Published 3 February 2009, doi:10.1136/bmj.b232
Cite this as: BMJ 2009;338:b232

Analysis

Relationships with the drug industry: Collaboration to improve care

¹ Schering Plough UK, Welwyn Garden City, Hertfordshire AL7 1TW

The relationship between the drug industry, academia, healthcare professionals, and patients has reached an all time low and few doubt that it is in the interests of all parties to improve it. A recent report from the Royal College of Physicians attempts to define a path towards achieving a more productive relationship. Here we set out five contrasting views on what the ideal relationship between industry and prescribers and patients should be and what steps need to be taken to achieve it (doi:10.1136/bmj.b222, doi:10.1136/bmj.b211, doi:10.1136/bmj.b252, doi:10.1136/bmj.b234)

Healthcare professionals and patients need to have the most up to date information on all the treatment options available to them, including medicines. There is therefore a legitimate place for a responsible relationship between the drug industry and the NHS, prescribers, and patients. This relationship should support the promotion of good medical care, improve health outcomes, and reduce health inequalities. It should include the provision of information to guide valid patient choice.

Prescribers

Doctors, nurses, and pharmacists all receive rigorous training, and patients demand a high degree of medical and pharmacological knowledge from them. Despite this, there are those who would deny healthcare professionals access to the drug industry, which researched and undertook the clinical trials to develop the medicines.

It is paradoxical that some do not consider doctors capable of separating good information from bad. Relations with industry have changed in recent years. The appropriately derided medical conference junket culture is over, ¹ and interaction between doctors and the drug industry is highly regulated by a code of practice and UK law.²

Both the Department of Health and the Association of the British Pharmaceutical Industry are seeking to re-cast the relationship between the pharmaceutical industry and the NHS and promote joint working to improve outcomes for patients. To this end a ministerial industry strategy group was established in 2001,³ and in 2007 this group published a strategy report recommending ways to strengthen the relationships between government and the drug industry. Guidelines and a toolkit for joint working have been developed.⁴

Joint working has the potential to create breakthroughs in how the UK tackles major health challenges including cardiovascular disease and teenage pregnancies. It draws on complementary skills from the NHS and the drug industry. For example, Ashton Leigh and Wigan Primary Care Trust is tackling low life expectancy and high rates of heart disease and diabetes by working with industry on a "find and treat" strategy for high risk patients. Typically such work involves the promulgation of good medical practice by addressing a local public health priority using nationally agreed guidance such as that provided by the National Institute for Health and Clinical Excellence (NICE) and national service frameworks. Industry may work with the NHS on stratification of patient risk, treatment intervention skills, local clinical leadership, and creating connections between different parts of the NHS.

If these initiatives are to fulfil their promise appropriately trained staff from the NHS and the pharmaceutical industry need to be assigned to joint working projects. Accreditation criteria for such posts are being evaluated.

Educating patients

Lord Darzi’s recent review of the NHS called for greater empowerment of patients and a better understanding of the impact of ill health.⁵ It also delineates patients’ rights to medicines and treatments approved by NICE. If patients are to make informed choices they need access to information about their disease and treatment options. The European Commission has recently undertaken extensive consultation on the topic.⁶ Although there is a consensus that the ban on direct to patient advertising of prescription drugs in Europe should remain, no one should have an exclusive right to provide the public with information about medicines. Patients should have unimpeded access to multiple sources of information, none of which can claim to be free of any possible bias. Ultimately there is no option but for each party—prescribers, patients, and the drug industry—to build trust with each other.

Cite this as: BMJ 2009;338:b232

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Competing interests: GC is a doctor, patient, cochairman of the partnership working group of ministerial industry strategy group, vice president and general manager of Schering Plough UK, and board member of the Association of the British Pharmaceutical Industry.

Provenance and peer review: Commissioned; not externally peer reviewed.

References

1. Abbasi K, Smith R. No more free lunches. BMJ 2003;326:1155-6.[Free Full Text]
2. Association of the British Pharmaceutical Industry. Code of practice 2008.www.pmcpa.org.uk/?q=getcopiesofcode.
3. Department of Health. Ministerial industry strategy group. www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Industrybranch/DH_4113974.
4. Department of Health, Association of the British Pharmaceutical Industry. Moving beyond sponsorship: Interactive toolkit for joint working between the NHS and the pharmaceutical industry. 2008. www.dh.gov.uk (search for: 9569).
5. Darzi A. High quality care for all: NHS next stage review final report. 2008. www.dh.gov.uk (search for: 10106).
6. European Commission. Report on current practice with regard to provision of information to patients on medicinal products. 2007. http://ec.europa.eu/enterprise/pharmaceuticals/pharmacos/docs/doc2007/2007_12/inf_to_patients_com_2007_862_en.pdf.

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