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

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

Editorials

Doctors, patients, and the pharmaceutical industry

New report reflects a working party that has lost its
way

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

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

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

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

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

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

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

Cite this as: BMJ 2009;338:b443

Joe Collier, emeritus professor of medicines
policy

1 St George’s, London SW17 0RE

jcollier{at}sgul.ac.uk

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

Provenance and peer review: Commissioned;
externally peer reviewed.

References

Royal College of Physicians. Innovating for health:
patients, physicians, the pharmaceutical industry and the NHS. Report of a
working party. London: RCP, 2009.

House of Commons Health Committee. The influence of the
pharmaceutical industry. Fourth Report of Session 2004-05. 2005. www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf.

Collier J. Changes to the regulation of drug prices in
the UK. BMJ 2008;337:a2735.[Free Full Text]

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Rapid Responses:

Read all Rapid
Responses

Did you read the report Joe?

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bmj.com, 4 Feb 2009 [Full text]

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