Response of the BMA to the Royal College of Physicians Working Party consultation document, 'Physicians and the pharmaceutical industry questionnaire'
April 2008
Thank you for consulting the BMA on the Royal College of Physicians (RCP) working party questionnaire on physicians and the pharmaceutical industry. Our response intends to provide comments on the four questions as set out in your questionnaire, with some general comments at the end of the document.
What should be the nature of the ideal relationship between the pharmaceutical industry, the NHS, and academic medicine?
The industry and academic medicine are both vital for the development of new treatments which are innovative and safe for use by patients. The NHS as the main customer of the industry has a major interest in getting value for money and in promoting the development of new products, which may save the NHS money through improvements in patient health.
The relationship between the pharmaceutical industry, the NHS, and academic medicine should be one of cooperation and support and their goals should be aligned in the interests of patients. If a balance could be maintained between these competing demands, the pharmaceutical industry could make profits in ways that benefit patients as well as shareholders (e.g. through the establishment of Clinical Research Facilities by the Wellcome Trust and other organisations) the NHS could assist by agreeing on costs with manufacturers and at the same time support and accommodate the researchers necessary to develop, test and validate new treatments.
There should also be better interaction between NICE, MRC and the pharmaceutical industry to ensure more research is beneficial to patients, a point which has already been suggested in the Cooksey report ('A review of health research funding', Sir David Cooksey, 2006).
What are the current political, economic, commercial, organisational, professional, and public barriers to creating this kind of relationship?
There is a climate of suspicion in political and public circles about the relationship between the medical profession and the pharmaceutical industry. We do not believe that this is a significant cause for concern, as there is effective scrutiny of the links between manufacturers and prescribers through voluntary regulation and statutory policing of physicians (through appraisal, revalidation and clinical governance procedures).
There is also some mistrust amongst doctors and patients of pharmaceutical companies with suspicions that their aims to maximise shareholder return could sometimes lead to commercial interests being served ahead of patient interests. Medical professionals in turn are put in a difficult position when conducting research, because research grants are hard to come by and yet grants made by commercial organisations can put a strain on the impartiality of the research. Although researchers are vigilant against bias or influence in their methods and outcomes, there is a need for increased public funding for research.
On the other hand, we are also concerned that the current climate of suspicion against pharmaceutical companies has reached the point where it is possible that new and appropriate drugs are being delayed in their deployment in the pharmacological supply chain, simply because of the mistrust of the industry amongst the profession and the NHS purchasers. There is a kind of prejudice among researchers and Universities that money from pharmaceutical companies is not only tainted by commerce but also is not really as highly valued as money from charities, councils or foundations.
The Medical Research Council, Wellcome Trust, Cancer Research UK and the British Heart Foundation are all amongst the major players in research and have a vital role to play to limit the potential influence of pharmaceutical company funding on research outcomes.
What changes within industry, the NHS, research, undergraduate and postgraduate medical education, professional and pharmaceutical regulation, and the wider UK political environment would augment and protect the relationship you are describing?
The BMA supports reports such as 'Best Research for Best Health'¸ Department for Health (2006) and Cooksey’s review of UK Health Research (2006) and note they have recommended numerous changes that are intended to improve the relationship between clinical academia, the NHS and industry for the benefit of patients.
There needs to be teaching at undergraduate and trainee doctor level about drug development, marketing and ethical aspects of the relationship with the pharmaceutical industry and about the merits of research governance.
We would support the development of training programmes in pharmaceutical medicine, to encourage the pharmaceutical industry to value training in education and research in pharmaceutical medicine at undergraduate level and during the Foundation years and beyond, so that they build up expertise in this specialty during all aspects of medical training. It is vital such training programmes offer the opportunity to gain the experience and competencies required to obtain a CCT.
More independent funding for research would be welcome, for example, drug companies could be asked to contribute to a central fund for research (perhaps administered by the Medical Research Council) as well as to individual projects, although we accept that there is likely to be resistance to this from both the industry (who like the individual relationships that are built up through supporting particular researchers) and the researchers themselves (or at least those who have an established relationship or who feel their research will struggle to attract funding from a centrally-administered pot).
The industry also needs to continue to implement good practice in marketing its products.
How can doctors – and specifically the Royal College of Physicians – help to advance an ethical and productive relationship between industry, the NHS, and academic medicine to improve the overall health of the UK population?
Doctors can promote a productive relationship between the industry, academic medicine, and the NHS by respecting the role of the Prescription Medicines Regulatory Body and reporting issues of concern to them. Equally, pharmaceutical companies should report doctors who misuse their position e.g. by research fraud/ exploiting marketing hospitality.
We would like to commend the Academy of Medical Sciences, which has this as part of its remit and has established a Forum to take forward such an initiative.
Further thoughts
It is important that the funding of educational activities continues both locally and at national level.
The provision of funding should not influence educational content.
There is a problem of the perhaps pernicious influence of drug trials being sponsored by companies and other therapeutic trials not being done.
Finally, given recent examples of publication bias and failure to disclose in good time serious adverse events e.g. COX 2 inhibitors and SSRI's, we commend the way in which some companies have funded clinical trials designed and run by the Clinical Trials Services unit in Oxford and organised through the NHS e.g. the Heart Protection Study.