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Home > News > BMJ 2009;338:b442,
doi: 10.1136/bmj.b442 (Published 4 February 2009)

Published 4 February 2009, doi:10.1136/bmj.b442
Cite
this as: BMJ 2009;338:b442

News

Individual drug firms should stop paying for medical education

Zosia Kmietowicz

1 London

All educational links between individual drug companies and the
medical profession should cease, says a report from the Royal College
of Physicians. Gifts to doctors and medical students, including food
and travel, should also stop "in the spirit of a more balanced and
mutually respectful partnership," it says.

The report, which has been produced by a specially convened
multisector working party, has examined the relationships between
doctors, patients, the NHS, and the industry. Its aim is "to
rewrite the contract between patient care and industry in the
UK in order to improve national health outcomes," said Richard
Horton, editor of the Lancet, who chaired the working party
and was author of the report.

The report says that patients have lost confidence in the prescribing
process because of unequal access to drugs in the United Kingdom
and the withholding of information about innovative drugs that
could be available to them.

And patient care is unlikely to improve in the future unless the
drug industry and the medical profession can find a way to resolve
the tensions between them.

Trust between the NHS and the industry has broken down, it says.
Doctors are concerned that continuing professional development
programmes are too dependent on funding from drug companies,
and the industry complains that ambivalence from the NHS and
academia blocks future innovation.

At the moment the drug industry pays for about half of all postgraduate
medical education and sponsors some parts of undergraduate courses.
But a deadline, say of five years, should end the practice,
says the report.

The working party, which includes members from medical academia,
the NHS, the drug industry, and patient groups, was convened by
the royal college in September 2007.

Its report proposes a new era of medical education, with undergraduate
courses fully financed by public money. Postgraduate medical
education should be paid for through the royal colleges and the
Department of Health, it recommends.

In addition, the Association of the British Pharmaceutical Industry
and its members should establish a pooled fund to invest in
medical education to "unlink financing from a single company,
diminishing the perception of undue commercial influence and
bias," says the report.

"The relationship [between the NHS and the drug industry] is
currently afflicted by several serious wounds, wounds that are
leaving preventable scars on the body of UK health," said Dr
Horton.

"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."

The report makes 42 recommendations on patient care, professional
education, research, culture, and relationships.

It says a new medicines technical advisory group should be created
to produce a UK-wide drug strategy "to fulfil current unmet
clinical need for prescription drugs and to remove inequalities
in medicines provision across Britain." The multidisciplinary
group "could defuse conflict, provide a forum for constructive
discussion, enhance transparency, and build trust."

The report says, "This kind of collaboration would simply scale
existing local collaborations up to national level, to plan
services countrywide between the NHS and the pharmaceutical
industry."

Among the working group’s other recommendations is a comprehensive
information strategy for patients, which should include independent
sources of evidence about prescription drugs and diseases and a
patient’s version of the British National Formulary.

Education for medical students on how drugs are developed and
regulated, pharmacovigilance, and safer prescribing should also
be strengthened.

The royal and academic colleges are called on to lead "with a
stronger voice," to support research collaborations between industry
and the NHS, to devise incentives for NHS bodies and doctors to take
part in research, especially clinical trials, and to "challenge the
increasing regulatory bureaucracy that is eroding the UK’s
competitive edge in clinical trial research."

"The intention is that the recommendations contained in the report
will enable clinicians, academia, industry and the national agencies
. . . to create a climate of trust and cooperation that transcends
the interests of any one party," says Ian Gilmore, president of the
college, in a foreword to the report.

"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," he said.

The college 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.

Richard Tiner, medical director of the Association of the British
Pharmaceutical Industry, said: "The RCP [Royal College of Physicians]
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 with 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."

Cite this as: BMJ 2009;338:b442

Innovation for Health: Patients, Physicians, the
Pharmaceutical Industry and the NHS is at http://www.rcplondon.ac.uk/.

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Relevant Article

Doctors, patients, and the drug industry

Fiona Godlee
BMJ 2009 338: b463. [Extract]
[Full Text]

Rapid Responses:

Read all Rapid
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UK Doctors should be able to offset medical education expenses
against their tax bill

John D Woods
bmj.com, 12 Feb 2009 [Full text]

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