Intended for healthcare professionals


UK drug companies must disclose funding of patients' groups

BMJ 2006; 332 doi: (Published 12 January 2006) Cite this as: BMJ 2006;332:69

Could pharmaceutical industry help promote health by reversed drug pricing schemes?

Dear Editor

It is now an accepted practice to use incentives to achieve wider
health promotion. The current incentives are mainly aimed at reducing
cardiovascular morbidity and mortality but it is clear that the thresholds
have to be carefully monitored especially in areas such as hypertension to
achieve the best outcome.[1] There is clear evidence that a number of
proven treatments such as angiotensin converting enzyme inhibitors in
heart failure or statins in established vascular disease are either under-
prescribed or prescribed at low doses.[2,3] It would be useful if the
pharmaceutical industry prices its drugs in a decremental fashion per dose
escalation as an incentive to achieve the objective of effective high
dosage treatment. For example the NHS cost of Ramipril in its non-
proprietary form is £3.74 for a 2.5mg 28 day dosage and £6.42 for a 10mg
28 day dosage, reversing the pricing will not only act as an incentive for
physicians to achieve cost savings in an increasingly cash strapped NHS
but also promote the effective use of these agents in heart failure and
decrease morbidity and mortality. With the increase in their
effectiveness, physicians are more likely to be persuaded by their
benefits and thereby increase the prescribing of these agents resulting in
increased sales which will make up for any lost revenue as a result of the
reversed pricing by the pharmaceutical industry. The effect on health
promotion is likely to be significant especially if such pricing is
applied to anti-hypertensives and help the pharmaceutical industry with
some good publicity given the parliamentary health select committee


1. Payment incentives for GPs bear no relation to health benefits
Dobson BMJ.2006; 332: 71.

2. Kasje WN; Denig P; Stewart RE; de Graeff PA; Haaijer-Ruskamp FM.
Physician, organisational and patient characteristics explaining the use
of angiotensin converting enzyme inhibitors in heart failure treatment: a
multilevel study. Eur J Clin Pharmacol. 2005; 61(2):145-51

3. M. Teeling, K. Bennett, J. Feely The influence of guidelines on the use
of statins: analysis of prescribing trends 1998–2002. British Journal of
Clinical Pharmacology 2005; 59: Page 227

Competing interests:
None declared

Competing interests: No competing interests

23 January 2006
Sunku H Guptha
Consultant Physician
Medicine for the Elderly, Edith Cavell Hospital, Peterborough PE3 9GZ