Bad Pharma

I am reading this book by Ben Goldacre, and it is a fascinating insight into commercially sponsored academic research. While his comments are insightful, very few people or organisations are actually breaking the law.

The pharmaceutical companies are doing exactly what they should do - making a profit. They are running businesses, and as a business, they have to make money.

The regulatory bodies, are, largely, taking the data they are given and making decisions about whether a particular drug has a benefit. They might not always push as hard as they could, or demand enough information. But they have a job to do, and they do that as simply as they can.

The NHS takes the information on the drugs that are approved, and uses the supplied information to make prescribing decisions. Of course, Goldacre argues that the end-point providers are not getting all of the information they need, so their decisions are not always good, but they are doing the best they can with the information they have.

The problem, Goldacre points out, is that the entire regulatory structure and system is not working for the primary benefit of end consumer - the patient. The problem is that the patient is not really represented in the process. There is nobody definitively asking the questions about what is best for the patients, because it is nobody's job to do so. The doctors who prescribe have some of this responsibility, but they do not have the information (or the time) to identify all of the possibilities, and decide on one appropriate solution.

However, the other side of this is that the government seem to desperately want to reduce the cost of the NHS, who are the major purchaser of medicines in the UK. The medicines bill is a significant part of this cost, and a portion of it is unnecessary.

Following from Goldacres ideas, if the government were to do rigorous assessments of all of the available medicines to identify the ones that provide actual benefit, and only permit those to be prescribed, then the cost overall would be reduced. If this was followed by a refusal to license anything else that does not show a clear benefit over an existing treatment. Of course there are two core problems with this:

1. The pharmaceutical companies - who are significant donors to the political process - would lose out very substantially. Lets be clear, if the medications bill is reduced significantly, then this is money coming from the pharmaceutical companies, of the order of billions (the NHS drugs bill is around £8Bn). Appearances are that this is not the sort of cuts that the government wants to make.

2. Some people would lose the medications that they are convinced are working well for them. Now I know this personally - I take a medication that is not the cheapest or simplest version, but when I moved to a simpler version, which should have been identical, it didn't work. This is a big challenge, because I will fight a long time to keep my meds, as will many others! But in many cases, as Goldacre makes clear, there is no proven benefit of one medication over another. So, while it may prove a difficult transition, it should be possible. I do think in some areas, like mental illness, there is a place for multiple forms of medication, because the response and reaction to them can vary significantly. However, there is probably a case for aa reduction even here.

So that is my challenge to David Cameron - if you are serious about reducing the cost of the NHS, then do something about the drugs bill by stopping some of the abuse of the system that people like Goldacre highlight.