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Adam Afriyie : The hon. Gentleman is making a powerful case. NICE does a good job, but is he confident that it will pick up these erroneous reports, trials and information in its processes?
Paul Flynn: We all hope so. Like many, I thought that having a rational and genuinely independent body to look at these matters was a fine reform. The difficulty is the pressure that we all feel as human beings. If a member of our family or a close constituent wanted a drug, we would go along with it, even if there was only a 1 per cent. chance of success, and would want to hurry NICE along. But if we as politicians take a decision, as we should, we should look at what happens with rushed approvals. The reason that Seroxat caused problems was that it was approved off-label for people under 18 when it had not been trialled.
As I said earlier, a fairly recent report, published since the Health Committee report, said that we withdrew 24 drugs in the long period between 1971 and 1992, while the United States withdrew only nine. We had approved all those 15 other drugs, which did a great deal of damage, when America had refused to approve them. A balance must be madethis is often impossiblewhen patients who suffer from terminal diseases demand drugs that might have even a very slim chance of postponing the inevitable. They want us to approve those drugs, and we politicians tend to put pressure on NICE to give quick decisions.
The evidence is that that the faster the licensing process works, the more frequent the problems and a greater number of lethal reactions take place. If we continue to accelerate our review times, there will be
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more adverse reactions. That is a difficult case to put across, and it is perhaps almost impossible for us, as politicians, to do so when we see someone sitting in our surgeries telling us that they have a fatal disease and want a drug that might be available in France or Wales, but not elsewhere.
Dr. Blumsohn spent a year requesting to see the full data on which the work that was published under his name was based. He was one of two lead authors. Two years after raising his concern, he was suspended from his university post. In The Observer last Sunday, Proctor and Gamble is reported as saying that it is "standard industry practice" not to hand over all data to professionals. That seems extraordinary, and it is regrettable that the Government have failed to respond in any way to that crucial issue in their response to the report. That is the key issue turned up by the Health Committee.
No reforms are proposed for the Medicines and Healthcare products Regulatory Agency, although it has been criticised in debate after debate in the House because of its nature, organisation and funding. That was another main concern that the Government left untouched in their response. The MHRA is still 100 per cent. funded by the industry and the system relies on self-regulation. There is talk of reviews every four years, but a thorough, independent review was not agreed to.
We have seen the pathetically weak response from the ABPI, which was mentioned by the hon. Member for Falmouth and Camborne (Julia Goldsworthy). An early-day motion was tabled last nightit has amassed one signature so farand I tried generously to amend it to point out that there was presumably some support for the ABPI in praising its new code. As the hon. Lady rightly said, the code of practice has been described as weak by the BMJ and by the Drug and Therapeutics Bulletin. She rightly made the point that the ABPI has never expelled a member. It has never even forced one of them to publish any corrective statement, although there are dozens of examples of misleading advertising and products that should not have been marketed as they were. We are dealing with a defensive group, lobbying for and defending the industry and putting at the top of its priorities not the concerns and health of the public, but the financial interests of the pharmaceutical industry.
: My hon. Friend paints a very black picture indeed of the pharmaceutical industry. I cannot deny that the industry has had some failures, but would he admit that, overall, its benefits far outweigh its deficiencies? Would he admit that the large mental institutions have been emptied by the introduction of modern drugs for the treatment of mental illness? Would he admit that the treatment of cardiovascular disease has been revolutionised by the introduction of beta blockers? Would he admit that the treatment of ulcers has been revolutionisedindeed, no ulcer patient goes into hospital anymoreby the discovery by Smith Kline and French at Welwyn Garden City of H2 inhibitors, of which cimetidine was the first? Would he admit that the pharmaceutical industry does far more good than harm of the kind that he is highlighting?
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Paul Flynn: I agree entirely; we could continue to record such successes at great length. Indeed, I think in my opening remarks I used the word "miraculous" when talking about the industry. I am trying to separate the job creation and the benefits to humankind, which have been enormous, as my hon. Friend said, from the marketing side of the industry. That is the whole point of the debate. We want to give the industry the pat on the back that it definitely needs, but we also want to draw attention to the points that the Health Committee legitimately raised.
Dr. Iddon: So will my hon. Friend admit that scientists throughout the pharmaceutical industry are acting purely ethically and that the main trouble lies with the marketing of drugs, and with the salespeople and accountants of those firms?
Paul Flynn: I am not sure whether my hon. Friend was present earlier, but I tried to make that distinction when I said that the integrity of the scientists in the industry and their devotion to their work was not in question.
The Select Committee report called for much greater action from the Government in every way. It is disappointing that so few members of the previous Committee are members of the new one, but I am sure that the new Committee will vigorously take up the report and the deficiency in the Government's response to it. As my hon. Friend the Member for Bolton, South-East (Dr. Iddon) said, enormous strides have been made in the work of the drug industry over the years, but there is still an awful energy in the industry that is used with malign effectdisease-mongering by inventing diseases and then a cure for them. The medicalisation of society has proceeded at a great rate and is looting huge amounts of money from the national health service to the detriment of other services. The drug budget increases constantly. Some of those drugs are essential and life-saving but others are not; in fact, they are life-damaging.
Mr. David Amess (Southend, West) (Con): The hon. Member for Newport, West (Paul Flynn) has strong views on these issues. He and I have discussed them on various occasions, and we are joint officers of a group that is particularly interested in such matters. I am not sure how widely the hon. Gentleman's views are shared in the House. He may prove to be a Churchillian figure and eventually his views will be shared by a majority of us. As a member of the Select Committee, I am grateful for his support of our views.
The inquiry into the influence of the pharmaceutical industry was the idea of David Hinchliffe, our excellent former Chairman. I am sure that his successor, the right hon. Member for Rother Valley (Mr. Barron), will prove equally excellent. It is a shame that David Hinchliffe, who retired at a relatively early age at the last election, is not with us this afternoon. He was keen to hold the inquiry, a highlight of which was our visit to Australia. I warn the House that I shall shortly be submitting a photograph taken on that trip to the caption competition in The House Magazine. I was not in the photograph, which shows a number of my colleagues who look like Snow White and the seven dwarfs. I hope that the winner of the caption competition will invite me to enjoy a glass of whisky.
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As the hon. Member for Newport, West said, unfortunately only two members of the Select Committee responsible for the report are in the Chamber today. That is no discourtesy to the House. One of the members who participated in the inquiry, Patsy Calton, tragically died at an early age. As several other such members were regrettably defeated at the last electionI say that genuinelythe membership of the Committee changed.
The report is excellent. Following on from a point made by the hon. Member for Newport, West, may I say to the Minister that we are just a little disappointed that in contrast to many responses to the report, the Government seem to have said no to more of our recommendations than is usual? I would appreciate hearing from the Minister why the Government were so firm.
I now part company with the hon. Member for Newport, West because there is a danger that this is a debate in which we will want to have our cake and eat it at the same time. After hon. Members have heard my speech, they might say, "Hang on, that is exactly what the hon. Member for Southend, West has just done." The United Kingdom owes a great debt of gratitude to the pharmaceutical industry for its funding of significant amounts of medical research and the consequent reductions in cost to the national health service.
There is an argument that the regulatory burden on developing new medicines has increased markedly over the past two decades and that the balance between risk and benefit has been tipped a little too far in favour of the former. The National Institute for Health and Clinical Excellence is an important body, and my hon. Friend the Member for Windsor (Adam Afriyie) has referred to it several times today. However, our report said that the recent cut to its budget might have a significant impact on the speed at which new medicines reach patients. The Government's recent moves to extend the prescribing power of nurses and pharmacists, which many of us welcome, might render it more difficult to restrain the growing influence of the pharmaceutical industry and the increase in the medicalisation of our society.
I hope that I will not regret making this statement, although it will please the hon. Member for Newport, West, but there is a view in certain quarters that we can sometimes be seen as a nation of hypochondriacs. We all know about those who are really ill and perhaps never even go to a GP, while other people always think that they are dying, although they invariably live to be 100 or more. All the new products on the market to make us look more wonderful and feel better pressurise people to think, "It's out there; let's have it." However, as the hon. Member for Bolton, South-East (Dr. Iddon) said, that is perhaps due to accountants and advertisers, rather than scientists, who do such wonderful work.
There was a theme throughout the Health Committee's inquiry that highlighted the increased medicalisation of our society. Every malfunction in the human body can now be diagnosed as a defect and some sort of medication is available to treat it. It is thus no surprise that self-medication is on the increase and that GPs are put under more pressure by their patients. People can now access websites on which they can find out about whatever their problems are. I was interested
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by what was said about pancreatic cancer because many of us deal with constituents who come along and say, "My loved one is in dire straits. Here's this product; what can you do to try to make it available?" It is difficult to deal with such a situation.
The phenomenon is symptomatic of the pharmaceutical industry. It can be argued that the industry has been left to its own devices for too long. That was the thrust of the Health Committee report. The industry can target not only general practitioners, hospitals, treatment groups, medical journals and professional bodies in distribution campaigns, but individuals as well. The Health Committee thought that that practice put genuinely ill and vulnerable people at risk to some extent. Everyone, including patients and consumers, should be protected from pharmaceutical companies' persuasive product pushing. As a Conservative, I am certainly not in favour of the nanny state, but a balance must be struck and there is a role for Government, which is why we are genuinely disappointed that more of our recommendations were not accepted. The powers of the statutory regulatorthe Medicines and Healthcare products Regulatory Agencyshould be strengthened to ensure that the evidence produced by pharmaceutical companies truly reflects the findings of their clinical trials. That research should be undertaken in a professional manner, and the disadvantages as well as the benefits of licensed drugs should be well known to people who prescribe and use them.
I welcome the revised and updated Association of the British Pharmaceutical Industry code of practice, which was announced on 16 November. It will govern the UK-based pharmaceutical industry's relations with health care professionals from January next year. It highlights the key priority of patient safety, and sets guidelines and restrictions on pharmaceutical companies' advertising strategies. It bans promotional competitions, including one cited in the Library briefing. In September 2005, a dentistry magazine featured a promotion for the drug Periostat that included a competition to win an iPod Mini. I have not entered the competition, but I am tempted to encourage my children to do so, as they all want iPods for Christmas.
Responsibility for ethical practices should not lie with the pharmaceutical industry alone. The Health Committee strongly recommended that doctors should be obliged to declare significant sums of money or gifts that they receive as hospitality, and that they should register them with their professional bodies. The profession will say that only a tiny minority is involved but, even so, we believe that those gifts should be registered. Likewise, the ABPI code tightens the rules on hospitality, stating that delegates to company sponsored events, as we have heard, should only be flown economy class. However, it does not go as far as banning provision for five-star hotel accommodation, which is a shame.
"There are rigorous guidelines for conducting clinical trials and a code of practice governing all promotional activities."
Despite those assertions, a number of practices have emerged that are clearly against the public interest, including the suppression of negative clinical trial findings resulting in a body of evidence that does not
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allow a transparent view of a product's risk-benefit ratio. That is especially important, as guidance such as that produced by NICE is based on such published evidence.
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