Select Committee on Health Fourth Report

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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