things
I was interested in from the evidence we have got from yourselves
was the extent to which continuing professional education of doctors
in particular is very much financially supported by the industry.
What proportion of continuing professional education would you
say is typically funded by the industry?
Dr Wilmshurst: Ninety per cent
plus.
Q143 Chairman: As much as that? Can
you give us a quick summary of what would be the appropriate level
of influence of the industry? Certainly you are arguing that the
industry is very influential, and influential in ways that are
very much open to question. What would be, in your view, an appropriate
level sufficient to sell the products but not to the extent that
we have now?
Dr Spence: I think there has to
be transparency between all the agencies and the industry.
Q144 Chairman: So more transparency
would be your response on the issues of the kind we have just
been talking about?
Dr Spence: Yes.
Q145 Mr Burns: Very briefly, Dr Wilmshurst,
from your written evidence and what you have now said in answer
to the Chairman, this is a matter of grave concern. You said in
your oral evidence that it was common practice and it was well
known. Do you think briefly, for the public record, you could
give us some specific examples?
Dr Wilmshurst: Yes. I attended
a meeting, a satellite symposium, at the British Cardiac Society
a few years ago where a number of eminent speakers spoke about
a drug called Posicor—that was the trade name. I knew a
couple of them and I spoke to them afterwards, and they really
had no experience of use of the drug but were prepared . . . .
I did not ask them how much they earned.
Q146 Mr Burns: Did you ask them though
that they were earning something?
Dr Wilmshurst: I am sure they
were.
Q147 Mr Burns: But did you ask them?
Dr Wilmshurst: No, I did not.
OK. I will have to check my records. There is another company—I
just have to remember which company.
Chairman: It might be helpful if you
came back to us in writing.
Mr Burns: I would quite like an answer
to my question first.
Chairman: He is not able to on specific
examples.
Mr Burns: He has made the allegations,
so surely he can back them up.
Chairman: Of course, but what I am asking
is for him to follow up in writing with detail that he probably
cannot give at the moment.
Mr Burns: If it is a very common practice
and well known and he has submitted written evidence, surely,
given the seriousness of it, Dr Wilmshurst should be able to give
us at least one oral example for the record.
Chairman: He has just given you one.
Q148 Mr Burns: He has not actually.
He tailed off.
Dr Wilmshurst: If I might finish,
I will just tell you about the Posicor, if I might. The doctors
that I spoke to I assumed were earning money because I knew—
Q149 Mr Burns: That is an assumption,
not necessarily a fact.
Dr Wilmshurst:—because I
knew that one of the two I spoke to was in fact also employed
by another pharmaceutical company, Rhone-Poulenc Rorer, and he
was a member of what I have described in the literature as the
"roadshow" and would earn between £2,000 and £5,000
a time for speaking plus travelling expenses in this country.
He spoke about once a fortnight with one of his colleagues for
the company. I have this from a representative of the company.
The company called the pair of them "the roadshow" and
they travelled around, talking about a drug made by the company.
Also afterwards I spoke to a colleague who had done similar work
for a company making Captopril, and in fact his experience was
quite bad. He had gone off message, and unfortunately he was in
Amsterdam at the time, and they refused to bring him back, so
he then had to find his own way back. That is what happens if
you go off message. So there is an incentive. If you are getting
a large amount of money from the company, there is an incentive
to keep on saying it because one, the money will dry up if you
say the wrong things, and of course, there is also the danger
you will embellish it because you are trying to make it sound
even better.
Chairman: Can I ask on behalf of the
Committee that you follow up in writing to satisfy the concerns
that Simon Burns has, and give as much evidence as you can of
the examples you are referring to, because obviously this is a
key issue from our point of view.
Mr Burns: So as not to delay things any
longer, can I just add to what the Chairman has just said that
when you do come back, we are looking for specific examples of
eminent cardiologists getting up to £4,000 plus expenses
for an hour-long talk on their products. Specific examples. That
is the allegation you make, and I am not questioning whether it
is true or not; I just want the evidence, because it is a very
serious matter if the evidence exists.
Q150 John Austin: Earlier on you
were talking about the importance of listening to the patients
on issues of adverse reactions etc, and I think all of us would
agree that the voice of the patients and patient organisations
has to be listened to. It has also been suggested that in some
cases there is a very cosy relationship between the pharmaceutical
industry and some patient organisations, whereby patient organisations
may be used by pharmaceutical companies to pursue their own ends.
Do you have any evidence of that?
Dr Iheanacho: I have a clear example.
The example I would suggest is GlaxoSmithKline's involvement with
a small charity called Allergy UK. That involved producing a book,
a little "Mr Men" book based on the children's characters—here
it is—and it appears to be a very ordinary Mr Men book until
you get to the back, where you find some advertising for some
of the company's products. This book was in fact illegal and is
no longer available; it had to be withdrawn. The law makes it
very clear that children cannot be used as a promotional vehicle
in this kind of way. The charity did not know about the problem,
that this was bad behaviour, until they were alerted by the media,
who pointed out: "What is going on here? This isn't the done
thing." So the charity was in a very embarrassing position
because they had been acting in good faith but essentially they
had been taken in by the company.
Dr Wilmshurst: I should have thought
of this. I should have mentioned my own position, of course, because
I have not declared any conflicts of interest, and perhaps I should.
I am often offered money by pharmaceutical companies to talk.
I do not ever take it. I ask them to give it to a charity, because
I feel it would be invidious for me to take money for that, and
I often receive several hundred pounds just for talking to local
GPs.
Q151 Mr Burns: On what?
Dr Wilmshurst: About drugs, and
about their drugs, but I only talk about drugs that influence
me. I am also a consultant—this is slightly different—for
a device manufacturer. It is covered by the Medicine Device Agency,
so it is slightly different but it is a medical device. I have
been asked to be a consultant for them, and it is difficult for
me to do so because I am a specialist adviser to NICE, so I have
agreed with them that they pay the money to a charity so that
I cannot receive it. It is an overseas charity in Africa for kids
with AIDS. I thought that would be a way that no-one could ever
say I had a conflict of interest. But the sums involved for my
few hours of work with them will be £22,000. That is the
sort of level that they pay a DGH cardiologist. If you are a professor
of cardiology somewhere else, you can earn considerably more.
Chairman: Can I thank our witnesses for
an excellent session. I am sorry we have had to somewhat curtail
it but it has been very helpful and we are most grateful to you.
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