Niet minder dan een ‘fundamentele aanpak’ is nodig om de invloed van de farmaceuten op politiek en samenleving terug te brengen. Dat is de conclusie van een Britse parlementaire commissie die deze invloed heeft onderzocht.
De elf leden sterke commissie heeft op eigen initiatief de farmaceutische invloed onderzocht omdat “het publiek zich steeds meer bewust wordt van de excessieve invloed van die industrie” en omdat aan de “medicalisatie van de samenleving” een halt moet worden geroepen.
The committee’s report makes clear that reducing the influence of the industry would be good for everybody, including—paradoxically—the industry itself, which could concentrate on developing new drugs rather than on corrupting doctors, patient organisations, and others. “It is not in the long term interests of the industry for prescribers and the public to lose faith in it,” says the report. “We need an industry which is led by the values of its scientists not those of its marketing force.”
The committee came up with 48 conclusions and recommendations, and I have listed some of the highlights in Box 2. The committee’s main recommendation for the problems it identifies is transparency: “let the sun shine in.” It begins by recommending that there be a clinical trials register, “maintained by an independent body” and containing full information. Companies should be required to put the information on the register “at launch as a condition of the marketing licence.” The committee also wants regulatory authorities and ethics committees (the British equivalent of institutional review boards) to help with the design of trials to make sure that they are answering real questions. It didn’t, however, recommend more public funding of trials. I believe that such funding is necessary in order to ensure that trials are addressing the most important questions—including head-to-head comparisons and trials of new drugs against older drugs and non-drug treatments. Advice to companies is unlikely to be effective.
There should be, says the committee, limits on the quantity of marketing materials, particularly in the first six months after launch, and stricter controls on marketing to junior doctors, nurses, and pharmacists. These proposals don’t seem sufficiently thought through: it’s hard to imagine how the proposals would be enforced, and they are patronising to junior doctors, nurses, and pharmacists—many of whom are much better, I suspect, at assessing evidence than burnt out, ageing, high-prescribing general practitioners.
Doctors might come to be seen as the villains rather than the good guys.
Box 2. Recommendations from the Health Committee Enquiry: Some Highlights