Wednesday, 4 February 2009 12:00 AM
Unless points of contention between the pharmaceutical industry and the medical profession are resolved satisfactorily, future advances in the quality of patient care may be put at risk. This is the conclusion reached by a multi-sector working party convened by the Royal College of Physicians. The group's report, Innovating for health: Patients, physicians, the pharmaceutical industry and the NHS identifies a number of critical threats to clinical research in the UK. These coalesce around two key themes:
- Patient disillusionment with medicines policy. Evidence submitted to the group suggests that patients remain concerned that they do not enjoy equal access to medicines, nor do they believe that the full range of innovative medicines that are available is brought to their to attention, thus undermining their confidence in the entire prescribing process. Patients sampled also confirm a willingness to participate in clinical trials, or other drug related research but report a lack of opportunity.
- A failure of trust between the NHS and the pharmaceutical industry. There are also major issues in the relationship between industry and the medical profession in recent years, with education being one of the most contentious areas. Well respected physicians contend that continuing professional development programmes are too dependent on industry support, while the industry cites widespread ambivalence within the NHS and academia towards working with them as a key obstacle to future innovation.
To address these challenges, the group has formulated a series of steps they believe can help to restore trust and promote the effective exchange of ideas between sectors. The common theme cutting across the 42 recommendations is a drive to redefine the terms of engagement between the NHS, academic medicine, and the pharmaceutical industry, with the health and well-being of the patient as the over-riding objective.
The proposals include:
- A cross sector push to restore patient confidence in the prescribing process. This would involve two main measures; a strategic initiative to accelerate work on an access to medicines strategy with the aim of reducing inequalities in medicines provision across the country, and a comprehensive medicines information strategy for patients, the first step of which would be to create independent sources of evidence about the effectiveness of different prescription drugs for consumers.
- Measures to restore patient confidence in medical independence. The report cites evidence of patient unease with the perceptibly close relationship between some doctors and pharmaceutical companies. To address this, the authors recommend the medical profession collectively adopt the (Nolan) principles laid out by the Committee on Standards in Public Life for those in public service as a means of reassuring patients of their independence when performing their duties.
- Decoupling the pharmaceutical industry from continuing professional development. The industry presently pays for about half of all postgraduate medical education. In order to address widespread suspicions that drug promotion is carried out through continuing professional development, the working party recommends weaning postgraduate training off individual pharmaceutical company sponsorship over a time bound period while alternative sources of sustainable funding are organised through for example the royal colleges and the Department of Health
- Introducing a collaborative culture built on respect for the contribution made by those inside and outside of industry. The report, noting that the UK's recent comparative advantage in medical research has now been lost to European competitors advocates the inclusion of more proactive research leadership- clinically and managerially-within the NHS, alongside a better alignment to promote and sustain research and research careers.
To drive forward the report's recommendations, the Royal College of Physicians plans to establish a Pharmaceutical Forum which will include physicians, scientists, research funders, industry representatives, editors and patient groups. The group will review progress in two years' time at a national conference organised specifically for the purpose.
Dr. Richard Horton, Chair and Author of the Report said:
"The health of the relationship between the NHS and the pharmaceutical industry is an important measure of the health of the nation. But that relationship is currently afflicted by several serious wounds, wounds that are leaving preventable scars on the body of UK health. Patients' needs and expectations around medicines are not being met. The NHS is losing the vital input of industry in cutting-edge medical research. Doctors suffer from a lack of NHS investment in their continuing education, allowing industry to fill a critical void. And the nature of the relationship between the NHS and pharma is too often - and wrongly - portrayed as negative and unproductive. Our report aims to rewrite the contract between patient care and industry in the UK in order to improve national health outcomes. The pharmaceutical industry is an indispensable partner in that work."
Professor Ian Gilmore, President of the Royal College of Physicians said:
"Getting the relationship between the NHS, Academia and the industry right has the potential to deliver sustainable advances in patient treatment, a really worthwhile prize. We believe that the Royal College of Physicians has an important role in bringing together these partners and we are wholly committed to this task".
Professor George Griffin, Chairman, Association of Clinical Professors of Medicine said:
"This publication from the Royal College of Physicians working party is timely and excellent. It defines a three way relationship between the NHS, academic medicine and the pharmaceutical industry driven by clinical need and innovation both of which are crucial for the development of new drugs and patient care. The recommendations presented at the end of the document provide a clear framework towards achieving the very clearly articulated aims. In all, this is an important document to guide and inform the future."
Dr Richard Tiner, Medical Director of the Association of the British Pharmaceutical Industry, said:
"The RCP has taken a long, hard look at how doctors, academics and the pharmaceutical industry work together, with a specific focus on what is in the best interests of patients. It has come back with a powerful report which highlights how the views of the industry and NHS are fragmented and sets out concrete and constructive recommendations to get all sides pulling together. We welcome publication of the report, are grateful to have been asked to contribute to it and welcome the debate it ignites. We will consider all the recommendations very carefully and look forward to working the RCP and others to see how they can be progressed as we believe a strong, united NHS family is in everyone's best interests."
Notes to editors
1) Methodology: In order to gather data to inform the writing of the report, the Working Party adopted a comprehensive method of consultation, beginning in September 2007 and ending in November 2008. During this time, the Working Party took oral evidence from 17 witnesses; received over 70 written responses to a set of questions about the NHS, pharmaceutical industry and academic medicine; commissioned a survey from the Royal College of Physicians Patient and Carer Network; drew on extensive peer-reviewed literature; and took additional soundings from a broad range of opinion leaders, including meetings hosted by the Academy of Medical Royal Colleges with UK pharmaceutical industry leaders, and the American Pharmaceutical Group (UK affiliates of major US companies). The findings of the Working Party were reported and tested against the views of over 50 experts in September 2008.
2) Working party membership: Richard Horton (Chair and author of the report); [Editor-in-Chief, The Lancet], Susan Shepherd (Secretary) [Royal College of Physicians], Susan Bews [President, Faculty of Pharmaceutical Medicine], Derek Calam [Royal College of Physicians Patient and Carer Network], Stuart Dollow [Vice President and Medicines Development Leader, GlaxoSmithKline], Ahmed Elsharkawy [Specialist Registrar and Wellcome Trust Clinical Research Fellow, University of Newcastle], David Gillen [Medical Director, Pfizer], Ian Gilmore [President, Royal College of Physicians], Felicity Harvey [Director of Medicines, Pharmacy and Industry Group, Department of Health], Iona Heath [General Practitioner], Kate Lloyd [Specialist in Pharmaceutical Medicine], Hugo Mascie-Taylor [Medical Director, Leeds Teaching Hospitals NHS Trust], Hemant Patel [Former President, Royal Pharmaceutical Society], David Pruce [Director of Policy and Communications, Royal Pharmaceutical Society], Charles Pusey [Division of Medicine, Imperial College London], Peter Stephens [Vice President, Public Health Affairs, Europe, Middle East, and Africa, IMS Health], Richard Tiner [Director of Medicine, Association of the British Pharmaceutical Industry], Louise Wood [Head of Innovation and Industry Research and Development Relations, Research and Development Directorate, Department of Health].
3) For copies of the report, or to arrange an interview with one of the primary authors please contact the RCP Press Office on 0207 935 1174 x468 or email firstname.lastname@example.org