With moves towards greater transparency gaining momentum, pharma must do all it can to ensure patient safety
The introduction of the EFPIA code obliging all members to publish information on their interactions with healthcare professionals and organisations, monetary and otherwise, is a welcome development in what has become a fractious debate on the prescribing of medicines.
From a medico-legal perspective, this move towards greater transparency is a positive step in the campaign for greater patient safety, particularly in the wake of evidence suggesting that the elderly are especially adversely affected (sometimes fatally) by the side effects of polypharmacy.
Drug safety and patient safety are two sides of the same coin. Since the Francis public inquiry into poor care and high mortality rates at Mid Staffordshire NHS Foundation Trust, the UK government has made a virtue of putting patient safety centre stage. Patient safety hinges on reducing avoidable harm, and depends, among other things, on correct prescribing. As more people present with co-morbidities – particularly the elderly – prescribing the right balance of medications can be a major challenge for hard-pressed healthcare professionals.
Consequently, earlier this year, when a group of respected doctors called for the parliamentary Public Accounts Committee to hold an inquiry into the safety and efficacy of medicines, those of us who deal with the aftermath of negligent prescribing were bound to sit up and take notice.
It appeared to be NICE's advice for wider prescribing of statins that provoked them to speak out publically on what they see as the sometimes dysfunctional relationship between drug companies and doctors, which can lead to inappropriate prescribing.
More medicine is better?
The problem of incorrect or inappropriate prescribing is highlighted by our elderly population, many of whom are at risk from the side effects of taking multiple medicines. It is also highlighted in research by Professor Peter Gotzsche of Copenhagen University, who has claimed that mis-prescribing is the third-leading cause of death after cancer and heart problems.
Although the pharmaceutical industry cannot be blamed directly for healthcare professionals failing to check the full list of medicines an individual might be taking and their potential contraindications, there is no doubt that the industry invests a great deal of money promoting its products.
Pharma may resent the accusation that it puts profits before patients, but it is one it must address. Two of the calls by the group of doctors in February are, from a lawyer's point of view, eminently sensible; for the results of all drug trials to be published and for panels judging the efficacy of medicines to be entirely independent (following accusations that at least half the NICE panel that proposed greater use of statins had received funding from drug manufacturers).
It is crucial that doctors are as fully informed as possible about the drugs they are prescribing and that they are equally impartial. Without that openness and objectivity, there is always a danger that patient safety will be compromised.
Responsible prescribing and a smaller bill
The new database disclosing interactions between drug companies and healthcare professionals is a welcome addition to the culture of openness and honesty being encouraged throughout the healthcare sector. However, even better would be the detailed recording of drug-related adverse events in the UK, as is the case in the US, prompting a more open debate about the efficacy of a range of drugs.
An additional and welcome side effect of more careful management of patients' drug intake might be a smaller drugs bill for the NHS. Nonetheless, the mandatory adoption of the EFPIA disclosure requirements is one small step in the right direction, as is the continuation of the discussion about the long-term effects of polypharmacy on a population which is already rattling.