The lascivious seduction of incorruptible doctors by sugar-tongued pharma reps remains an enduring caricature of the relationship between industry and physicians, albeit one which contains a quantum of truth. Pharmaceutical executives holding leadership positions today will have started their career in a culture where the line between hospitality to doctors and unconstrained profligacy was, on occasion, blurred.
Successive reforms within the industry's Code of Practice over the last decade have sought to improve the pharmaceutical's ROI - that is, reputation of industry - but they have evidently not gone quite far enough. A new report written in consultation with industry representatives,1 under the auspices of the Royal College of Physicians (RCP), recommends actions for the industry on patient care, industry's role in professional education, and the promulgation of a more sober culture between industry and physicians. Dr Richard Tiner, who sat on the working party throughout the 18-month gestation period of the report, revealed that "the RCP recognised that the pharmaceutical industry is an important partner within healthcare but that the working relationship between clinicians and industry wasn't as good as it could be."
Of 42 wide-ranging recommendations to the UK National Health Service, physicians and industry, the ones most likely to raise eyebrows amongst industry relate to culture and professional education. All gifts to qualified and qualifying doctors - including food and travel - should end; moreover, educational funds donated by industry should be disbursed by a centralised administrative unit, not by individuals or companies.
Individual sponsorship to attend educational events is a pillar of many industry initiatives, but Dr Tiner calls for greater personal responsibility amongst health care professionals: "The days of doctors getting free education have gone. Just like many other professions, they have to put their hands in their pocket and support themselves. The Working Party felt it was important to distance industry from direct education, to diffuse accusations of bias, despite the rules and regulations under the Code of Practice."
A centralised educational fund would de-couple direct company sponsorship from individual clinicians, but how would it work in practice? Dr Tiner explained: "As a total pool for the whole country it would be difficult, but for specific projects this already happens. The National Council Research Institute annual conference, set up four years ago, has not been totally reliant on industry sponsorship, but a number of companies have come together to put money into a central pot for the institute to use that money as it sees fit."
As the industry has become more accustomed to full transparency in registering clinical trials, it is no surprise that the report recommends a publicly-accessible registry of all honoraria payments and fees to doctors. For Dr Tiner, transparency is the key: "This is an important area - if there was more transparency, a lot of the accusations of large sums of money being passed, would be revealed as not being the case. Until we have that transparency, people just don't believe us."
One of the criticisms of the report is that it is highly UK-focused, perhaps unsurprisingly considering the source. However, one of the seemingly uncontroversial recommendations may have ramifications in emerging markets, particularly since significant numbers of UK manufacturers operate globally. The Working Party recommends that to help the patient experience, manufacturers ensure that the same medicines always have a similar colour, shape, and size - among other variables. However, Dr Richard Laing of the WHO told delegates at the recent Economist Pharma Summit that one of the strategies seen in emerging markets was the marketing of the same medicine to different patient segments using, in his example, five different brand names, different labelling, different price points, and different distribution mechanisms.2 The medicines with identical colour, shape, and size may be from the same batch - but what exactly are the other variables which the RCP left unnamed?
Criticism aside, the RCP plans to hold a conference in 2010 to assess progress on the recommendations. I asked Dr Tiner if industry would fund this: "it will be the college's conference, and the college will be responsible for funding it." That'll be a yes, then!
THE SECRET OF SWISS SUCCESS
In 2008, the industry body representing 250 pharmaceutical and chemical firms in Switzerland published a 47-page report extolling the virtues of Swiss industry3 with impressive up-to-date facts; annual R&D spend by industry home and abroad is CHF19.9 billion (EUR 13.5 billion), global turnover of the top ten firms for pharmaceuticals and diagnostics is CHF102.3 billion (EUR 69.57 billion), and the industry employs 64,800 people in Switzerland alone. All this from a country which ranks 95th and 147th in the world for population and land area, respectively. How did this come to pass?
The academic literature abounds with evidence purporting to explain the Swiss life sciences phenomenon - not including the medical device industry; however, my explanation is devastatingly simple: Swiss trains run on time. A recent trip, involving comfortable and stunningly accurate train journeys to Geneva, Basel, Zurich, and to Vorarlberg, Austria, contrasted starkly with the horror of traversing London earlier this month, when the entire transport infrastructure spasmed at the sight of a few snowflakes. Even when travelling outside of London, endemic poor punctuality and shocking customer service on National Express coaches in particular is a National Embarrassment.
Thus the conclusion is inescapable, the logic - flawless. World domination in life sciences clearly starts with accurate trains
1. Royal College of Physicians, Innovating for health: patients, physicians, the pharmaceutical industry and the NHS, Report of a Working Party (RCP, London, 2009).
2. Laing, R, "Growing the business and meeting the healthcare needs of poor communities in emerging countries: panel discussion," The Economist Pharma Summit, 12 February 2009, London.
3. The Swiss Chemical and Pharmaceutical Industry, SGCI Chemie Pharma Schweiz (Zurich, Switzerland).