I don't think I have really done anything much to transform the way that the pharmaceutical and biopharmaceutical industries
conduct their business. I did, many years ago, publish an article in the Lancet criticizing my medical colleagues for colluding with the industry in the industry's marketing practices. It won me few friends
at the time, even though the excesses that I described have now largely been eliminated, at least in the UK.
Likewise, as chairman of the Committee on Safety of Medicines (1992 to 1998) I did too little to reduce regulatory demands.
Indeed, during those years, the numbers of patients in premarketing trials doubled, even though I hope it was not due to anything
I said or did.
Chairing NICE since its inception in 1999 has been the most exciting, rewarding, and invigorating part of my professional
career. If during those years I have done anything to influence the industry, it is—I hope—making industry understand that
it is competing for healthcare resources with other healthcare providers. And that if a healthcare system spends substantial
sums on a few patients, others will be deprived of cost-effective care. Moreover, those people that forgo effective healthcare
will often be the marginalized members of our societies who lack powerful advocacy groups or much public sympathy.
In this latter context I hope that the industry now realizes that giving covert support for patient advocacy groups, who are
unhappy when NICE advises against the use of a particular intervention, will be exposed. I fully accept the right of advocacy
groups to lobby on behalf of their members. But if I ever again learn that their public relations campaigns are being supported
by particular companies I will be very noisy in my condemnation of both the importunate company and the guilty advocacy group.
Looking ahead, the global economic meltdown is likely to have a serious impact on healthcare generally and on medicine in
particular. The notion that we cannot only just continue—but increase—our current levels of expenditure on healthcare will
be impossible. The pharmaceutical and biopharmaceutical industries will only be able to continue providing patients with safe
and effective medicines if the price is affordable. This will involve changes in attitudes by the industry, regulators, politicians,
and the public. I am more than willing to help.
Sir Michael Rawlins
Chairman of the UK National Institute for Health and Clinical Excellence