I am looking forward to the #GuardianLive debate tonight where the three main political parties will discuss the future of the NHS. Guardian’s health correspondent Denis Campbell will chair, and guest speakers will include Norman Lamb MP, Minister of state for care and support, and Liz Kendall MP, Shadow minister for care and older people. Should we be surprised that such an important debate is being sponsored by the Association of the British Pharmaceutical Industry (ABPI)?
The relationship between healthcare and industry (both pharmaceutical and medical devices) has always been an important but difficult one. Mass production of Penicillin during World War Two would not have been possible without the hand of industry. Lifesaving medication like Aspirin and Beta blockers have been developed and produced by industry. Similarly, none of the devices that cardiologists implant routinely, coronary stents and pacemakers for example, could have been developed without close collaboration between industry and clinicians.
Yet relations between healthcare and industry are at a low point. Many conflicts of interest arise when pharma influences healthcare delivery. The NHS drug budget is approximately £10 bn per year and rising. Looking at just the top 10 prescribed drug classes by cost, more than £3bn was spent in England alone on branded drugs where in most cases equally effective cheaper generic alternatives are available. Overdiagnosis (by changing diagnostic criteria or incentivising doctors to diagnose), lowering the threshold for treatment (as with statins, for example), and limited evidence that ‘innovative’, more expensive treatments work, all favour industry’s agenda. Many of these damage the NHS which strives for universal delivery of cost effective and evidence based treatments. The National Institute for Health and Care Excellence (NICE) has been set up to strike a balance, ensuring that effective and affordable treatments are available to everyone. How the different political parties will overhaul NICE following the election is of huge interest to all (see this excellent Guardian article, sponsored by ABPI).
Data transparency in clinical trials carried out by industry is an important issue. It has been estimated that only half of all registered and completed clinical trials are published. Positive trials are twice as likely to be published than negative ones. One example of this is the failure of the pharmaceutical company Roche to disclose all trial data concerning Tamiflu to the Cochrane Collaboration. The UK government has spent £500 million stockpiling Tamiflu on the basis of data that is not complete. Patients giving their consent for use of their personal data in these trials are seldom made aware of this. Studies suggest that only a fifth of all new drugs brought to market offer any advantage over existing therapies.
Key themes for tonight’s debate include:
· If the NHS has finite resources, how should they be spent? Is it more cost effective to outsource services?
· How can we improve access to innovative, new drugs to improve patient care?
· Patient data: who should have access, and why?
It is easy to see how the ABPI view on these may differ from that of most NHS clinicians. The relationship between clinicians and industry is an essential one. But there are serious tensions as well. I hope the debate tonight reflects these.