APPENDIX 36
Memorandum by Lilly (PI 129)
RESPONSE TO THE MEMORANDUM BY THE UNIVERSITY
OF STIRLING INSTITUTE FOR SOCIAL MARKETING ENTITLED "DEALING
IN DRUGS: AN ANALYSIS OF THE PHARMACEUTICAL INDUSTRY'S MARKETING
DOCUMENTS"
INTRODUCTION
Lilly inputted its views on the House of Commons
Health Select Committee inquiry into the influence of the pharmaceutical
industry through the Association of the British Pharmaceutical
Industry (ABPI). We received a request from the Health Select
Committee ("the Committee") on the afternoon of Friday
10 December 2004, to which Lilly responded on Wednesday 22 December
2004. The Committee requested that we provided all marketing documentation
related to two specific healthcare professional programmes associated
with two disease areas in which Lilly has medicines. The Committee
obtained information from five pharmaceutical companies in total,
which was analysed by the University of Stirling Institute for
Social Marketing (ISM), formerly the Centre for Social Marketing
at Strathclyde University. A memorandum was made available to
Lilly on Thursday 24 March 2005 (the "Stirling memorandum").
While the Stirling memorandum was anonymised
as to which companies' materials are discussed, Lilly was invited
by the Committee to respond to the issues raised. We are grateful
to the Committee for providing us with this opportunity to put
our views on the record.
ETHICS
Lilly's business is focused on the discovery
and development of ethical branded medicines to enable people
to live longer, fuller lives. Lilly takes its business ethics
and adherence to the ABPI Code of Practice very seriously. We
think it is gratuitous that the University of Stirling ISM has
chosen to entitle their memorandum "Dealing In Drugs".
In our view, this title misrepresents the type of company and
industry we are, and what we are about—"Dealing In
Drugs" has connotations of the recreational use of controlled
substances, which is very definitely not the subject of the Committee's
inquiry or their report.
Given that the Stirling ISM was following the
same process that the Committee asked them to adopt during their
earlier obesity inquiry,[113]
we note that on that occasion the title of the memorandum was
balanced and objective, namely "Preliminary Analysis of Food
Industry Advertising Documents".
DISCLOSURE
Paragraph two of the introduction to the memorandum
notes that each company was instructed to provide "all promotional
and product support material for specific brands or programmes".
As set out in Table 1 of the Stirling memorandum, Lilly was asked
for all documents in relation to two specific healthcare professional
programmes. Within this context, Lilly disclosed the documents
that we held in relation to these, one of which has been endorsed
as best practice in the Government's White Paper on public health,
"Choosing Health"[114]
and is being rolled out across Primary Care Trusts.
We were surprised to see that the Stirling memorandum
makes reference to "a very limited set of papers" considering
that the five companies supplied 49 boxes of documents before
Christmas 2004. Given this opinion, and the powers vested in the
Committee, one wonders why this was not pursued in the three months
after the initial request.
DISEASE AWARENESS
It is not clear on what basis the Stirling ISM
has concluded that disease awareness and public health campaigns
are in breach of the ABPI Code of Practice.
EMOTION
In relation to Figure 4 in the Stirling memorandum,
Lilly is concerned that one diagram from one company is being
used to portray "rational" and "emotional"
as being of equal importance, and also of being representative
of the approach taken to branding by the industry as a whole.
Lilly believes that a section of one sentence
in the Stirling memorandum may refer to the information Lilly
provided about one of its programmes. We believe that there is
no reference to the other programme.
The Stirling memorandum criticises the use of
emotive language to describe attributes of medicines, which it
says runs counter to the requirement to provide factual, objective
information. Examples given include "intimate", "relaxed"
and "freedom". Lilly believes that this is a reference
to our Cialis "36 Hours of Freedom" campaign to healthcare
professionals and that the use of such language is entirely appropriate,
legal and within the letter and spirit of the ABPI Code of Practice,
given that they were used in the context of a Lilly/ICOS medicine
licensed for the treatment of erectile dysfunction.
HEALTH SELECT
COMMITTEE REPORT
ON SEXUAL
HEALTH
Erectile dysfunction impacts the physical and
emotional aspects of the lives of men and their partners. So while
the claims made about the medicine are objective and accurate,
they are presented in a context appropriate to the condition.
The recently published "Recommended standards for sexual
health services"[115]
highlights the fact that people with sexual dysfunction may wait
years before seeking professional help and notes: "It is
important to create supportive environments that will enable early
self-referral." Similarly, in relation to sex and relationships
education, the Health Select Committee in its own recent report
entitled "New developments in sexual health and HIV/AIDS
policy"[116]
stated that: "The biological facts are intended to be supplemented
by, and interwoven with, a broader sex and relationships curriculum,
which includes the social and emotional aspects of sexual relationships,
through a dedicated framework for "Sex and Relationships
Education" (SRE), which forms part of the Personal Social
and Health Education (PSHE) curriculum." Lilly's activities
in relation to erectile dysfunction are intended to provide healthcare
professionals with an insight into the experience of the condition
in order that they can deal with patients in a sensitive and appropriate
way.
HEALTHCARE PROFESSIONALS
OR THE
GENERAL PUBLIC
The Stirling memorandum does not make a clear
distinction between promotion of medicines to healthcare professionals
and to the general public. The Lilly example mentioned above relates
to a specific communication directed solely to healthcare professionals.
INITIAL THOUGHTS
OR APPROVED
MATERIALS
The Stirling memorandum reflects a lack of understanding
of the ABPI Code of Practice. Lilly provided a whole range of
documents: initial thoughts, work-in-progress, proposals submitted
by our agencies, contracts and final, approved materials. The
Stirling memorandum does not distinguish between these different
types of document. All Lilly programmes are subject to internal
review to ensure that they are consistent with Lilly's business
ethics and the ABPI Code of Practice. There have been no complaints
to the Pharmaceutical Medicines Code of Practice Authority (PMCPA)
about either of the programmes on which the Committee requested
information.
It should also be noted that all member companies'
promotional activities are subject to the ABPI Code of Practice,
which is policed by the PMCPA and the Code of Practice Appeal
Board.
ABPI CODE OF
PRACTICE REVIEW
Lilly notes that the Stirling memorandum analysis
was conducted around themes taken from the ABPI Code of Practice,
although the memorandum reflects a lack of understanding of the
Code. It was established in 1958 and is one of the oldest in the
medicines sector. It is updated regularly and periodically there
are full reviews. The last major review was held in 1993. The
principle of self-regulation is enshrined in EU legislation; it
is well established in the UK: the Proprietary Association of
Great Britain, the Press Complaints Commission and the Advertising
Standards Authority regulate companies working in, respectively,
over-the-counter-medicines, print and broadcast media.
Self-regulation provides the flexibility to
adapt to change and, from time to time, the pharmaceutical industry
has a comprehensive review. The healthcare environment has changed
significantly since the last major review. The political focus
on creating a patient-centred NHS has led to widespread public
debate on how the pharmaceutical industry and other stakeholders
should communicate to patients.
Under the chairmanship of Lilly's managing director
in the UK, the ABPI embarked upon a major review of the Code of
Practice almost a year ago. We anticipate a new Code of Practice
with revised governance procedures will be published later this
year.
April 2005
113 House of Commons Health Committee Report, "Obesity",
Third Report 2003-04 Session, HC 23-III Ev 694, published on 14
June 2004. Back
114
Choosing Health: Making Healthier Choices Easier. Public health
white paper, Department of Health November 2004. Back
115
Medical Foundation for AIDS and Sexual Health, endorsed by the
Department of Health. Back
116
House of Commons Health Committee Report "New Developments
in Sexual Health and HIV/AIDS Policy", Third Report 2004-05
Session, HC 252-1, section 80, page 27, published on 20 March
2005. Back
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