Plans to make two antibiotics for treating urinary tract infections available to buy over the counter in the United Kingdom rather than being prescription only are governed by commercial rather than public health concerns, say doctors and pharmacists.
The Medicines and Healthcare Products Regulatory Agency (MHRA) is currently considering reclassifying trimethoprim and nitrofurantoin for the treatment of uncomplicated urinary tract infections, such as cystitis.
The move follows the agency’s approval earlier this month of a similar switch for the antibiotic azithromycin, for the treatment of chlamydia infection.
But members of the British Society of Antimicrobial Chemotherapy oppose the move, the GPs’ magazine Pulse reports (www.pulsetoday.co.uk, 28 Aug, “Fury over decision to make first mainstream antibiotic OTC”). In a letter to health ministers they express concerns that “approvals of this type are determined commercially and not on the basis of medical need.”
doi:10.1136/bmj.a1538
An unprecedented attack on drug companies’ prices by the head of England’s drug approvals body shows that it is jockeying for a key role in the forthcoming overhaul of drug pricing, observers say.
Michael Rawlins, who chairs the National Institute for Health and Clinical Excellence (NICE), has criticised the industry for profiteering. In an interview in The Observer (www.guardian.co.uk, 17 Aug, “Health chief attacks drug giants over huge profits”) he said that drug companies aimed for “double-digit growth year on year … not least because their senior management’s earnings are related to the share price.”
“All these perverse incentives drive the price up,” he said.
His comments came after NICE was criticised fiercely for failing to approve a batch of new kidney cancer drugs (BMJ 2008;337:a1262, 14 Aug, doi: 10.1136/bmj.a1262).
Joe Collier, an emeritus professor of medicines policy at St George’s, University of London, said that Professor Rawlins was “jockeying for a central role in price negotiation” in the forthcoming overhaul—due to be announced in the next few months—of the pharmaceutical price regulation scheme.
Richard Barker, director general of the Association of the British Pharmaceutical Industry, said, “NICE was not created to set medicine prices—nor indeed to drive them down, as NICE’s chairman now seems to see as his mission.”
BMJ 2008;337:a1422
In the United States, commercial support for continuing medical education has grown steadily over the past decade. In 2006 it provided more than half, about $1.5bn (£0.75bn, 0.95bn) or 60%, of the income for educational programmes doctors must take to maintain their medical licences. Evidence shows that commercial support distorts what doctors learn.
In 2007 the Josiah Macy, Jr conference on Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning (www.josiahmacyfoundation.org) recommended ethat organisations providing accredited continuing education should not receive commercial support from drug or medical device companies.
BMJ 2008;337:a1023 (http://www.bmj.com/cgi/content/full/337/aug14_1/a1023?eaf)
Doctors in the United States should brace themselves for a substantial decrease in conference dinners but a big increase in the quality of drug industry sponsored education. Responding to criticisms of the way that continuing medical education is funded by the drug industry and run by profit making, third party companies, Pfizer last month decided to cut education funding in 2008 from $80m to $60m (£43m to £32m; 55m to £41m). Its decision indicates a sea change in sponsorship of continuing education in the US that could have implications for the United Kingdom.
“Our analysis demonstrated that higher quality grants would increase the percent of funding that directly benefited learning while reducing expenditures on non-educational expenses like meals,” the company stated. By September it says some 90% of its funding will go into educational programmes run by academic institutions, hospitals, or medical societies.
In January, a report by the influential Manhattan based philanthropic institution, the Josiah Macy Foundation, went even further, concluding that drug manufacturers should not support continuing medical education.1 It says industry sponsorship affects the independence of doctors, invites bias, endangers professional commitment to evidence based learning, and promotes and validates an “entitlement” mindset among doctors that education should be paid for by others. It also says the conference lecture circuit isn’t improving patient care, it’s simply about “promotion and physician welfare.”
BMJ 2008;337:a1399 (http://www.bmj.com/cgi/content/full/337/aug26_1/a1399?eaf)
Continuing medical education has become so heavily dependent on support from drug and medical device companies that the ethical underpinnings and the reputation of the medical profession may be compromised. Continuing medical education is compulsory in Italy, and the Ministry of Health has recommended that local health authorities spend 1% of their total budget on educational activities. Nevertheless, most authorities spend much less than the recommended amount and up to 60% of the money comes from drug companies.
Here, Alfredo Pisacane gives an interesting proposals for limiting the commercial support to continuing medical education including concentrating on small groups, agreeing objectives for educational activities, evaluating providers, health institutions committing resources, making use of new technology, creating a central fund, asking doctors to pay.
BMJ 2008;337:a973 (http://www.bmj.com/cgi/content/full/337/aug14_1/a973)