Pharma should be placing patients front and center, claims a new report from the UK’s Royal College of Physicians. The report, “Innovating For Health: Patients, Physicians, The Pharmaceutical Industry and The NHS,” identifies a number of threats to clinical research. Two important themes run through the report: patients are disillusioned about access to medicines, and a lack of trust between industry and the National Health Service.
The report’s working group was drawn from across the spread of medicine, pharma companies, policy makers and patient groups, and the aim wasn’t to knock industry. “The goal was to draw a line under past confrontational debates,” the group’s chairman and editor in chief of the Lancet, Richard Horton, said at the report’s launch. “We wanted to end the war of words that has commonly taken place between doctors, researchers, industry and critics.”
The report sets out 42 recommendations in four areas–patient care, research, education and culture. In the first area, patient care, the top priority was a creating a strategy that would ensure patient access to medicine and independent information on them.
“It’s incredible that no such strategy exists in Britain today,” Horton said. “Key drugs for common diseases are underused, the UK has slow rates of adoption for new medicines, prescribing medicines is still subject to unfair geographic variation, and there’s still no long-term commitment to treat particular diseases to foster predictability for pharma R&D.”
He says it is clear that a new government advisory body is needed that would promote access, rather than the current patchwork of piecemeal intervention.
For research, Horton claimed that the high standards of clinical care is threatened by a steady loss of industry investment in research. “Our research base is shrinking relative to other countries, and that should be a concern to the NHS as well as scientists,” he said. “UK clinical research is slow, costly and inefficient, and there are failings in the way the NHS supports clinical trials.” The working group suggested that all stakeholders needed to focus on building partnerships between industry and academic medicine, and reverse the growth in regulatory bureaucracy in research. “NHS chief executives need to make research a central part of their mission; it shouldn’t be seen as an optional add-on for care–it’s a vital part of improving patient care.”
Education has been one of the most contentious aspects of medicine’s relationship with industry in recent years. The report proposes two main measures: addressing the fact that doctors are poorly prepared for prescribing when they leave medical school, and removing doctors’ dependency on industry for gifts, food and travel.
“Accepting travel, food, pens or mugs advertising specific medicines creates an impression of the taint of influence that patients tell us they’re concerned about,” he said. “There’s an emerging consensus that this gift culture damages trust and confidence in industry, and industry doesn’t want to be a blank cheque for doctors’ entertainment any longer.”
Currently in the UK, the pharma industry is responsible for funding about half of all postgraduate medical education. The suspicion is that this affords the companies too much opportunity to promote their own products, rather than provide independent education. The report’s working party suggests that postgrad training should be weaned off individual pharma company sponsorship while alternative, sustainable sources of funding are organised, perhaps through the NHS. A suggestion is that industry funding should be pooled, decoupling it from individual companies and perceptions of undue influence.
Finally, culture, which the report claims currently inhibits innovation within the NHS. “Industry’s relationship with the NHS is too often marred by suspicion, mistrust and bureaucracy,” he said. ‘We argue for symbiosis between NHS and industry, not schism, and this is the essence of the new contract we’ve called for between, industry, NHS and academic medicine.
Doctors need to view industry as clinical and scientific partners in patient care, not as a source of personal or professional financial support. Industry needs to emphasise its role as a vital participant in healthcare. All partners need to be less defensive and more confident about appropriate collaboration, and patient outcomes need to govern these relationships, not the current obsession with red tape and rhetoric.”
The Royal College of Physicians is now setting up a pharmaceutical forum, bringing together representatives from all stakeholders, and will be holding a national conference over the next 18 months to monitor progress and see how far the recommendations have been implemented.
“We have already signed up to the pharmaceutical forum and we believe that it will be an important group to bring some of these recommendations forward,” said Richard Tiner, medical director at the Association of the British Pharmaceutical Industry. “The time for industry being seen just as a check book has to end. We need to be seen as a trusted partner.”