Big Pharma – friend or foe?
In 2012 British doctor and best-selling author of ‘Bad Science’, Ben Goldacre, published his new book – ‘Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients’, adding fuel to an already heated debate on the ethics of the pharmaceutical industry. Each year in the UK, these companies contribute around £8 billion to GDP1. But how right is it that such a massive, profit-making industry is involved in such a precious topic as people’s lives?
Fears
With power comes responsibility or, in this case, public concern. This concern is often focused on two issues:
1. Pricing
2. Influence on research.
One of the important roles of drugs companies is to set the price of drugs they have developed. This is the price paid by patients choosing private healthcare in the UK, but also what the NHS pays. For common, easy to produce medicines such as paracetamol, prices can be kept low by competition. For example, paracetamol retails at around 20p a box in supermarkets.
The concerns arise over newly produced or complex drugs where one or two drugs companies have a monopoly or duopoly. Whilst it is true that these drugs can be expensive to produce, sudden price hikes beg the question: just how much of the price is profit? Last year, Pfizer, an American pharmaceutical company, was fined £84.2m by The Competition and Markets Authority for raising the price of phenytoin sodium capsules by 2600% overnight2. Phenytoin sodium capsules are an epilepsy medicine used by 48,000 people in the UK. Pfizer produces the drug for Flynn who sell it to the NHS and Flynn debranded the drug meaning it was no longer subjected to price regulation. The NHS had no choice but to pay this increased price to prevent the risks associated with moving all affected patients onto alternative drugs. This is a telling example of why many people have fears over the stronghold drug companies can have over the NHS, particularly in the current economic context.
The other key role of drugs companies, as well as selling the drugs, is to research and develop drugs for sale. While charities and the government often fund initial research and drug trials, the funds available to pharmaceutical companies are unmatched. GlaxoSmithKline alone spent £3629 million on research and development last year in the UK, compared to roughly £400 million by Cancer Research UK3. Some argue that this puts pressure on researchers funded by the companies to produce favourable results. One study (Nieto et al 2007) found authors of studies funded by a pharmaceutical manufacturer were more likely to conclude that a drug is safe than authors of studies not funded by a pharmaceutical manufacturer4. This could lead to a situation in which the NHS is overpaying for drugs that underperform.
A force for good?
However, large budgets are certainly not all bad. The Association of the British Pharmaceutical Industry estimates that each new drug takes roughly 12 years and £1.15bn to develop. Numerous so called ‘wonder drugs’ relied on pharma funding to be produced. These include the breast cancer drug Tamoxifen (developed by ICI/AstraZEneca) and a Zika vaccine which is currently in phase 1 clinical trials (developed with Moderna Therapeutics). This literally life-saving influence of drugs companies could prove ever-more useful in the coming years, when the difficult fight to produce new antibiotics reaches new levels.
It is also important to remember that the power held by drugs companies is monitored. In the UK, Medicines & Healthcare products Regulatory Agency, regulates the safety and efficacy of new. In addition, The Pharmaceutical Price Regulation Scheme uses the huge purchasing power of the NHS to ensure the NHS pays a fair price for its medicines. In doing so, these bodies tackle both main fears surrounding ‘big pharma’.
Overall, it is clear why concerns have arisen over the pharmaceutical industry. High profile examples of sudden price rises create a feeling of ‘big pharma against the people’, with images provoked of the NHS being held to ransom. In reality though, a comprehensive system of regulation helps to maintain what seems to be a mutually beneficial situation for both the NHS and the pharmaceutical industry, with the NHS and patients benefiting from the resources of the industry in terms of new developments.
Further information:
The Association of the British Pharmaceutical Industry
http://www.abpi.org.uk/about-us/Pages/default.aspx
Medicines & Healthcare products Regulatory Agency
http://83.98.30.20/MHRA/SearchHelp/Frequentlyaskedquestions/index.htm#l4
NHS Information
https://www.nhs.uk/conditions/medicines-information/#how-new-medicines-become-available
References:
1. "Did you know?: Facts and figures about the pharmaceutical industry in the UK - Second edition 2011" (PDF). The Association of the British Pharmaceutical Industry. 2011 [cited 2017 November 2010]. Available from: http://www.abpi.org.uk/our-work/library/industry/Documents/Did%20you%20know_Jan11.pdf
2. Competitions and Markets Authority. CMA fines Pfizer and Flynn £90 million for drug price hike to NHS. 2016 [cited 2017 November 10]. Available from: https://www.gov.uk/government/news/cma-fines-pfizer-and-flynn-90-million-for-drug-price-hike-to-nhs
3. Department for Business, Innovation and Skills. The Top 1,000 UK and 1,000 Global Companies by R&D Investment. 2010 [cited 2017 November 11]. Available from: http://webarchive.nationalarchives.gov.uk/20101208170517/http://www.innovation.gov.uk/rd_scoreboard/downloads/2010_RD_Scoreboard_data.pdf
4. Nieto A, Mazon A, Pamies R, Linana JJ, Lanuza A, Jimenez FO, et al. Adverse effects of inhaled corticosteroids in funded and nonfunded studies. Arch Intern Med. 2007;167:2047–2053.
