The time is now

HERE’S A QUOTE from the Health Select Committee report on the topic of new product launches:

“Limits should be set on the quantity of promotional material that prescribers receive, particularly within the first six months of a product’s launch.”

This is big. Even bigger than I’d expected. It seems to go against everything the pharma industry believes in to launch a new product and not talk about it. So why have they said this? The report talks about the “deluge of promotional messages” when a new product is released. And that is true. I have almost come to expect it. But while I am a trained pharmacist and have the skills necessary to evaluate product literature and promotional materials and make further assessments of safety, efficacy and cost-effectiveness, many nurses and inexperienced doctors (as the report points out) may not. In my opinion, many well-qualified and experienced doctors are unable to make these assessments. Having said that, how does one apply such differentials in reality? I can’t see reps thinking: “This health care professional does not look able to evaluate my product – I won’t talk to him.” On the contrary, it’s a basic point of selling that the customer’s inability to assess products in depth is often a gateway to the sales professional flashing some ‘sexy graphs’ and ‘colourful pictures’ that all lead up to the question “My drug is the best, so why not prescribe it for your patients?” The Health Select Committee goes on to say that some healthcare professionals are “illequipped” to cope with promotional materials, and that “stricter controls are needed regarding the promotion of new products”. It doesn’t detail what these controls should be, but they have certainly cut to the chase on this topic. Facing the facts There is a counter-argument, however, that giving information to prescribers when a new product is launched is crucial if that product is to be used safely and with confidence. As healthcare professionals, we are treating a vast range of conditions – how can we do that effectively if we don’t know about all the treatments that are available? Also, if we are unaware of the latest antihypertensive but the patient has downloaded reams of information on it from the Internet, where does that leave us? (This is already happening – and it’s not easy to deal with.) The ABPI also point out that the UK has the poorest uptake of new medicines within the first five years of launch of any European country. So if these measures are aimed at curbing the use of new medicines, that will leave the UK behind the times when it comes making important new drugs available to the population. As a commentator, I suspect the issue is really about “promotional material” as opposed to ‘information”. If you read the committee’s report in depth, and also some of the detailed hearings and presentations from the Consumers’ Association and other organisations, you will see some very polarised views. Some patient groups are crying out for new treatments to become available; others feel that the pharma companies are exploiting them. It leaves one with very mixed emotions. As a consumer of the system, I struggle with the idea that someone else could withhold treatment that might help my mother. Even if the treatment is only effective in one in 1000 patients, it might be my mother that it can help – so I would want to try it. The problem is, so does everyone else. We need to bear in mind that in relation to pharmaceuticals, issues of demand are just as important as issues of supply. Working together I will conclude on another tricky note. The committee recommends that “consideration should be given to limiting who can prescribe a drug in the first two years following its launch”. It discusses the involvement of drugs and therapeutics committees, MHRA considerations and NICE guidance reports in doing this. The report goes on to detail some aspect of the specialist pharmacist’s role in these committees: to provide advice and act as a gatekeeper on who can prescribe what, particularly with reference to new drugs. So is the report pitting the pharmacist against the pharma company? I think the best congruency of opinion was described by Vincent Lawton, the ABPI’s president, who said: “Future success can only be achieved by all those involved in healthcare by sharing knowledge and improving communication and partnership for the benefit of patients.” I would certainly agree with that. May tricks These are interesting times. The Matrix is certainly watching this issue closely – as are, I expect, all of the Pf readers out there. The Health Select Committee Report on the Influence of the Pharmaceutical Industry has been delivered to our re-elected government, and a new committee has now been set up. This committee will respond in about a month: it will detail which of the report’s recommendations are accepted and which ones are rejected, and provide explanatory notes. I will then reload The Matrix with some insights into what we can expect regarding this and many related issues . . . Keep your eyes open.

OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘alipha@aol.com’