So many criticisms and accusations of the pharmaceutical industry were
made to the last meeting of the House of Commons Select Committee inquiry
(BMJ, October 23) that it seems those giving evidence may have lost sight
of two most important facts: that the industry is the most highly
regulated in the country; and that it produces (and is very successful at
producing) life-saving, innovative medicines.
Certainly it is difficult to understand the rationale behind criticism of
public awareness campaigns because they encourage patients to go to GPs
who then prescribe medicines. If patients suffering from a condition for
which there is a treatment available are encouraged to seek medical
advice, surely this is to the good? To take the view that the less
patients know about treatments, the better – and cheaper – is to behave
dishonestly. Naturally, once they have attended the surgery, it will
always be the doctor’s decision as to whether treatment is necessary and,
if so, what form of treatment. But patients must not be kept in the dark
about potential treatments, and I make no apology for the fact that the
pharmaceutical industry occasionally provides such information.
Furthermore, disease awareness campaigns often lead to earlier diagnosis
of potentially fatal conditions, eg carcinoma of the bladder in the
bladder dysfunction campaign.
GPs’ knowledge of treatments needs to be continuously kept up-to-date.
One way in which they can ensure that they remain informed about the
latest medicines is through the services of pharmaceutical
representatives. I do hope that the witness who gave evidence to the
committee was right when he said that representatives’ influence can lead
to changes in prescribing habits, for the UK is notoriously slow at taking
up new therapies, lagging behind the rest of Europe. If doctors are
convinced by what they hear about the latest, innovative medicines – and
any information provided by a pharmaceutical representative must be backed
up by the relevant scientific data – then it would be surprising indeed if
they did not change their prescribing habits. The witness seemed to
believe that doctors only listen to such information if they are being
wined and dined at the same time. I have a better opinion of both
doctors’ and pharmaceutical companies’ probity, and the situation is in
any case covered by the industry’s rigorously enforced Code of Practice.
If any of the BMJ’s readers has evidence of unwarranted hospitality being
bestowed on healthcare professionals, the Code of Practice’s
administrators, the Prescription Medicines Code of Practice Authority,
would be pleased to investigate. In this context, it may be helpful to
remind doctors that, where they receive payment in excess of £25, whether
in money or in kind, from any external source including the pharmaceutical
industry then they should declare it in the locally held register set up
for these activities by the NHS in 2000.
Contrary to further assertions at the inquiry, the system of self-
regulation works well. The ABPI Code of Practice reflects and goes beyond
UK and European law, and is internationally hailed as a “gold standard” on
which many other countries’ codes are based. Times change, however, and
this has been recognised by the ABPI which has recently embarked on a
major overhaul of the code to ensure that it continues to cover all
relevant aspects of modern pharmaceutical companies’ activities. All
reported cases are published even if there is no case to answer – a very
transparent approach.
Certainly the PMCPA would gladly investigate any evidence that can be
produced to support the claim made at the inquiry that bribes have been
offered by a pharmaceutical company not to publish unfavourable research
results. On questioning, it appeared to emerge that the witness was
referring to a single instance some 20 years ago. Nevertheless, I should
like to assert strongly that flawed scientific data is of no possible use
to a pharmaceutical company. We work in a long-term business, where it
takes some 10-12 years to develop a single new medicine. Because the data
developed in supporting a marketing authorisation application has to be
provided to the regulators, provision of flawed data would soon be
detected.
The pharmaceutical industry aims to work in partnership with all those
involved in the provision of healthcare in the UK. This ranges from the
Government to the NHS, bodies such as NICE and the Scottish Medicines
Consortium, through to healthcare professionals, and, indeed, patients.
In that wide range of activities by many different people and many
different organisations, it is perhaps inevitable that, occasionally,
things may go wrong and, where that happens, it is very important that it
is discovered, reported and acted upon. But it is quite another matter to
draw from this the conclusion that the whole system is flawed and that we
would all work more efficiently if we refused to communicate with each
other.
Yours sincerely
Richard Tiner
(Dr Richard Tiner,
Medical Director,
Association of the British Pharmaceutical Industry
12 Whitehall,
London SW1A 2DY
Email: rtiner@abpi.org.uk)
Rapid Response:
WHY INDUSTRY AND DOCTORS NEED TO WORK TOGETHER
Dear Editor
So many criticisms and accusations of the pharmaceutical industry were
made to the last meeting of the House of Commons Select Committee inquiry
(BMJ, October 23) that it seems those giving evidence may have lost sight
of two most important facts: that the industry is the most highly
regulated in the country; and that it produces (and is very successful at
producing) life-saving, innovative medicines.
Certainly it is difficult to understand the rationale behind criticism of
public awareness campaigns because they encourage patients to go to GPs
who then prescribe medicines. If patients suffering from a condition for
which there is a treatment available are encouraged to seek medical
advice, surely this is to the good? To take the view that the less
patients know about treatments, the better – and cheaper – is to behave
dishonestly. Naturally, once they have attended the surgery, it will
always be the doctor’s decision as to whether treatment is necessary and,
if so, what form of treatment. But patients must not be kept in the dark
about potential treatments, and I make no apology for the fact that the
pharmaceutical industry occasionally provides such information.
Furthermore, disease awareness campaigns often lead to earlier diagnosis
of potentially fatal conditions, eg carcinoma of the bladder in the
bladder dysfunction campaign.
GPs’ knowledge of treatments needs to be continuously kept up-to-date.
One way in which they can ensure that they remain informed about the
latest medicines is through the services of pharmaceutical
representatives. I do hope that the witness who gave evidence to the
committee was right when he said that representatives’ influence can lead
to changes in prescribing habits, for the UK is notoriously slow at taking
up new therapies, lagging behind the rest of Europe. If doctors are
convinced by what they hear about the latest, innovative medicines – and
any information provided by a pharmaceutical representative must be backed
up by the relevant scientific data – then it would be surprising indeed if
they did not change their prescribing habits. The witness seemed to
believe that doctors only listen to such information if they are being
wined and dined at the same time. I have a better opinion of both
doctors’ and pharmaceutical companies’ probity, and the situation is in
any case covered by the industry’s rigorously enforced Code of Practice.
If any of the BMJ’s readers has evidence of unwarranted hospitality being
bestowed on healthcare professionals, the Code of Practice’s
administrators, the Prescription Medicines Code of Practice Authority,
would be pleased to investigate. In this context, it may be helpful to
remind doctors that, where they receive payment in excess of £25, whether
in money or in kind, from any external source including the pharmaceutical
industry then they should declare it in the locally held register set up
for these activities by the NHS in 2000.
Contrary to further assertions at the inquiry, the system of self-
regulation works well. The ABPI Code of Practice reflects and goes beyond
UK and European law, and is internationally hailed as a “gold standard” on
which many other countries’ codes are based. Times change, however, and
this has been recognised by the ABPI which has recently embarked on a
major overhaul of the code to ensure that it continues to cover all
relevant aspects of modern pharmaceutical companies’ activities. All
reported cases are published even if there is no case to answer – a very
transparent approach.
Certainly the PMCPA would gladly investigate any evidence that can be
produced to support the claim made at the inquiry that bribes have been
offered by a pharmaceutical company not to publish unfavourable research
results. On questioning, it appeared to emerge that the witness was
referring to a single instance some 20 years ago. Nevertheless, I should
like to assert strongly that flawed scientific data is of no possible use
to a pharmaceutical company. We work in a long-term business, where it
takes some 10-12 years to develop a single new medicine. Because the data
developed in supporting a marketing authorisation application has to be
provided to the regulators, provision of flawed data would soon be
detected.
The pharmaceutical industry aims to work in partnership with all those
involved in the provision of healthcare in the UK. This ranges from the
Government to the NHS, bodies such as NICE and the Scottish Medicines
Consortium, through to healthcare professionals, and, indeed, patients.
In that wide range of activities by many different people and many
different organisations, it is perhaps inevitable that, occasionally,
things may go wrong and, where that happens, it is very important that it
is discovered, reported and acted upon. But it is quite another matter to
draw from this the conclusion that the whole system is flawed and that we
would all work more efficiently if we refused to communicate with each
other.
Yours sincerely
Richard Tiner
(Dr Richard Tiner,
Medical Director,
Association of the British Pharmaceutical Industry
12 Whitehall,
London SW1A 2DY
Email: rtiner@abpi.org.uk)
Competing interests:
None declared
Competing interests: No competing interests