Many central and eastern European drug companies are using backdoor lobbying and payments to leading doctors and patient groups to ensure governments buy their medicines, according to an academic investigation.
A study of the methods used by companies in Poland – the largest pharmaceutical market in central and eastern Europe – to ensure their drugs are prescribed is likely to be applicable to the whole region, say researchers involved in the Cambridge University-led study.
"This may be part of a broader syndrome of the prominence of informal institutions in post-communist policy-making, rather than something which is unique to Poland. For the New Europe, this could be a warning," said Dr Lawrence King, from Cambridge University's department of sociology.
The Polish government's system for deciding which drugs will be paid for by the state is deeply flawed, the researchers found. One lawyer they spoke to described reimbursement as "legal terra incognita", while others described the process of decision-making as akin to "black magic". The expert body that is supposed to recommend drugs to the ministry of health rarely has good data to go on. One official told the team: "In half of research results, we deal with drugs whose effectiveness cannot be established."
Meanwhile, they say, informal deals are taking place. Companies build up relationships with key decision-makers by offering them mutual favours, such as support for sick relatives, or lucrative positions in the industry. One heart drug was accepted for reimbursement even though the scientific evidence supporting it was doubtful. Later, the press discovered that the decision had been taken after the relative of a high-ranking ministerial official had a new flat "arranged" by the drug company.
Where drug companies cannot access ministers directly, the researchers found that they attempt to influence consultants instead. Drug companies offer financial support to leading doctors, who are not well paid by the state, or give them access to trials and medical knowledge that will help them to raise their academic profile.
Drug companies support patient groups – or even set them up. One former government official told the researchers about a case in which a reimbursement application for a kidney cancer drug was submitted. Almost simultaneously, a patients' association lobbying for precisely this kind of treatment appeared on the scene. "It could not have been a coincidence," the interviewee is reported as having said.
The paper, published in the journal Health Economics, Policy and Law, says newspaper journalists are also lobbied by drug companies wanting to "order an article" in their paper. Some international companies are also said to have asked their own governments to lobby the Polish decision-makers.
The academics recommend comprehensive reform of the Polish pharmaceutical system and a toughening of controls over contacts between government and drug companies.