Prescriptions make up a quarter of NHS costs
Published: 20 September, 2012
by ROBERT MACGIBBON
FORTY-three years ago my GP trainer advised me not to meet drug reps one-to-one in my consulting room. It was a waste of time and we would be fed questionable information about new, often much more expensive drugs to use in our everyday practice. I never did meet reps in this way for rest of my career as a GP.
Around about the same time I talked to a young newly recruited drug rep. He recounted how he had taken a GP out to lunch and talked about a new antibiotic on the market. Then I asked if the sales talk had worked and he said he had seen a prescription signed by the same GP in the local pharmacy that same day. The profit from that one prescription had more than paid for the cost of the meal.
Over the years we GPs have been discouraged from prescribing new antibiotics which should be reserved for infections with identified resistant bacteria. But such was the pressure from the pharmaceutical industry on us to prescribe the latest “prescription only” medicines.
If the cost of running an NHS group practice in 1999 (all the wages, salaries, the capital and the running of the premises) was, say, £1million the cost of referrals to secondary care (hospitals for instance) might be £2m. The cost of our prescribing would be another £1m.
It is not surprising that the pharmaceutical industry has been a leading global industry for profit. But that profit is at the cost to us all that drug-induced injuries are now the fourth leading cause of death in hospital settings.
In this very important book, Pharmageddon, you will read that the influence of the industry has now become more subtle, more insidious and much more worrying. Only last week two eminent French specialists concluded that half of all drugs prescribed in France are either useless or actually dangerous.
In his introduction Healy sets out the history of how the pharmaceutical industry has inexorably and profoundly influenced the very practice of medicine over the past 60 years. He shows that the industry has shifted from selling cures to selling diseases.
In the following chapters he eruditely and in detail explains (with 28 pages of references and fully indexed) how the industry has managed to do this whilst taking the medical profession with them, unaware of what has been happening. In the final chapter he reiterates the danger and suggests some palliative actions.
The book shows how the very way your own doctor responds to the problem that you take to her has been changed beyond my recognition of how I was taught to be a doctor and how I taught many students and young doctors over the past 40 years. The independent and personal care that we expect from our doctors has been insidiously replaced by the contracts under which doctors are partly, but significantly paid.
The adherence to prescribed “clinical guidelines”, “clinical pathways”, “evidence-based medicine” and the treating of questionable findings from screening tests are all programmed into the computer in the consulting room directing the doctor how to respond to the patient’s problem. Computerised outcome data then even contribute to how the GP’s practice is paid.
The development of all these concepts has been strongly, often surreptitiously and sometimes downright deceitfully influenced by academic research papers very often funded and written by doctors in the pay of the pharmaceutical industry.
To support this development the industry has moved from finding drugs to cure diseases to finding or inventing diseases for the drugs they produce to be prescribed for.
The disease has become more important than the person who is ill. Medical care has been replaced by adherence to the treatment of computerised physiological measurements.
Charles Medawar, that champion of patients, in his warning to us has called all this “Pharmageddon”.
David Healy, professor of psychiatry at Cardiff and lifelong campaigner to protect us all from “drug-induced injury”, has detailed the facts, the history and background to how medical care and practice has reached Pharmageddon.
It is a terrifying read.
• Robert MacGibbon is a retired Camden GP.
• Pharmageddon. By David Healy. University of California Press, £27.95