role in NHS raises fears over ethics
By Michael Day, Health
The National Health Service is employing
nurses paid for by drug companies to encourage patients
to take medication under schemes that doctors fear could
result in some people receiving inappropriate
In the most advanced scheme, nurses
funded by Pfizer, the world's biggest pharmaceutical
firm, are advising patients in north London on how to
manage heart disease and diabetes.
The British Medical Association has
called for new ethics standards to be agreed immediately
to protect the independence of doctors and patients.
Dr Charles Simenoff, a member of the
BMA's prescribing committee, and a general practitioner
in Manchester, said: "I think that this is bordering on
the unethical. There are issues about making sure that
GPs prescribe their products rather than someone
"If these care managers see that patients
aren't being treated, or aren't being treated with
Pfizer drugs then they might put the suggestion in
patients' minds that maybe they should be."
NHS officials have conceded that the
deals mark a profound shift in strategy by the drugs
companies, as they focus on the expanding market for
drugs that treat diseases of old age.
In north London, a four-strong team of
"care managers" funded by Pfizer, has recently begun
producing treatment plans for 600 patients in the
Haringey Teaching Primary Care Trust health
The care managers, who are trained
nurses, use Pfizer software to produce treatment plans
for the patients who are suffering ischaemic heart
disease, diabetes or heart failure.
Although they will not be able to see
patients' medical records, they will be told by doctors
what medication is being prescribed so that they can
"reinforce" the care given by GPs.
Sarah Barron, the assistant director for
chronic diseases in Haringey, said that the Pfizer staff
regularly contacted patients by telephone to "coach,
support and advise" them.
One of their main functions was to ensure
that patients continued to take their medication.
Failure to comply with medication is a problem in caring
for the burgeoning number of people with long-term
diseases such as heart failure, diabetes, high blood
pressure and high cholesterol.
In cases where patients have not been
prescribed necessary drugs or where patients are on the
wrong treatment, care managers can refer patients back
to their GP. Some of the money for the scheme is coming
from the Department of Health, but Pfizer is
contributing half the cost - £125,000. The scheme is
intended to save the NHS money by keeping patients out
Pfizer said that it was unable to provide
figures for its drug sales before and after the project
in Haringey began.
Miss Barron added, however: "We're under
no illusion why Pfizer is doing this. They're keen to be
part of something that is going to be very big in the
NHS - the treatment and management of chronic
Already 17.5 million Britons are being
treated for chronic conditions and the figure will grow
as the population ages.
Dr Richard Nicholson, the editor of the
Bulletin of Medical Ethics, said: "We need an immediate
public debate on this. The scheme in Haringey was
happening on my own doorstep and I wasn't even aware of
"The Department of Health is happy to
work with drugs companies regardless of whether this is
in the long-term interest of patients. But we need to
know whether the public really wants this and whether we
should be opening up the NHS to private firms with
The Sunday Telegraph has learnt that
several other similar arrangements, funded by either
GlaxoSmithKline or Pfizer are planned for health
authorities or hospital trusts across London.
Dr Peter Fellows, the chairman of the
BMA's prescribing committee, said that it was
"inevitable" that the arrangement would influence GPs'
Pfizer has emphasised that the programme
does not demand the prescription of its own heart drugs
and that NHS doctors will have the final say on which
drugs the patients receive.
Dr Olivier Brandicourt, the managing
director of Pfizer UK, said: "Providing this kind of
personalised education and support enables patients to
become more active partners in their own
A spokesman for GlaxoSmithKline said:
"We're working with a number of strategic health
authorities to help primary care trusts review patients.
We can provide some of the resources to do that. We're
helping the NHS achieve their objectives.
"While patients are not being reviewed,
they might be going without treatment." He added,
however: "Ultimately it's still the GP who decides what
drugs the patients get."
Alan Maynard, a professor of health
economics at the University of York, expressed
"This gives the drugs companies a way in,
the chance of more direct contact with patients.
Ultimately they think that it will prove commercially
advantageous or they wouldn't be doing it."
Charles Medawar, the director of Social
Audit, an organisation that campaigns for greater
transparency in drug regulation, said: "If there was
ever a subject that deserves thorough examination, then
this it is. The implications are very, very worrying
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