I have just returned from the Financial Times’ offices, where I was the guest for their regular science podcast hosted by Clive Cookson and Andrew Jack (it will appear here later today). The theme of the discussion was ‘Selling Sickness.’ Andrew was reporting on a recent conference of the same name that took place last month in Holland. The programme and presentations from the conference can be found here and they made interesting reading as I was prepping last night.
For those who don’t know, ‘Selling Sickness’ is a term used to describe the way in which the pharmaceutical industry and other companies are said to collude with medicine and science to create markets for new and existing products. The claim is that they do this either by exaggerating the existence of a condition, fashioning a disease out of what one might call the ‘unbearable ordinariness of being,’ or playing on the anxieties of both the worried well and unwell. Sometimes all three of course, as I am sure many of us have witnessed.
It is a contentious issue and the discussion this morning was interesting. That companies should be able to hop, skip and jump through the established routes of defining disease in order to market and sell products should be a concern to us all.
From a patient and medical research charity perspective the worry is more specific. It is that such antics lead the genuinely-ill down the wrong road with regard to treatment, while encouraging the genuinely-well to believe the worst and follow a path that means taking unnecessary risks with their health. Only through a combination of greater openness, better regulation and also patient champions working with and within companies can we perhaps avoid the worst vestiges of this.
But it also says something about deep trends and changes in our culture and society. One in which the expectation is set that we must all carry some vestige of ill-health or impending sickness if we are to be ’complete,’ to be able to exercise choice in its fullest sense in a world increasingly run on fear and neurosis.
The irony of course is that, as individuals, we are not good at taking medicine which is right for us. Also, that people are generally lacking in the support needed to alter their treatment regime if and when their condition changes. The challenge is not so much medicines wastage but how to ensure more effective use of existing medicines. That certainly seems to be the evidence published toay by the York Health Economics Consortium and The School of Pharmacy, UCL.
This study shows that waste from primary care prescriptions amounts to about £300 million a year. As the authors point out, in the context of an £8 billion drugs bill in the UK, that’s not bad. Indeed, the report is at pains to say that the NHS is quite robust at tackling waste i.e the stuff that is thrown away. The real issue, it says, is ensuring more effective use of medicine:
‘The new research finds that up to £500 million of extra value could be generated in just five therapeutic areas (asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia) if medicines were used in an optimal manner,’ it says.
Pharma Times is reporting today that Earl Howe (who is speaking at our AGM tomorrow) last week backed the idea of a new medicines service attached to pharmacies to help improve medicines adherence when he spoke at the Pharmaceutical Services Negotiating Committee annual dinner (I miss all the best gigs in town).
Moving swiftly on, the research by the York and London teams could not be more timely. For the last six months I have been involved in a fascinating piece of work stemming from the Royal College of Physicians report last year: ‘Innovating for health: Patients, physicians, the pharmaceutical industry and the NHS.’ Following its report, the College established a ‘Medicines Forum’ which was charged with looking at how the report’s recommendations could be taken forward. This was to be done with the help of some sub-groups focusing on specific streams of work.
I am on what is called the patient sub-group – chaired by Harry Cayton and composed of patient representatives, pharmacists, GPs, regulators and others including Professor David Taylor from the School of Pharmacy at UCL. We have chosen to focus on two issues: medicines concordance and; public involvement in research. We are nearing the end of a series of enrgossing evidence sessions with a wide variety of people and organisations – from Boots the Chemist to the Royal College of Pharmacists, from the Science Media Centre to some of my members such as the Motor Neurone Disease (MND) Association – and will report to the College shortly ahead of a conference it is doing in February.
I feel that we are arriving at a good diagnosis of why people don’t take their medicines (it is as much to do with the quality of interaction with a health professional as with the quality of information). We are now turning our minds to some solutions and recommendations. I am sure that the need for more investigation and research into this issue will be one of them, and I hope that my members will take up the challenge as I know some already have.
But it has also highlighted for me that, in the endless discussions about translational gaps in getting science from the bench to the bedside, we have spent far too little energy in the UK exploring how to ensure that it gets from the bedside to the, well, patient’s inside? A simple process one would have thought. But many influences can determine whether it happens fully, partially or not at all; I have already mentioned just two. In the drive to create and develop medicines that meet real need, we must not forget the need to pay greater attention to this final, translational gap.
That’s a long way from selling sickness I know. But much more in the public interest, wouldn’t you say?