It is about time the pharmaceutical industry stopped playing the system | PJ Online

Wed, 20/07/2011 - 16:33

By Graham Phillips, Perry Melnick and Lee Doherty

According to the front page of The Times on 6 June 2011, “Drugs companies must behave in step with society and put people before profits”. This assertion came neither from a social commentator nor a Government minister, but from a letter (ibid, p20) written by no less than Andrew Witty, chief executive officer of GlaxoSmithKline.

If Mr Witty was talking on behalf of the industry as a whole, then perhaps it is time the industry put its money where its mouth is.

For example, two commonly prescribed dressings recently had apparently inexplicable alterations made to their sizes: one a change from 10cm x 10cm to 10cm x 12cm and one from 7.5cm x 7.5cm to 7cm x 7.5cm. The manufacturers claimed that the change was due to “popular demand” — the most muted and voiceless of all justifications. Interestingly, both changes were made shortly after their parallel imported equivalents made their appearance on the UK market.

Moreover, we can think of many an occasion where a tablet formulation of a commonly prescribed capsule that was shortly to go off patent made its appearance, and others where preparations with an inherently long action and a “once daily” dosage were withdrawn and replaced by a modified release formulation with a dose frequency of, yes, “once daily”, just as the patent was expiring.

These are all examples of legitimate market manipulation undertaken by members of the Association of the British Pharmaceutical Industry either to prolong a drug’s patent life or to take advantage of Drug Tariff rules to protect their interests.

So you may well imagine our reaction to the recent letter to The Pharmaceutical Journal (21 May 2011, p586) from the then ABPI director-general Richard Barker. He hand-wringingly described the heroic efforts to which ABPI members have gone to supply the UK market with much-needed medicines in the face of almost insurmountable odds and constant ambushes from their enemies, but failed to explain why, when ABPI members claim already to supply more stock than is prescribed for UK patients, we pharmacists have to jump through absurd hoops to acquire supplies. He wrote that he believes that there is a definite need to cut drastically the 1,800 wholesaler dealer’s licences issued in the UK because “the system as it currently stands cannot be effectively policed”. Are we to understand then that he had irrefutable evidence of the inadequacies of the Medicines and Healthcare products Regulatory Agency (the regulator) in administering and, where appropriate, “policing” the system? Or is this more likely related to the behaviour Mr Witty wants the industry to disavow: the voice of vested interests and commercialism out of step with societal expectations?

Mr Barker’s final paragraph — “The answer, quite simply, is for the Government to tighten existing legislation and ensure that everyone downstream from the manufacturers operates within EU regulations to ensure NHS patients are the priority” — is utterly disingenuous. For a start, the EU will not regard an NHS patient as any more of a priority than anyone else and, moreover, successive UK governments have always been regarded as the most likely of EU member states to implement and enforce EU regulations to the letter.

We operate under EU law and, among other things, Mr Barker will have been well aware that the Treaty of Rome provides for the unencumbered and free passage of goods across member state boundaries.

Now, the Government is hardly likely to revalue the pound to benefit the pharmaceutical industry and, frustratingly, the Government is keeping its options open about whether to impose “a public service obligation” on drug manufacturers to guarantee a supply of medicines within 24 hours of a request. So what else can be done?

Perhaps Mr Barker might have done better to have taken a leaf from Mr Witty’s book and reflected on the reputational damage being done to ABPI members. He might also have reminded members who still insist on seeing a faxed prescription before arranging a supply that that runs contrary to their own organisations’ recommendations and that their insistence on this practice wastes our valuable time and guarantees that there will be no stock available in the dispensary to meet another prescription. Further, the existence of a monthly quota of which a pharmacy is unaware (yes — this is fact) is not only unhelpful, but means that further supplies cannot be organised in time to meet excess demand in any given month and that the rigid limits ensure that such situations are handled with utter insensitivity towards patients’ needs.  

We had occasion recently to apologise to a patient who returned to collect his prostate cancer injection that we could not make his supply that afternoon as originally promised because it was the 31st of the month and one more of these injections would have been in excess of our “unknown” quota, but he would be able receive it the following day, it being the first day of a new month and a new quota.

Recently we had a further trauma regarding the supply of a crucial antipsychotic medicine. There had been a delay in obtaining the prescription from the patient’s GP and, consequently, the prescription was only printed shortly before the patient ran out of medicines.

We received the prescription at around 5.20pm and could not obtain the product from our usual wholesaler or the manufacturer. As a consequence, our patient had no evening dose. Suffice to say, the patient then self-harmed and the patient’s representative is utterly disgusted with the inadequacies of the supply arrangements for this important medicine. He has been understanding of our attempts to resolve this situation by insisting that the “direct supply” service authorised our wholesaler to release the stock for the next day’s delivery. However, not unreasonably, he does not totally believe our explanation. Doubtless he believes that our failure to supply this medicine more promptly was really due to our own inadequacies or failings. We tremendously value our relationships with patients. We think that, through no fault of our own, we are letting patients down. This is yet another contributor to workplace stress.

The truth is that pharmaceutical companies do have the option of equalising their prices across Europe, but they fear that will affect their bottom line. The failure of the current system, then, is not the failure of Government, nor the inadequacy of the DoH, and most certainly it is not our fault. Fault clearly lies with the collective decision by ABPI members to continue to protect their markets.  

via pjonline.com

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