Definición de programa

common sense, who recognise what they are doing, understand what they are doing, understand what the relationship is, no one’s bribing anyone to do anything, um, they almost see it I suppose as a business, I think they understand what the industry is about, what the trials are about, and it’s only those on the outside as usual who don’t participate and therefore don’t know what is going on who are the ones that stand on the outside and criticise. And you know, you’re back to academic studies, you know, they, they try to criticise, but if you actually looked at what they did themselves you could drive a coach and horses through it probably, it’s quite frightening, but because he wears a white coat and he’s academic and he doesn’t work for the pharmaceutical industry he must be O.K.”

(P3)

Views of NHS professional on

pharma

This section reports on the views of the

researchers on the pharmaceutical industry, which emerged in the course of the interviews with the health professionals discussed in Chapters 8 and 9.

Discomfort

NHS researchers were almost all uncomfortable working with pharma:

“Commercial … it’s like a dirty word really doing commercial research … And certainly I think the NHS hasn’t really come to terms with where does this fit in – this commercial research?”

(GP6) “I don’t like working with drug companies, I don’t like the way they operate and my limited involvement with being, tempted to be enticed to do various things by a company has just reinforced that view … .”

(HR6) The pharmaceutical industry: its views on incentives and how it was viewed by NHS professionals

“I mean I did tinker, when I was an SpR [specialist registrar], there were lots of drugs reps and they used to take you out to dinner and pay you for giving talks and things like that, I did tinker with it and try it out, I just started feeling uncomfortable about whether I was prescribing a certain drug because this drug rep had taken me out or, if I questioned myself. That’s why I stopped, and I don’t do it any more.”

HD9 “… as far as I’m concerned there’s a clear cut

between research that is sponsored by the research bodies, be it Wellcome, MRC, whoever and the HTA, and commercial. If it’s commercial they are in it to make money so I want to make money as well.”

(HD11)

The reasons given were varied, but many had to do with seeing commercial trials as biased and pharmaceutical companies as manipulative.

Commercially funded trials were

perceived to be biased

“I don’t think I would ever say never, never say no, but I would feel very uncomfortable about being part of a study that was drug funded … . Because we cannot ensure that biases are not being introduced … all research should be epidemiologically sound because patients participate in these studies … if you do badly designed studies, I just think that is outrageous … that case of that academic in Sheffield who wasn’t allowed access to the data, … I just don’t want to be manipulated …”

(HD9) “I do tend to read who funded it. I think … . there’s more openness and clarity about it now. Certainly in the BMJ… it’s all very clear who has been paid what. It’s not that I don’t believe anything that a

multinational drug company produces it’s just that you’ve got to realise where they are coming from haven’t you? I mean obviously they want their product to succeed so there’s always going to be some conflict on one side I guess.”

(GP4) “… it was easier than being funded by a drug

company where there’s a concern that you might be biased … you certainly look when you are reading a paper to see who funded it.”

(HR3)

Pharmaceutical companies were seen

as manipulative

“I think the drug companies … clearly have a lot of experience of how to get clinicians to do what they want.”

(HR6)

“You only need to read a few articles to realise that drug companies use … highly sophisticated techniques in working with patients and health professionals.”

(HD9) “… there’s been a general move away from being manipulated by pharma companies … in general practice myself and all my colleagues near me don’t see anywhere near the amount of reps we used to see because we do perceive that kind of threat and the way that pharmaceutical companies do manipulate both the market and both drug prices and the way that changes what we prescribe.”

(GP13)

The types of questions asked by pharmaceutical companies were seen as inherently biased:

“I’d have a slight innate bias against pure pharmacological research from a pharmaceutical company that was out just to provide another possible ‘me too’ kind of preparation.”

(GP4) “If you over-incentivise investigators, you will drive them more towards industrial led trials and that may reduce the quality of trials in terms of gaining important new insights … often pharmaceutical trials are designed to try to position drugs, and they are not going to generate important new insights. …

investigators, if they’re paid a thousand or two thousand pounds per patient going into a trial, they would be very keen to do that in order to develop their research funds and so on. And that’s fine and that may be an acceptable reward for the work they’re putting in … Fortunately in this country the public sector research is very healthy and there’s plenty of money for research so people are not driven necessarily in this country to rely on [commercially funded] trials.”

(HD6) “There’s two camps at the [hospital] … the people that do a lot of biological research, and pharmacological research, they have quite close links with the drug companies. … (in the) epidemiology and social psychiatry department … drug companies tend not to be interested in funding us because we tend to look more at risk factors.”

(HD9) “I would be very happy to (be) … doing commercially funded trials … when it’s in an area that I’m interested in … the key thing is that actually if I’m investigating it I want to have control of the data and the company doesn’t have control of what analysis I do … Most of my stuff is about the balance between self-help and managed care, by-and-large trying to encourage people to look after themselves and drug companies really aren’t interested in that sort of research at all.”

Pharmaceutical companies were seen