Healthy Skepticism Library item: 14992
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Publication type: report
Horton R et al
Innovating for Health: Patients, physicians, the pharmaceutical industry and the NHS. Report of a Working Party
London: Royal College of Physicians 2009 Feb
http://pharmalive.com/news/index.cfm?articleID=602517
Abstract:
Executive summary
Medicines and medicine are inextricably connected. Today, the NHS, academic medicine and the pharmaceutical industry have a symbiotic relationship. Each depends on the others for success. And there have been enormous successes clinically, scientifically and economically. However, in recent years, diverse critics in the medical profession, politics and the media have questioned the strength and integrity of these relationships.
The concept that links all three entities is innovation: creating new ideas and new medicines, translating and implementing research findings, and finding new ways of working to enhance patient care, patient outcomes and patient satisfaction. At a local level throughout much of the NHS, the relationships needed to deliver innovation are badly damaged, even broken in some instances. This Working Party aimed to draw a line under past confrontational debates. We wanted to redefine the terms of engagement between the NHS, academic medicine and the pharmaceutical industry; to set out the conditions necessary for a flourishing culture between these sectors, with the health and well-being of the patient as the overriding objective.
A survey of the Royal College of Physicians Patient and Carer Network revealed anxieties about the nexus between the NHS, research and industry, specifically concerning access to the most effective medicines, access to information about those medicines, the independence of doctors who make prescribing decisions, problems with adherence to medications, adverse drug reactions and participation in clinical trials. The funding of patient organisations by industry can convey the impression that these organisations are biased. A more patient-centred culture in devising edicines policy could deliver substantial gains in access, information, independence, adherence,
safety and inclusion in trials.
Education is one of the most contentious areas between doctors, scientists and industry. Respected
physicians at home and abroad have attacked pharmaceutical companies for using educational initiatives as promotional tools. It is also clear that medical schools are often not adequately
preparing new doctors for prescribing. A stronger and more consistent undergraduate curriculum could do much to improve prescribing knowledge, understanding, skills and attitudes. Students also need to be protected from undue pharmaceutical marketing. Many of the same issues pertain to doctors in training. Continuing professional development programmes are too dependent on industry support. Royal colleges and faculties, together with NHS institutions, need to rethink their role in postgraduate education. Industry and its institutions must work harder to disseminate and enforce the Association of the British Pharmaceutical Industry (ABPI) Code of Practice. Meanwhile, all parties need to strive to find an acceptable way for the pharmaceutical industry to contribute to medical education. Doctors too must take greater financial responsibility for their own postgraduate education.
This is a highly significant moment for clinical research. There is more investment, stronger scientific leadership and greater political will behind biomedical research than at any time in recent history. But the Working Party received evidence suggesting that the UK research community has serious gaps – a lack of well qualified science graduates, deficiencies in in vivo research skills and weaknesses in sustaining clinical trials. Part of the difficulty has been the weak incentive system in the NHS to support research. Collaboration between the private and public sectors has been fragmented. The NHS needs more muscular research leadership – clinically and
managerially – together with a better alignment of incentives to promote and sustain research and research careers.
The key to the future is culture. Innovation is vital for the future of patient care. But respected
observers are challenging contemporary models of innovation. And loss of trust in industry seems endemic. Trust has to be restored if progress is to be made in harnessing the best of industry, academia and the NHS. The Faculty of Pharmaceutical Medicine, together with a new generation of clinical pharmacologists and an enhanced clinical role for pharmacists, will play a critical part in this new covenant. And government initiatives, such as Ara Darzi’s Next stage review, aim to put innovation at the heart of NHS reform. The Royal College of Physicians has an essential role in accelerating change.
We are optimistic about the future relationships between the NHS, academia and industry. Transparency and communication can promote a more strategic exchange of ideas. Doctors’ leaders must speak up more forcefully for the advantages (to the patient) of greater intersectoral
collaboration. Industry too must step up its public leadership. The strengthening of these voices
is necessary if the overlapping sectors are to adapt to rapidly changing burdens of disease and
patient expectations. Meanwhile, increasing prescribing volumes and costs are having a
significant and growing impact on NHS strategy – for example, through the work of the National
Institute for Health and Clinical Excellence (NICE).
The Royal College of Physicians has an important convening and catalytic role in rewriting the
covenant between the NHS, academia and industry. The ultimate prize is great: an improved and sustainable future for patient care. The Working Party has set out 42 recommendations to turn this hope into a reality.
Notes:
Full report can be downloaded from PharmaLive site (link to .pdf at bottom of http://pharmalive.com/news/index.cfm?articleID=602517)
