Select Committee on Health Fourth Report

1  Introduction

"After careful consideration of the evidence laid before them your Committee find:

(1) That there is a large and increasing sale in this country of patent and proprietary remedies and appliances and of medicated wines.

(2) That these remedies are of a widely differing characters, comprising (a) genuine scientific preparations; (b) unobjectionable remedies for simple ailments; and (c) many secret remedies making grossly exaggerated claims of efficacy…

(3) That this last-mentioned class (c) of remedies contains none which spring from therapeutical or medical knowledge, but that they are put upon the market by ignorant persons, and in many cases by cunning swindlers who exploit for their own profit the apparently invincible credulity of the public.

(4) That this constitutes a grave and widespread public evil…"[2]

Select Committee Report on Patent Medicines, 1914

1. The consumption of medicinal drugs[3] is vast and is increasing. Purchase of medicines currently accounts for about 12% of the NHS budget. 650 million prescription items were dispensed in England in 2003, an average of 13.1 prescription items per head of population. This represents a 40% increase over the previous decade. The cost[4] of prescriptions dispensed in England has risen remorselessly with year-on-year increases well above inflation. In 1993 the cost was £3.1 billion. In 2003 it was £ 7.5 billion, an increase of 9.7 per cent or 6.4 per cent in real terms on 2002.[5] In addition, £1.8 billion was spent on over-the-counter medicines.[6]

2. The drugs are produced by a very large and successful industry. It employs 83,000 people directly and many more indirectly, and makes a huge contribution to the balance of trade each year. Overall, the industry represents the country's third most profitable economic activity, after tourism and finance. It is of great importance to the UK economy.

3. Drugs have produced many benefits. They have an important, sometimes vital, role to play both in saving lives and improving the quality of life. No one should take these benefits for granted: at some time or other, most people need drugs and are grateful for them. Our recent report on venous thromboembolism underlines this Committee's recognition of the need for appropriate pharmacological interventions.

4. However, the increasing consumption of drugs has also brought disadvantages. Two stand out. One is a syndrome which has been described as 'medicalisation', that is an unhealthy reliance on, and over-use of, medicines - the view that there is a pill for every ill. There is a strong and growing tendency to believe that life's problems are best dealt with as medical conditions. Diagnostic labels are readily applied and drug intervention follows. People hope for health solutions, and come to rely on the inspiration of 'get well' messages from commercial and professional sources rather than focus on sometimes grim realities. Medicalisation could lead to unsustainable demand on the NHS, a confused vision of how good health is maintained and a failure to ensure preventative public health measures are at the forefront of health policy.

5. The second disadvantage arises from the first. Excessive use of medicines leads to increased exposure to the risk of drug-induced illness and harm. No figures for the economic burden of drug-induced illness yet exist, but it is feared that it could amount to several billions of pounds per year. The adverse drug reactions, which account for some 3% to 5% of all hospital admissions in the UK, cost in the order of £500 million per year. No estimates have yet been made of the presumably greater cost of adverse drug reactions which do not lead to hospital treatment at all, nor of those experienced by perhaps 15% of all hospitalised patients.

6. These problems are not caused by the pharmaceutical industry, but do reflect its influence. People have been taking ineffective and harmful medicines for centuries. However, there is reason to fear that the industry has positively nurtured anxieties about ill-health. The fundamental problem, it is alleged, is that the industry is increasingly dominated by pressure from its investors and the influence of its marketing force and advertising agencies rather than its scientists. The industry is hugely influential, affecting every aspect of the medical world, including prescribers, patients, academics, the media, and even the institutions designed to regulate it. Its influence in Parliament is extensive. The Annex lists the All-Party Groups the pharmaceutical industry supports. It is claimed that pharmaceutical companies encourage us to see ourselves as 'abnormal' and thereby requiring (drug) treatment. They have a powerful incentive to do so. The more people who see themselves as suffering from a medical condition, the larger the market and the greater the profits.

7. The timing of this Inquiry coincided with an investigation by the medicines regulator into the safety of the newer 'SSRI' antidepressant drugs, and we refer to these drugs to illustrate some concerns. Depression can be a severely disabling and life-threatening condition, when urgent treatment is needed, but only about 5% of all prescriptions are written for 'severe' depression, and about two-thirds are for forms of depression classified as 'mild'[7]- i.e. mainly for people who are unhappy and distressed by difficult situations and circumstances. Although it is often suggested that antidepressant drugs will help these people, there is no good evidence that they will. Most people prescribed SSRIs in such circumstances can expect modest benefits, but are exposed to substantial risks of harm.

8. Government has a dilemma: it has to balance the need to promote the competitiveness of this industry with the need to address health concerns and to promote the effectiveness of the NHS. The Department of Health has constantly to balance trade imperatives and health priorities. This is a hard task. Sometimes, it means serving two masters at the same time.

9. In view of these concerns, in June 2004 we announced our decision to undertake an inquiry. Our terms of reference were as follows:

The Health Committee is to undertake an inquiry into the influence of the pharmaceutical industry on health policies, health outcomes and future health priorities and needs. The inquiry will focus, in particular, on the impact of the industry on:

  • drug innovation
  • the conduct of medical research
  • the provision of drug information and promotion
  • professional and patient education
  • regulatory review of drug safety and efficacy
  • product evaluation, including assessments of value for money

In doing so, the Committee will examine the influence of the pharmaceutical industry on the NHS; National Institute for Clinical Excellence (NICE); regulatory authorities and advisory and consultative bodies; prescribers, suppliers and providers of medicines; professional, academic and educational institutions; the (professional and lay) press and other media; and patients, consumers, the general public and representative bodies.

10. The pharmaceutical industry includes companies which differ hugely in size, work in many different spheres, and do quite different things. There are giant international companies and medium, small and modest enterprises. The people who work for them may be engaged in research, academic medicine, clinical practice, production and quality control, public relations (PR), administration, law and more. Our main focus was on the companies that lead the industry, and on the driving forces behind them.

11. This was a major inquiry, but we acknowledge that we have not touched on every detail of what is an enormous subject. The written and oral evidence presented, however, allowed us to gain a strategic sense of the influence of the pharmaceutical industry and of the implications of its significance and impact.

12. We have taken oral evidence on nine occasions. We have heard from Ministers and officials from the Department of Health and the Department of Trade and Industry; health professionals and academics; the pharmaceutical industry; journalists; PR companies; patient organisations; medical charities; Phil Woolas MP and Paul Flynn MP[8]; NICE and the MHRA. We received well over 100 written memoranda. We would like to thank all who provided us with oral and written evidence.[9]

13. During the inquiry we made several visits. In Australia, in September, we had the opportunity to observe the operation of a different medicines regulatory system than exists in the UK. We were able to explore the benefits of their National Drugs Policy and also heard evidence regarding the regulatory mechanisms in New Zealand.[10] We received invaluable information from many experts. We much appreciated our visits to GlaxoSmithKline (GSK) and AstraZeneca, where we were able to inspect modern manufacturing plants. In December, we went to Brussels and met representatives from the Enterprise Directorate-General (DG), the Directorate sponsoring the pharmaceutical industry, who explained the role of the EU in drug regulation and sponsorship. Unfortunately, no representative from DG Sanco (responsible for health) could be present. We were also fortunate in being able to visit Pfizer at its impressive facilities in Sandwich. Finally, we went to the Use of Medicines Committee at University College Hospital, where we received a very useful briefing on how mechanisms can be put in place to ensure effective prescribing. We much appreciated the time that all the people we met on these visits gave us.

14. We are also very grateful for the expert guidance we received from our specialist advisers. They were: Professor John Abraham, Department of Sociology, University of Sussex; Professor Joe Collier of St George's Medical School; Professor Gerard Hastings, University of Stirling; Charles Medawar, Executive Director of Social Audit Ltd; and Dr Harriet Scorer, an independent consultant to the pharmaceutical industry.

15. The report is organised as follows. The next five chapters provide brief descriptions of the industry and the difficulties it faces, the process of developing and licensing a drug, the arrangements for controlling the industry and the control of access to medicines. Chapter 7 examines what level of influence the industry should have. Chapter 8 looks at the evidence we received about the industry's influence on key groups. Finally, we present our main conclusions and recommendations in Chapter 9.

16. This is the first major study of the pharmaceutical industry by a Select Committee since the Select Committee on Patent Medicines reported on 4th August 1914. We trust that it will not be another century before the next.[11]

2   Report from the Select Committee on Patent Medicines, Session 1914, HC 414. Back

3   The terms 'medicine' and 'drug' are used interchangeably throughout the report. Back

4   Net ingredient cost Back

5   Prescriptions dispensed in the community. Statistics for 1993-2003: England. Back

6   Figures provided by PAGB Back

7   Martinez C, Rietbrock S, Wise L et al. BMJ  2005;330:389, doi:10.1136/bmj.330.7488.389. See


8   Phil Woolas MP appeared as a trustee of the Beat the Benzos campaign. Paul Flynn MP has a long-standing interest in the activities of the pharmaceutical industry and submitted a memorandum detailing particular concerns. Back

9   Some of the written evidence is published in Volume 2 of the Report. Volume 2 also contains a list of unprinted written evidence which has been reported to the House but, to save printing costs, has not been printed. Copies will be placed in the House of Commons Library, where they may be inspected by Members. Other copies are in the Record Office, House of Lords, and are available to the public for inspection. Back

10   We received valuable written and oral evidence from Prof Les Toop and Dr Dee Richards from the University of Otago in Christchurch, New Zealand. We are very grateful to them for travelling to Melbourne to meet with us. Back

11   Report from the Select Committee on Patent Medicines, Session 1914, HC 414. Back

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