Dr. Brian Iddon (Bolton, South-East) (Lab):
I have not come prepared to give a speech, but I should like to comment briefly on patient safety. I congratulate the
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Health Committee on an excellent report and my right hon. Friend the Member for Rother Valley (Mr. Barron) on introducing the debate.
I turn first to internet sales and self-medication, although the report does not cover that particular aspect. We are reaching the point where we have to think about regulating internet sales of medicines. A growing number of people are buying medicines that are available in this country and cheaper on the internet or that are unavailable in this country and have potential risks attached to their use. I am worried that people may be putting themselves at risk by self-medicating in this way. I am told that some of the information associated with these products that is given on the internet can be inaccurate. People should therefore use it with caution. I ask my hon. Friend the Minister to consider that.
Parallel trading is of even greater concern to me. Britain is one of the leading research countries in the discovery of new medicines. We have a very proud record, going back to the early sulphonamides and leading up to some of the most advanced anti-cancer drugs of today. That fine record continues to thrive, for various reasons. We have a good science base. The universities produce excellent scientists and medical people who do the research. We have tremendous hospitals that carry out excellent clinical trials, despite what has been said.
The whole environment in Britain is conducive to the discovery of first-class medicines. The pharmaceutical industry is of course profitable, as we have just heard. The pricing structure for the purchase of drugs by the national health service aids in the discovery of drugs in this country because medicines are sold at a higher price to the NHS than they are in many other countries throughout the world, including in Europe. Products that are available in this country can also be bought in Greece, but a country such as Greece does not contribute to the research and development of drugs to anywhere near the degree that Britain does. A product will be on sale in Greece, and in many other countries, at a much cheaper price than in Britain. The pharmaceutical companies in, for example, America, Germany and Britain export their products to countries such as Greece and Bulgaria with foreign-language packets and foreign-language inserted leaflets, so that the patient knows about all the side effects. An entrepreneur can therefore pick up those products in Greece much more cheaply than he or she can buy them in this country. The entrepreneurs then trade them back to Britain, where many may have been made in the first place.
There is a requirement to repackage the product if the box and the leaflet inside it have been printed in a foreign language. Therein lies the difficulty. The boxes are reopened, the leaflets are removed, new leaflets are put in, sometimes new labels are stuck over the French or Greek on the box and, often, even the boxes are reprinted. The product is then sold through the outlets that are commonly available in this country. That might appear okay, but there are problems.
Earlier this year, the Science and Technology Committee visited the small African country of Malawi. We split up into two teamsan agriculture team and a health teamand I joined the health team. We visited hospitals in Lilongwe and elsewhere in the country. I visited a small district hospital in the centre of Malawi,
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which orders its drugs for some very sick patients from the central stores in Lilongwe. They are supposed to reach the hospital on the back of a wagon. Unfortunately, corruption is rife in many African countries as in many countries throughout the world. Many drugs do not reach the patients; they fall off the back of a wagon into the hands of a criminal entrepreneur. Consequently, patients die of tuberculosis, AIDS, HIV and all sorts of tropical diseases. They die as a result of parallel trading.
The entrepreneur trades the product that has been exported from a western country to Africa back to the western country because it is available much more cheaply in the African country than it is in, for example, Britain. Those parallel traders cause immense damage. In repackaging the products and sticking in another leaflet, mistakes can be made. For example, the drugs can be mixed up. However, I am even more worried about parallel trading from what I heard recently. As I said earlier, my great worry is counterfeiting.
The trade in counterfeiting drugs is growing at an enormous pace. People are copying drugs all over the world. Last evening, at a joint meeting of the all-party group on the packaging manufacturing industry and the all-party group on pharmacy, I heard that the counterfeiters are professional and are even buying the same packaging material as the professional companies usefor example, Pfizer in Kent. Obviously they do not have the same careful production processes and, in particular, they do not have the same quality control processes.
Last night, we were shown pictures of drugs that had been counterfeited. They had been made chemically, using the same processes, but there are impurities in all chemical processes. Our pharmaceutical companies have good quality control to ensure that there are no dangerous impurities in the drugs on the market in our countries.
So, what happens? A drug is counterfeited, often with impurities in it, and placed in packaging identical to that produced by firms such as Pfizer, GlaxoSmithKline and AstraZeneca. We were shown examples of those packages last night. When they were placed side by side with the real ones, we could hardly tell the difference. Inside the packages, the leaflets and blister packs also looked authentic. When we in the audience were asked which was the authentic drug and which was the counterfeit, or parallel-traded, drug, it was very difficult to tell the difference.
I agree. I am suggesting that criminal entrepreneurs have now entered the parallel trading market. Last night, I was given a figure for the amount of counterfeit, parallel-traded products that are now entering the market in this country. I shall not repeat it because I cannot remember it accurately, but it was a very significant figure indeed. I ask my hon. Friend the Minister to listen to the industry on this issue, because it is now complaining very loudly, not only directly to the
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Department of Health but through trade organisations such as the Association of the British Pharmaceutical Industry.
Dr. Gibson: Is my hon. Friend saying that pharmacists do not know where the pills have come from? Do they simply make a judgment based on the colour of the box? How do they know whether they are getting the real thing?
Dr. Iddon: Pharmacists often do not know where the box has come from. Last night, we were shown a trick that the pharmaceutical companies have introduced. They have invented a new kind of print that is stuck on to the box. In the example that we were shown, the name "Pfizer" was used. The pharmacist is provided with a device that allows them to match an example of the print with the print on the box. If the print on the box is not authentic, it is possible to see the difference. However, it will not be long before the criminal entrepreneurs are doing the same thing.
Last night, we discussed how we could prevent the counterfeiting of drugs and the use of the parallel trading system. One suggestion was that electronic tags could be placed in the boxes. I suggested to the meetingand I suggest to the House todaythat when a pharmaceutical product leaves the factory, it goes out with a transport audit. For example, if it had been manufactured by Pfizer, it would come out of Kent and the transport audit would follow it through every stage of its journey. Perhaps, however, I have not thought the idea through; criminal entrepreneurs could find a way round that, too.
I must tell the Minister that we urgentlyand I do mean urgentlyneed to have discussions about this matter, otherwise patients in our national health service are going to start dying as a result of taking these contaminated, counterfeit, parallel-traded products.
Dr. Richard Taylor (Wyre Forest) (Ind): I should like to start by echoing the comments of the hon. Member for Southend, West (Mr. Amess), who paid tribute to the previous Chair of the Health Committee, the former hon. Member for Wakefield. I also pay tribute to the staff of the Committee, particularly the excellent Committee specialists, who assist the Clerks so ably. I also echo the comment that the right hon. Member for Rother Valley (Mr. Barron) has shaped up well in his first few Health Committee meetings.
I agree with the hon. Member for Newport, West (Paul Flynn) that the Government's response to the report was rather slim. It was also incredibly late. We finished our report on 5 April, but the response did not come out until September. I had imagined that the people who wrote these responses would not have much to do during the general election campaign. I do not think that the Minister wrote very much of it. Why was the response released right in the middle of the recess, when no one could really comment on it and we could not get any press coverage?
My other complaint about the response is that it is the most difficult one to follow that I have ever seen. We made 48 recommendations. The Government, in their wisdom, have renumbered them, so anyone who reads them has to
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have both copies open in front of them. They would need to work out that our recommendation No. 18 was the Government's recommendation No. 2. Perhaps we made a mistake with the heading "Conclusions and recommendations". The Government may have thought that they were to respond to recommendations and not to conclusions. In any event, they responded to only 32 of our 48 recommendations, although, to be fair, some of their responses to those covered some of the others.
Although much has been said by other Members, regrettably only the hon. Member for Southend, West and I were on the Committee. I think that I can reassure those who were photographed in a remarkable disguise. The hon. Member for Southend, West somehow avoided that. I must take it up with him afterwards: why on earth was he not present? The disguise was like Ku Klux Klan garb, without the pointed hat but with just a narrow slit to look through. As I do not think that many of us will have been recognisable, I am not too worried.
Members have left me a good deal to cover. I shall begin with research. Five recommendations mentioned it, but only one was given the honour of a reply. As is well known, the Department of Health invests about a sixth of the amount invested by the drugs industry in researchabout 0.8 per cent. of its budget. That may be why it did not feel willing or able to comment on an activity that is funded so generously by the industry.
"Priorities for research into medicines inevitably reflect the interests of the pharmaceutical companies and are not necessarily well aligned with the medical needs of all patients. The industry will continue to undertake the bulk of research in this area, but there are improvements which could be made. We welcome Lord Warner's recognition of this and look forward to his proposals to align more closely the drug companies' research strategies with the public health aims of the NHS."