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Drug industry broke promises on medical research, say experts

BMJ 2018; 360 doi: (Published 02 March 2018) Cite this as: BMJ 2018;360:k1021

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Re: Drug industry broke promises on medical research, say experts -are the costs of indulging the industry greater than the benefits?

It seems the basic lessons of good government are never learned [1]. In 2005 the House of Commons Health Committee reported on "The Influence of the pharmaceutical industry" [2]:

"The Department of Health has for too long optimistically assumed that the interests of health and of the industry are as one. This may reflect the fact that the Department sponsors the industry as well as looking after health....

"The consequences of lax oversight is that the industry’s influence has expanded and a number of practices have developed which act against the public interest. The industry affects every level of healthcare provision, from the drugs that are initially discovered and developed through clinical trials, to the promotion of drugs to the prescriber and the patient groups, to the prescription of medicines and the compilation of clinical guidelines..."

A year later the politicians were back asking the industry to solve their problems and perhaps inevitably they only made them worse [1]. There seems to be some basic misunderstanding that the interests of the state and its citizens can ever be the same as a global corporation. Of course, the 2005 Health Committee having reported was immediately dissolved because the General Election and reformed with other perhaps less astute members.

Late last year there were a series of remarkable pharma related appointments to government including Andrew Witty, recently CEO of GSK as head of of Accelerated Access Review programme, Patrick Vallance head of R&D at GSK as Chief Medical Officer and Jonathan van Tam a former employee of GSK, Roche and Aventis Pasteur MSD as Deputy Chief Medical Oficer responsible for emergency preparedness and pandemic planning [3]. These as far as I can see were never even reported in the main edition of this journal, but only remarked upon by Tom Jefferson in on-line opinion piece. He commented [3]:

"The lowering of regulatory and HTA standards is in full swing and its main driver is the pharmaceutical industry. The general rhetoric of rushing drugs and devices through to needy patients willing to accept substantial risk rests on very thin evidence of benefit and unclear public support.

"Improving the quality of evidence is desperately needed as shown by the scores of examples of clinical trials that have been abandoned or distorted that have come to light in the last decade. Pandemic planning also requires some rethinking as the millions of pounds spent on a dubious pandemic with equally dubious fixes has shown. The close space of time of these “revolving doors” makes me wonder whether the government has objectively and properly overseen the decision making which has led to such important public positions being filled by senior industry figures. Can one walk away from leading industry, or rubbing shoulders with it, and perform an important public health function with impartiality? HM Government seems to think so, but if you are unsure (as I am) you may be given pause for thought."

About the Accelerated Access Review Naci and Mossialos remarked (not noting the recent appointment of Witty) [4]:

"Nonetheless, the proposal says too little on expected benefits for patients and wider society. Instead, several concrete pledges are made to industry, including a promise to establish a new commercial unit within the NHS to “immediately streamline the pathway for access discussions” and pave the way for “flexible and confidential commercial arrangements.” Why? Because innovators want it, according to the report."

The implications for public health and the public purse are serious enough, even before you get to the issue of whether the benefits of increased industry investment in the country are ever realised. It is assumed by lazy politicians that business will offer some dynamic answer to our problems, when it will inevitably only provide a dynamic answer to its own.

Not only are lessons not learnt, not only are basic principles ignored, but these very important stories - and the informed public debates which should surround them - are relegated well beneath the public view and for the most part even that of the medical profession.

[1] Nigel Hawkes, 'Drug industry broke promises on medical research, say experts' BMJ 2018; 360 doi: (Published 02 March 2018)
[2] House of Commons Health Committee, The Influence of the Pharmaceutical Industry, 2005 p.3
[3] Tom Jefferson, 'Tom Jefferson: The UK turns to Witty, Vallance, and Van Tam for leadership: revolving doors?'
[4] Naci H and Mossialos E, Accelerated access to new drugs and technologies, BMJ 2017; (Published 22 November 2017)

Competing interests: No competing interests

13 March 2018
John Stone
UK Editor
London N22