Mr. Lansley : We have not heard the hon. Lady's proposal on Herceptin. On the face of it, Herceptin has significant beneficial effects as disclosed in clinical trials, but a licence application has yet to be made in respect of it. In France, there is explicit recognition that in certain circumstances, certain drugs can provisionally be made available for use, pending licensing and approval. Is that not the right mechanism? If not, what does the hon. Lady propose?
Julia Goldsworthy: It is of course important to make such drugs available as quickly as possible, but certain systemic problems have been highlighted, such as NICE blight. We need to take steps to prevent such exceptions from having to be made.
Finally, given moves to increase the transparency of data relating to clinical trials, why do negotiations with the Treasury on the pharmaceutical price regulation scheme take place in such deep secrecy? Do the Department plan to make this process more open?
Adam Afriyie : I thank the hon. Lady for giving way before she moves to her final, final point. She focused on costs, but does she agree that although the work that NICE does is very important, it is also important that it be done quickly? In many cases, it is a matter of life and death as to whether or not a particular drug gets to the patient quickly. Does she also share my concern at the fact that, rather than the budget increasing, it has just been reduced by £3.5 million? That will surely cause more problems than even the difficulties relating to Herceptin.
I think that the hon. Gentleman is right. What will happen once the funding structure changes and what the impact will be on the availability of certain drugs are important issues to consider.
8 Dec 2005 : Column 1034
Reference has already been made to the shift to cheaper generic drugs and the practice of drugs bought in other EU countries being repackaged and relabelled through parallel trading. In both cases, I understand that while the medication itself remains the sameI have discussed the matter with an hon. Friend who is a pharmacistexcipients such as additives for colour might change or vary in the medication. That can cause unfortunate side effects, particularly in the case of epilepsy drugs.
Dr. Iddon: I must challenge that statement. Evidence was given at a meeting in the House last night that packages of parallel traded products contained drugs that were not the same as the drugs made by the professional company that had discovered them. Such products contained impurities that could cause serious side effects and in some cases death in the patient.
Julia Goldsworthy: I thank the hon. Gentleman for his point. I was just coming to that. The issue is not simply a question of different additives that might be used in different countries, but the possibility that such trade might be a soft underbelly for the counterfeit trade. There have been examples of counterfeits, such as those for Viagra, Cialis and Reductil, entering the legitimate supply chain, as the hon. Gentleman said. That is a significant cause of concern, and action to counteract it is outside the strict regulation of the industry.
The extent to which the Government truly appreciate the scale of this problem is also an issue. Recent answers to questions asked by my hon. Friend the Member for Sutton and Cheam reveal that the Government have made no estimates of the level of counterfeit medicines circulating in the legitimate supply chain and available on the internet. If they have made no estimate of the scale of the problem, how can they deal with it properly?
Further problems include the possible misprescribing of medication due to lack of training. Not all the problems lie at the foot of the pharmaceutical industry, but we have heard plenty of evidence this afternoon that more effective regulation of the industry will help to establish a clear balance
Julia Goldsworthy: I thank the hon. Gentleman for his intervention. We support many of the recommendations outlined in the report, which seem to be sensible proposals to redress the balance between maintaining a successful pharmaceutical industry that continues to develop life-changing and potentially world-changing drugs, and maintaining and representing the best interests of the patient and the NHS. Regulation will help to ensure a more equitable balance.
I am concerned however, that the Government have not even recognised adequately that that imbalance exists. They also seem to display a similar attitude to other, greater potential threats to public health and the available, appropriate and effective medication to deal with them. Let us hope that today's debate will help the Government to take the first steps towards recognising those problems and addressing them, so that the public can be confident that their health will remain at the heart of the issue of when and why they are prescribed drugs.
8 Dec 2005 : Column 1035
Paul Flynn (Newport, West) (Lab): I believe that this report is among the three best that I have seen in my 20 years in Parliament. I believe that it required a response from the Government that reflected the courage and thoroughness of David Hinchliffe and the other members of the Committee. Sadly, the Government's response is lamentable. Not only did they not respond to the Committee's clear and important calls, but they ignored many of them altogether.
I will go along with what has been said about the enormous, miraculous progress in pharmaceuticals in the past 100 years or so. Tens of thousands of people would be dead today were it not for drugs, particularly the recent advances in cancer drugs. I make no criticism of the science involved or of that part of the work of the industry whatever. We and the Committee, however, should be very critical of the dark side of the industrythe disease-mongering, the medicalisation of society, and the way that it abuses all the dark arts to encourage all of society to believe that we are ill and need a pill every day. Recently, the greatest increase has been in the incidence of depression, for which prescriptions have risen by more than 400 per cent. in a decade. In the great majority of cases people are suffering from mild depression, but we are taught to believe that if we are sadder today than we were yesterday, we are ill, and we need medication. That is useful for the pharmaceutical industry.
The worst aspect of that was contained in report that came out of America less than a week ago, which suggested that many two to five-year-olds need Ritalin or anti-psychotic drugs. As a consequence of this view, in America one in seven children are on Ritalinsimilar to amphetamines in some waysand worse drugs. The ambition of the pharmaceutical industry is to get us all taking those drugs, which are of questionable value.
I want to consider in particular the effect of the pharmaceutical industry's strategy on us as MPs. About an hour and a half ago in this Chamber, a Member called for the acceleration of the supply of Velcade, I think, which my constituents can get, but many other Members' constituents cannot, because it can be obtained in Wales but not here. There was warm support and almost universal approval for accelerating NICE's processes. I briefly pointed out the results of that in an intervention.
Let me give one story as an example. Yesterday, I received an e-mail from somebody trying to persuade me to raise with the Minister the health problems of obesity, which are well known and a serious matter. I noticed that the e-mail came from a well known lobbying company. I therefore got in touch with it and I asked it who was paying its wages. It turned out to be a group of people called the obesity council. Who pays the obesity council? It is the drug industrythe people who sell slimming aids.
A few weeks ago, I received a letter that interested me greatly, as I had a constituent suffering from pancreatic cancer. The letter was about a new wonder drug called Tarceva, of which I had never heard. I got in touch with the letter's writer, and I felt that I must investigate the matter if such a drug would help my constituents. On investigation, however, it turns out that the cost of
8 Dec 2005 : Column 1036
prescribing this drug will be £16,000 a year. Its effect was to increase the life expectancy of pancreatic cancer patients by 12 days, and it had adverse side effects including death in 10 per cent. of the patients involved. Increasingly, MPs are being approached to use our office here to put forward a case for the drug industry. That is a thorough abuse of our position. From the Health Committee, however, we had a splendid clarion call against the great abuses that have occurred.
The Medicines and Healthcare products Regulatory Agency and the Association of the British Pharmaceutical industry work jointly together, hold joint seminars and campaign together. The MHRA, the regulatory body, is funded 100 per cent. from the pharmaceutical industry. The pharmaceutical industry calls the tune. We could give numerous examples of that. Perhaps the worst was Seroxat, on which I have had two debates in the recent past, before its problems were discovered. The MHRA set up a sub-committee to look into the issue, but it had to disband after some nine months because the majority of the members had a financial interest in the company that produced the drug. The sub-committee had to be re-formed and progress was very slow.
The Health Committee invited me to give evidence and I was able to raise the question of the influence that drug companies have on bodies in this House, such as the all-party groups which have well-intentioned, good hon. Members on them who are trying to reduce the effects of diseases. However, almost all of them are infected by the influence of the pharmaceutical companies. An example that applies to Seroxat and the treatment of mild depression was revealed in a book that I sent to all the members of the Committee before it started its work on the issue. The book is called "Medicines Out of Control?" by Charles Medawar. It asks what would have happened if we had gone to see Sigmund Freud when he practised as a doctor. He gave all his patients and friends, and took himself, a medicine he knew that was believed to improve people's mental health and stability. That medicine was cocaine: it was the popular drug of the time. A later popular drug was bromide, which creates its own form of psychosis, called bromism, which was a scourge of society at the time of the first world war.
For an awful period in the 1960s and 1970s, diazepamor valiumand other similar drugs were prescribed like smarties. That caused great distress and did very little good. There was also the experimental period of the mental health industry in the 1950s, with the inducement of deep psychosis, lobotomies, leucotomies insulin coma therapy and electroconvulsive therapy. People were used as guinea pigs and suffered greatly. Many of those therapies are rightly no longer used.
More recently, we have had the tricyclics, which were regarded as wonder drugs, but they are now seen as old-fashioned and have been replaced by selective serotonin reuptake inhibitorsSSRIsof which Seroxat is one. When the campaign against Seroxat was mounted by a few courageous people outside the drug industry, the drug companies mounted a ferocious campaign to ensure that the voices who were protesting about the dangers of Seroxat were muffled. For example, Depression Alliance, a patient group that is virtually a creature of the pharmaceutical industry and gets 80 per
8 Dec 2005 : Column 1037
cent. of its funding from itas it has admitted to mecriticised those people who drew attention to the dreadful effects of Seroxat in turning depressed people into suicidal people.
The organisations that emerge with great credit are those that take not a penny from the pharmaceutical industry, such as MIND, which continues to act in the patients' interests. Many so-called patient organisations still receive instructions from and carry out the work of the pharmaceutical industry, and some otherwise splendid organisations are affected. For example, on the day that Vioxx was banned, I went on to the Arthritis Care website. I greatly respect that organisation and it does fine work in encouraging the use of non-drug interventions such as exercise in the treatment of arthritis. On that day, its website told people not to panic if they were taking Vioxx. That drug has been identified as causing 144,000 heart attacks and strokes in the US. I would have thought that reasonable advice in such circumstances would be to panic, if people were taking such a drug. The website also advised people to visit their doctor and follow their advice about changing to another drug. However, it is significant that the website of that respectable organisation contains a notice saying that the site has been refurbished with help from Merck Sharp and Dohme, the company that makes Vioxx. Even a worthy, conscientious organisation such as Arthritis Care must be influenced in some way by the fact that if it upsets the pharmaceutical companies or fails to do their bidding, it will lose some of its staff or funding. Understandably, the Committee recommended action on those patient groups, which should declare all significant funding. It also recommended that the Government should make changes to charity law to ensure that that happens. Unfortunately, the Government have stated that self-regulation should be the first resort in improving fundraising standards, so no action has been taken, although the Home Secretary maintains reserve powers.
This House is infested with organisations that, on the surface, are perfectly good. I had some influence in one of themI shall not name itand I see that it is now organising a relaunch with help from a lobbyist. Who is paying the lobbyist? It is one of the pharmaceutical companies. Their influence is everywhere and their tentacles stretch into the Government, the patient bodies and elsewhere.
The key, and most dramatic, moment in the Health Committee inquiry was the unbelievable evidence about the inducements given to clinicians and others to use particular drugs. One of the questioners asked whether the free trips, the holidays and the chance to take one's wife, husband or girlfriend to the Bahamas or the Alps had any effect. The witness replied that they did not, but that articles in the British Medical Journal and The Lancet did. The point, made with great force, was that the way to influence public and medical opinion was to get articles written by authoritative figures in those journals.
As someone with scientific training who has always defended double-blind and properly peer-reviewed trials, my greatest shock in the last couple of years was when the BMJ published an article two years ago, giving examples of reports presented in the medical journalsreports that had got past the very suspicious editorsin which the conclusions did not match the data. The data
8 Dec 2005 : Column 1038
said something and the conclusions said something else. There were examples of how this was done; the pharmaceutical companies write most of the reports and hawk them round for others to sign and approve. They get some figures and they provide some fat fees.
This element of ghost-writing, raised by my right hon. Friend the Member for Rother Valley (Mr. Barron) in opening the debate, is a matter of great concern, and it is continuing. We saw the accounts given by Dr Blumsohn in last week's edition of The Observer. I met this gentleman and heard what had happened in his case. People talk about life and death; often, it is death and death. The number of people who have lost their lives from an adverse reaction to drugs is enormous. In America, it is claimed that the fourth-largest cause of death is adverse reactions to drugs.
The Leemon McHenry Hastings centre report pointed out that the companies first select the data that promote the drugs. They file away the results that are unfavourable and buy the right academic credentials to sign a ghost-written article produced by marketing department staff or by public relations agencies employed by the company. What are we to regard as the fundamental science, the authoritative work, to which doctors and physicians look if they want to approve a new drug? We know these articles are being ghost-written and the case of Dr. Blumsohn, published last week, made it clear that the companies refused to give him the data on an article to which his name was attached. They claimed his authority for the article and he had not seen the data.