Drug firms bankroll attacks on NHS
Special investigation: Charities' protests against Nice funded by pharmaceutical companies
By Jeremy Laurance, Health Editor, Wednesday, 1 October 2008
The rising tide of protest over the refusal by the NHS to provide expensive drugs for cancer and other conditions is being funded by the pharmaceutical industry, an investigation by The Independent has revealed.
Patient groups that have been among the most vocal in spearheading attacks on the National Institute for Clinical Excellence (Nice) over decisions to restrict access to drugs on the NHS depend for up to half of their income on drug companies, but details are often undisclosed.
The growing clamour over decisions by Nice to ban access to certain drugs has outraged patients and the public, and undermined confidence in the NHS.
Protests have been launched by charities including the National Kidney Federation, the Arthritis and Musculoskeletal Alliance, the National Rheumatoid Arthritis Society, Beating Bowel Cancer, the Royal National Institute for the Blind and the Alzheimer's Society. All of these charities received sums of up to six figures from drug companies in 2007.
The extent of the drug companies' support for the smaller charities has led to criticisms that supposedly grassroots patient organisations are puppets of the pharmaceutical industry, being used to bludgeon Nice into making the drugs available on the health service. A positive decision by Nice on a drug not only guarantees sales to the NHS but can influence global markets worth billions of pounds.
Yet none of the charities named has criticised the high prices charged by the pharmaceutical companies for their products in their recent campaigns.
The National Kidney Federation (NKF) accused Nice of taking a "barbaric, damaging and unacceptable" decision when it turned down four kidney cancer drugs for NHS use this year and pledged to campaign against the decision. It did not criticise the cost of the drugs, at more than £3,000 for a 30-tablet pack. Half the NKF's £300,000 budget comes from the pharmaceutical and renal industries.
The Arthritis and Musculoskeletal Alliance (Arma) organised a protest letter from 10 professors of rheumatology, published in The Sunday Times last month, over a recent Nice decision to restrict access to arthritis drugs. The letter made no mention of the cost of the drugs but Ros Meek, chief executive, admitted that "half, or more" of the charity's £147,000 income came from the drug industry.
The National Rheumatoid Arthritis Society described the same Nice decision as "another nail in the coffin" for arthritis treatment and launched an appeal against it this week, with Arma and three drug companies. The society received 49 per cent of its £300,000 budget from the pharmaceutical industry in 2005-06, reducing to 26 per cent of its £472,000 budget in 2006-07.
Beating Bowel Cancer, which condemned a Nice decision to turn down the bowel cancer drugs Avastin and Erbitux as "a scandal", and assisted a BBC Panorama programme on the postcode lottery in drugs for cancer, received 10 per cent of its £1m income from pharmaceutical companies last year. It also made no mention of the cost of the treatments. Two of the biggest campaigns against Nice decisions in recent years were organised by the Royal National Institute for the Blind (RNIB) and the Alzheimer's Society which, between them, represent millions of patients. Six figure sums were paid to both charities by drug companies last year but because they are large organisations, the donations accounted for less than 1 per cent of their total income.
The Association of the British Pharmaceutical Industry has tightened its code on drug company funding of patient groups, which requires companies to agree grants in writing and to be transparent. Both the RNIB and the Alzheimer's Society declare their drug company funding on their websites, in the spirit of the code, but many smaller charities do not. Tim Kendall, director of research at the Royal College of Psychiatrists said the pharmaceutical industry reached into "every corner of the health service" in order to gain influence.
"Drug companies will try to do anything to align their interests with those of patients. They do things at every level of the health service and we know they do it with patient groups. It is a multi-pronged approach to persuade patients that their drug is the one."
Cost effective? The medication selection process
1. The drug is licensed for use as safe and effective by the European Medicines Agency.
2. The Department of Health refers the drug to Nice for assessment.
3. Nice convenes a committee of 20, including doctors, nurses, specialists, patients, drug company representatives and health economists.
4. The committee compares the new drug with existing drugs on cost and effectiveness.
5. The committee decides if the drug is cost effective using the Quality Adjusted Life Year (Qaly), a measure of health gain for quality and length of life.
6. Drugs are mostly approved up to £30,000 per Qaly.