Should Details of Payments and Benefits to the Healthcare Sector Be Disclosed? – It’s Time to Have Your Say.

Pharmaceutical giants are pouring tens of millions of pounds into NHS services – including paying the salaries of medical staff and funding the redesign of patient treatment – as they seek to boost drug sales in the UK. Fortunately, this week, the Department of Health and Social Care (DHSC) has launched an open consultation on disclosing industry payments to the healthcare sector. We will now have an opportunity to have a say on whether manufacturers and commercial suppliers of medicines and devices should report details of the payments and other benefits they provide to healthcare professionals and organisations.

It would have been so much easier for us as patients if we had been able to trust that the medical profession was prescribing a drug because they believed it would be beneficial to us, and not because they were acting as big pharma salesmen.

Unfortunately, those within the medical profession do not wear their sponsors on their coats as racing drivers do, however, it has been common knowledge that big pharmaceutical companies have financial ties to them, but real transparency is lacking.

Drug firms are funding groups that lobby for greater investment in their disease areas, and in some cases are paying generous consultancy fees to influential ­healthcare professionals, including GPs who have worked as clinical leads for NHS England and have received as much as £480,000 each from industry since 2019. (source)

Drug companies are systematically funding grassroots patient groups that lobby the NHS medicines watchdog to approve the rollout of their drugs, says the Observer which carried out an investigation that found “of 173 drug appraisals conducted by the National Institute for Health and Care Excellence (Nice) since April 2021, 138 involved patient groups that had a financial link to the maker of the drug being assessed, or have since received funding.” (source)

Often, the financial interests were not clearly disclosed in Nice transparency documents, but the Observer did reveal that many of the groups that received the payments went on to make “impassioned pleas” to England’s medicines watchdog calling for treatments to be approved for diseases and illnesses including cancer, heart disease, migraine and diabetes. Others made submissions appealing Nice decisions when medicines were refused for being too expensive. (source)

Lack of Disclosure

One study published in the British Medical Journal (BMJ) in 2019 by Mandeville et al found that during NICE appraisal meetings, fewer than 25% of all relevant financial ties between patient organisations and pharmaceutical companies were disclosed. As discussed by Mandeville and colleagues, this lack of transparency increases the risk of conflicts of interest not being properly detected and managed.

Undermining Credibility

Another study conducted Gentilini and Parvanova in 2020 assessed the relationship between UK-based patient organisation funding and companies’ commercial interests in rare and non-rare diseases. They found that companies predominantly funded patient organisations operating in therapeutic areas relevant to companies’ portfolios or drug development pipelines.

The researchers found that “the almost-perfect concordance between industry interests and patient organisation activities likely reflect the commercial attractiveness of conditions targeted by pharmaceutical companies, adding that “such close alignment between the interests of companies and patient organisations might undermine the credibility of patient organisations as perceived by the general public and might raise questions about patient organisations’ inputs in regulatory and health technology appraisals.

Important Future Research

The researchers made a very important point, saying that while their analysis “did not evaluate the effect of COVID-19 on the financial dynamics between pharmaceutical companies and patient organisations, we expect that the pandemic had
a substantial effect on the type, value, and distribution of payments. Future research should examine the impact of
COVID-19 on industry funding of patient organisations.” This is an area that certainly would be of interest to the general public.

The Public Has a Right to Know

Carl Heneghan and Tom Jefferson have reported that “The Independent Medicines and Medical Devices Safety Review, chaired by Julia Cumberlege, recommended that “the register of the General Medical Council (GMC) should be expanded to include a list of financial and non-pecuniary interests for all doctors. The public has a right to know.” 

The House of Commons Health Select Committee recommended a GMC declaration register in 2005. Yet, unlike other countries that have thought this through and sorted the issue, the UK still lacks legislation. For example, The US Physician Payments Sunshine Act requires manufacturers to collect, track, and report all financial relationships with clinicians and teaching hospitals. 

The Sunshine Act

Those with conflicts think the voluntary system works fine. However, the IMMDS review showed that the system is failing.    

The Association of British Pharmaceutical Industries created a voluntary register, but because it was discretionary, vast numbers of payments to doctors were not disclosed. 

NHS Trusts in England must also collate employees’ financial interests annually and publish them on their websites. In 2022, we asked how declarations of interest work – we found the system fails miserably.

In a random sample of NHS Trusts, three-quarters of registers did not routinely include all declaration of interest categories recommended by NHS England. In Scotland, only 14% of Boards published staff registers of interest. Organisations often had multiple registers lacking search facilities that were often uninterpretable.

In 2019, Carl told Sky News: “It’s really important that the public trust how we deliver medicines and no one really has an understanding of who is being paid what.

“There is evidence that conflict of interest distorts results and clinical practice because there is so much money in healthcare – there’s a real incentive for industry to get their product out there.”

One in Four Investigators Have Financial Ties

Financial and non-financial conflicts of interest are widespread among academic institutions and researchers. Industry sponsorship is often associated with restrictions on publication, lack of access to results and a shift in research emphasis. One in four investigators have industry ties, and roughly two-thirds of academic institutions hold equity in start-up companies that sponsor research at the same institutions.

 If anything, the situation is getting worse. 

The Royal Colleges have received more than £9m from drug and medical devices companies since 2015. Last month, the Observer reported a sharp rise in spending by drug firms in the UK health sector: “In 2022, the total value of such payments was more than £200m – up 26% compared with the previous year, and almost double the amount spent by industry in 2015.” From 2012 to 2016, the industry donated over £57m to UK patient organisations – the yearly sum more than doubled.

The new consultation highlights that the Health and Care Act 2022 allows the Secretary of State to impose a requirement for businesses to make public details of the payments to persons providing healthcare in the UK.

The consultation is open for six weeks and will close on 16 October 2023. The easiest way to respond is by completing the online survey. Views are being sought to define further who should be required to publish information – this is your opportunity to have a say. (source).