Examination of Witnesses (Questions 200
- 202)
THURSDAY 14 OCTOBER 2004
MR RICHARD
BROOK, PROFESSOR
DAVID HEALY
AND PROFESSOR
ANDREW HERXHEIMER
Q200 Dr Naysmith: I was just going
to ask you another question, Professor Herxheimer, and you can
say what you have got to say in reply to this as well. One of
the major problems with drug promotion, you say in your written
evidence, is to do with volume and intensity rather than the quality
of the message. Can you just expand on that a little bit?
Professor Herxheimer: Absolutely.
I think that the volume is huge. It is not just the mail and the
representatives and the meetings, but it penetrates through ghost-written
articles and through the consultants who are paid by companies;
it creates an enveloping atmosphere that you do not know you are
in. There was another point that I was going to add to what Richard
Brook was saying, that the timing of the information is, of course,
very much in favour of the industry. They have all the data on
their new products and on all of their products, and before any
independent person can get at the data it takes months or years
so that independent information limps a long way behind the commercially
driven information and is in a much lower volume. The funding
for that is extremely small compared with the industrial funding
of promotion; so that creates a very serious overwhelming imbalance,
and I think that an approach to that would be to have, again,
some mechanism for ensuring that independent information is properly
funded and maybe there should be a levy on promotion to do that.
Q201 Mr Jones: It is going to be
extremely expensive to do what Professor Herxheimer has just proposed,
extremely expensive, and the level of expenditure that is in any
likelihood going to be made available to this form of checking
and regulating is infinitesimally small in comparison to the level
of funding available on the opposite side. Since what the drugs
companies wish to do is influence the industry and the Government
in order to sell their product, would it not be better if, one
way or another, either through the Royal Colleges, or whatever,
you regulated the system whereby information was brought into
the public arena, into the Royal Colleges' attention, in such
a way that the only way to get that information out properly from
the industry would be in order to publish data properly and that
there would be an intolerance within the industry for publishing
data improperly? Then you would not have to try and find some
huge balancing sum of money: you will have changed the rules of
the game so that the only way that the industry can play the game
is according to your rules?
Professor Herxheimer: I think
that the Royal Colleges are not really set up in a way that would
make that straightforward. I think that by limiting the amount
of promotion and taxing it so that it would have financial independent
information but there would not be an end cost from that, you
would have to limit this flood somehow and balance it with independent
information, and that could be done in terms of money. There is
another consideration, which I think is a very important one for
your inquiry, which is that if we do not get it right in this
country we are also harming many, many other countries which look
to the UK as a lead in drug regulation; and that really is a serious
mistake.
Q202 Dr Naysmith: I think we need
to begin to draw to a close in a couple of minutes. The very final
thing is, would each of you like to offer what you think would
be an appropriate level of influence for the pharmaceutical industry
that they could or should exert in order to sell its products?
I will ask Professor Herxheimer first and then Mr Brook and, finally,
Professor Healy.
Professor Herxheimer: I think
that we would all hope for impartial statements, impartial advocacy,
if such a thing is possible, whereby companies have to compare
their offerings with other things that are being used for the
same purpose and make those comparisons objective, clear and open
to public discussion.
Mr Brook: I think for me it is
quite hard to believe, given how we look at the corporate world,
that we can expect in every situation pharmaceutical companies
to behave in a way that I would like. So I think for me the emphasis
is around regulation, and particularly around communication to
patients and tough ways of looking at how pharmaceutical companies
interrelate with that regulator. I think there are a whole lot
of issues around communication which we have not had time to talk
about today that are desperately important for patients, because
they just do not receive that information. I end with a final
example of why I think it is so difficult. On a working group
recently on the patient information leaflet reforms we were sent
some information about how the patient information leaflet should
change and they were marked, "Confidential. You will be breaking
the law if you release these to people." It was just about
how to communicate with patients, and I think that is the strength
of the pharmaceutical companies' influence at the moment within
the regulator, and until we break that and create a new structure,
and you have heard some ideas today, I am sure you will hear other
ideas, but until we get post-licensing away from the influence
of pre-licensing in particular, I think actually that is the issue,
in a sense, that is how you will start to make pharmaceutical
companies have the appropriate influence, by better and clear
regulation.
Professor Healy: Very quickly,
two points. One is that the problem you face, at least one aspect
of it, is that you are trying to force a financial camel through
the eye of a scientific needle, and this is always going to cause
problems. The best you can do in this area, I think, is to get
people to adhere to what are the norms of science, the norms of
ethics, and increasingly the norms of business whatever side of
the political divide you come from, which involve transparency—this
is an issue we put great store on these days—and, the other
point, where there is a changing mood so that people are beginning
to say for the first time, "If prescribers actually prescribe
these drugs, are forced to prescribe these drugs, without all
the information that they ought to have, this comes close to fraud."
The other point is that in the Sixties when most of these drugs
began to come on stream, the expectation was that physicians would
play a role rather like the role they play vis-a"-vis tobacco
and alcohol, that they would say, "Look, you do not want
to believe all the hype that you hear about these things, there
may be good uses for them, but they are not always that good."
At this point in time one of the biggest problems that we have
in the system is the silence of physicians. What you are going
to do to change that I am not sure.
Dr Naysmith: Can I thank all three of
you for the evidence you have given and for the witnesses from
the previous session earlier this morning. I think it has been
a fascinating morning. Thank you all very much indeed.
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