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Drug manufacturers' role in NHS raises fears over ethics
By Michael Day, Health Correspondent
(Filed: 26/09/2004)

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 treatments.

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 else's.

"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 authority.

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 of hospital.

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 diseases."

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 it.

"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 vested interests."

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' prescribing choices.

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 healthcare."

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 concern.

"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 indeed."

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British Medical Association

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