7 Inappropriate level of industry
influence?
152. In the EU, companies undertaking legitimate
business have a right to market their goods and services and,
as part of accepted business strategy, will endeavour to influence
their market environment to the company's advantage.
153. In each member state there are laws, codes and
informal arrangements designed to control company activity and
ensure probity. UK-based drug companies and those working on their
behalf are subject to general legislation as it relates to, for
example, employment, contracts, companies, patents, investment,
negligence and human rights. In addition, drug companies are subject
to legislation related specifically to medicines and their use,
such as the laws that control the manufacture, promotion, sales
and supply of medicines, or the conduct of clinical trials. Drug
companies are also subject to non-statutory codes of conduct and
informal arrangements based on 'good practice'. Non-statutory
controls determine, for instance, much of the business associated
with the PPRS, ethics committees, the MHRA, and aspects of the
industry's own Code of Practice.
154. It is clear that influence is inappropriate
if it is gained through company activities that breach statutory
or other accepted control arrangements. In this instance, inappropriate
activity would include, for instance: publishing misleading advertisements;
advertising (or covertly promoting) prescription-only medicines
to the public; failing to advise the MHRA of new research findings
that might indicate additional risks that accompany the use of
their products.
155. Notwithstanding that there are areas of influence
covered by controls, other areas of influence exist for which
there are no such controls. There is evidence that in certain
areas, company influence is excessive and contrary to the public
good. A distortion in the balance between industry and public
interests can be seen as inappropriate not by breaching any law
but because the very excess might be a destabilising influence
and put patients at risk. Such behaviour would legitimately raise
concerns equivalent to those recognised when companies maintain
a monopoly position. Examples where the influence might be excessive,
and so inappropriate, are discussed in the next chapter.
156. Deciding precisely when 'non-statutory' excesses
are being undertaken and that their effects are counter to those
of the public interest is not an easy task. It requires the ability
to detect the excess, consider the issues in the widest context,
act promptly, make judgements that are impartial, and be in a
position to provide (or suggest) workable remedies.
157. The degree of the industry's influence leads
to questions of expectations, responsibilities, accountability
and the nature of its collaboration with other interests. There
is obviously huge scope for productive collaborations between
public and private sector, but to what extent is complicity and
conflict of interest involved? These are clearly issues for public
debate, central to the effectiveness of the NHS, and key factors
in shaping health policy and responding to medical needs.
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