Healthy Skepticism Library item: 16373

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Publication type: news

Boseley S
Soaring drugs bill 'threatens to bankrupt NHS'
The Guardian 2009 Aug 29
http://www.guardian.co.uk/business/2009/aug/29/nhs-drugs-bill-pharmaceutical-compass

Abstract:

Pressure group calls for regulation to curb prices
• Industry accused of buying medical influence

Full text:

The NHS risks bankruptcy from a soaring drugs bill which is outstripping Britain’s GDP growth, according to a report published today.

The report, by the pressure group Compass, calls for regulation of the pharmaceutical industry to curb prices. The coalition of academics, campaigners and union leaders also warns that the billions spent by big pharma on seminars and conferences gives companies undue influence over doctors.

The report highlights several concerns:

• The drugs bill, which has gone up by £7.5bn since 1991, at a rate faster than GDP growth.

• Lack of innovation. The number of new drugs to treat conditions for which there are no effective remedies has been declining. Between 1993 and 2003 fewer than half the drugs licensed offered a potential improvement on those doctors already use – 152 out of 321.

• The £1.65bn spent annually by pharmaceutical companies on “continuing medical education” – such as conferences and seminars – for doctors, 300 times the Department of Health’s contribution of £4.95m.

The report warns that the industry is in trouble because of a lack of innovation, declining productivity and governments’ increasing reluctance to pay the high costs of drugs.

The pharmaceutical industry risks becoming the next big economic disaster after the banks, the report says, but it is too important to public health to be allowed to fail.

“The argument in this report is that the pharmaceutical industry must be more effectively regulated, so that all stakeholders – the public as well as the private investors – get a better deal. Like housing, transport, gas, electricity and now financial services, some things are too important to be left to the whims of the market,” said Zoe Gannon, research fellow at Compass and the report’s co-author.

“We have learnt from the banking crisis that some things are too important to let fail – the pharmaceutical industry is one of them. The report shows that unless we take action now we are not going to get the lifesaving drugs we need in the future,” said co-author Jon Cruddas, the Labour MP for Dagenham.

“We want to see effective regulation that would stop biased clinical trials and excessive influence over the medical profession. It is now essential that the government steps in. Only through effective regulation can the pharmaceutical industry be saved from its own worst enemy – itself.”

The report raises concerns about the integrity of clinical trials to provide evidence of safety and effectiveness to get a drug licensed for sale. Most are paid for by pharmaceutical companies. “Trials sponsored by the industry have been shown to contain significant bias in favour of the industry sponsor,” says the report. It recommends mandatory disclosure of results – good or bad – within a year of a trial ending, as in the US, with fines and public naming and shaming of those who break the rules. It suggests a national standards committee be set up and supports independent trials in the last stage before licensing, which could be paid for by a levy on the industry.

To reduce industry influence over doctors, Compass suggests measures including declarations at GP surgeries and on websites of gifts and sponsorship doctors have received from drug companies, and the funding of medical education seminars by the taxpayer. Drug reps could be excluded from training hospitals and universities while young doctors are taught how to deal with them.

The industry sponsors more than two-thirds of all medical postgraduate education and information. The bill for continuing medical education is estimated at £1.65bn in the UK, which is just under half what the industry spends on R&D here. Drug companies pay for doctors to fly to conferences, sometimes in Europe but often in the US.

While the rules have got tighter on gifts, so that a doctor can these days barely receive a free pen, they can accept flights, hotel rooms and meals in the interests of attending educational talks and mixing with peers. Conferences are an opportunity for companies to present product data but also for their staff to establish relations with doctors who they hope will prescribe them.At some conferences, such as those for cardiologists where lucrative heart drugs are discussed, pharmaceutical companies hire coaches to ship doctors off to meals en masse at the end of a presentation.