From: "Saved by Windows Internet Explorer 7" Subject: Doctors, patients, and the pharmaceutical industry -- Collier 338: b443 -- BMJ Date: Tue, 10 Feb 2009 20:39:36 -0000 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C98BBF.AFF9FC20" X-MimeOLE: Produced By Microsoft MimeOLE V6.0.6001.18049 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C98BBF.AFF9FC20 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.bmj.com/cgi/content/full/338/feb03_2/b443 Doctors, patients, and the pharmaceutical industry -- = Collier 338: b443 -- BMJ

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Home > Comment > BMJ=20 2009;338:b443, doi: 10.1136/bmj.b443 (Published 3 February = 2009)

Published 3 February 2009, = doi:10.1136/bmj.b443
Cite=20 this as: BMJ 2009;338:b443

Editorials

Doctors, patients, and the pharmaceutical industry

New report reflects a working party that has lost = its=20 way

On 4 February 2009, the Royal College of Physicians of London=20 (RCP) published a report entitled Innovating for Health: = Patients,=20 Physicians, the Pharmaceutical Industry and the NHS.1<= /SUP> The=20 report is the outcome of deliberations by a working party=20 convened by the college in September 2007, chaired by Richard = Horton (editor of the Lancet), and it comprises 70 = pages and=20 42 recommendations. Despite its heritage the work is flawed, = thereby=20 diminishing the validity of the recommendations and the = obligation to=20 take them seriously.

The ideal working party has clear and understandable terms of=20 reference; has a membership selected to tackle the problems = at=20 hand; concentrates primarily on resolving questions posed by = its=20 terms; produces a report that sets out the problems in such a = way=20 that each recommendation follows logically from the text; and = finally, offers recommendations that are realistic and = correctly=20 targeted. In this instance, these ideals are often = unmet.

Let us start with the terms of reference. Here the key request=20 (presumably set by the RCP) is that the working party should=20 "obtain evidence about the current and future prospects of = the=20 pharmaceutical industry" and about "the successes or failures = in its relationships with the NHS and academic medicine." = Then,=20 armed with such information the working party should = "identify=20 policies that would promote . . . a relationship between the=20 NHS, academic medicine and the pharmaceutical industry, the=20 purpose of which is to discover and deliver safe, effective = and=20 affordable new medicines to patients based on need." Although = time is=20 spent on the delivery of safe and effective medicines, the = group=20 essentially ignores drug development, so almost no attention = is paid=20 to the direction of drug development. The report certainly = has no=20 regard for ideas of developing drugs to match patients=92 = needs and=20 makes no recommendations relating to the affordability of = drugs.=20 These gaps, and the fact that the interests of patients seem = to be a=20 secondary consideration, give the report a hollow ring and = its title=20 an uneasy fit.

One possible explanation for the working party=92s shift = in=20 direction is that its real agenda was to rehabilitate the = image of=20 the drug industry and its relations with clinicians and the = NHS,=20 which the group recognised were seriously hurt by the 2005 = Health=20 Select Committee=92s report on the industry=92s = influence.2<= /SUP> As=20 part of this rehabilitation, there is little direct criticism = of the=20 workings of industry or serious enquiry into how the industry = might=20 do better. So, in a short section on "Medical journals: = victims or=20 assailants," an opening salvo reads, "Editors of medical = journals=20 report examples of manipulation, distortion, bias, secrecy, = overt=20 promotion, and ghost writing in publishing medical research" = and goes=20 on to give detailed examples of the "excesses" of industry. = The=20 subsequent recommendation does not ask drug companies to = refrain from=20 such behaviour but instead turns its attention to the = journals,=20 asking editors "to do more to strengthen public and = professional=20 confidence." This stance defies logic.

If these problems were not enough, why do at least two = recommendations=20 (about the presentation of medicines) have essentially no = supporting=20 text? Why do some recommendations seem to be = misdirected=97why=20 should doctors report a drug promotional violation to the = Association=20 of the British Pharmaceutical Industry=92s code of practice=20 authority, where it may be swept under the industry "carpet," = when reporting to the Medicines and Healthcare Products = Regulatory=20 Agency could lead to prosecution in a criminal court? Why did = the committee make a key recommendation on patients=92 access = to=20 medicines that covers much the same ground as the Pharmaceutical=20 Price Regulation Scheme published on 1 January 2009,3<= /SUP> as=20 if it knew nothing about the new scheme although members of = the=20 committee who work for industry or the Association of the = British=20 Pharmaceutical Industry would have seen all the details in = good=20 time for the proposals to be incorporated? Why are many of = the=20 recommendations far from new=97why do we need 42 when half = that=20 number would suffice=97and why are the recommendations not=20 numbered?

Notwithstanding these concerns, we would do well to adopt = several=20 of the recommendations. So=97for example, more impartial=20 information about medicines and treatments should be = available=20 to patients; we should have a national day to promote public=20 awareness of medicines; the teaching of clinical pharmacology = should be strengthened; students and doctors should receive = no=20 industry perks and the provision of postgraduate education = should not=20 depend on industry "generosity"; healthcare professionals = with links=20 to industry should make these public; ways should be found to = strengthen research or working collaboration; and the = Medicines and=20 Healthcare Products Regulatory Agency should be more=20 transparent.

Despite these positive recommendations the product of the = working=20 party=92s deliberations is weakened by a flawed process, = and so a=20 real opportunity has been lost.

Cite this as: BMJ 2009;338:b443

Joe Collier, emeritus professor of medicines=20 policy

1 St George=92s, London SW17 0RE

jcollier{at}sgul.ac.uk

Competing interests: JC gave oral evidence = to the=20 RCP working party that produced Innovating for Health, = was an=20 adviser to the Health Select Committee in its 2005 enquiry = into the=20 influence of the pharmaceutical industry, and is a fellow of = the=20 RCP.

Provenance and peer review: = Commissioned;=20 externally peer reviewed.

References

  1. Royal College of Physicians. Innovating for = health:=20 patients, physicians, the pharmaceutical industry and the NHS. Report = of a=20 working party. London: RCP, 2009.
  2. House of Commons Health Committee. The = influence of the=20 pharmaceutical industry. Fourth Report of Session 2004-05. 2005. www.publications.parliament.uk/pa/cm200405/cmselect/cmhealt= h/42/42.pdf.=20
  3. Collier J. Changes to the regulation of drug = prices in=20 the UK. BMJ 2008;337:a2735.[Free Full Text]=20
3D"
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