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Milking the NHS

So even the chair of the government’s own drugs watchdog has had to acknowledge what everyone else working in health has always known – the pharmaceutical corporations milk the NHS for all its worth and patients in need are the biggest losers (along with taxpayers).

Professor Sir Michael Rawlins launched his tirade against drugs companies after the National Institute for Health and Clinical Excellence (Nice) was accused of “barbarism” for refusing to approve new kidney drugs for NHS use because of their cost. Rawlins said it was common knowledge that some companies charged what they thought they could get away with. “We are told we are being mean all the time, but what nobody mentions is why the drugs are so expensive,” he said. Kidney cancer drugs could be produced for about a tenth of their current cost, Rawlins claimed.

Rawlins cited three key factors in the cost of drugs. One was the fact that many older drugs were soon losing patent protection, allowing rivals to produce cheaper versions. Secondly, the price of shares was paramount. Rawlins insisted: “Pharmaceutical companies have enjoyed double-digit growth year on year and they are out to sustain that, not least because their senior management's earnings are related to the share price. It's not in their interests to take less profit, personally as well as from the point of view of the business. All these perverse incentives drive the price up.” The third factor was the cost of marketing.

This is not a new story. In 2005, the Commons health committee reported that the pharmaceutical industry “has been left to its own devices for too long” and added: “The Department of Health has for too long optimistically assumed that the interests of health and of the industry are as one. This may reflect the fact that the Department sponsors the industry as well as looking after health.”

The committee heard allegations that clinical trials could be designed to show the new drug in the best light – and sometimes failed to indicate the true effects of a medicine on health outcomes relevant to the patient. They were informed of several high-profile cases of suppression of negative clinical trial results and of selective publication strategies and ghost-writing. The committee lambasted the intensive promotion of medicines to prescribers, especially GPs. Promotion of medicines to patients and links between drug companies and patient organisations may add to this problem, said the report, which added:

“The most immediately worrying consequence of the problems described above is the unsafe use of drugs. Over-prescription of the COX-2 inhibitors, Vioxx and Celebrex, has been linked to thousands of deaths and many more cases of heart failure. These case illustrate a series of failures. Manufacturers are known to have suppressed certain trials for these drugs in the US and may have done the same in the UK. In addition, there were inadequacies in the licensing and post-marketing surveillance procedures and excessive promotion of the drugs to doctors.”

The NHS drugs bill has doubled under New Labour to over £11 billion a year, 80% of which goes on prescribed medicines. The real question is, if 1.3 million people can work in the not-for-profit NHS, with the majority of basic research done in publicly-funded universities, why can’t drugs be produced in the same way? The answer is that the market state acts as a guarantor for the drugs companies instead of the needs of the sick and is a barrier to the comprehensive socialisation of health care.

Paul Feldman
Communications editor
18 August 2008

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