Rather than paying for research, education, and promotion through drug prices that are much higher than production costs, taxpayers would get better value by paying for those functions through separate competitive tenders, Dr Mansfield said.



One option could be to pay a combination of the traditional payments according to sales volume, but at lower prices, supplemented by bonus payments for achieving performance targets, such as appropriate use.

But pharma consultant Alexander Gray says it just won’t work.

Dr Mansfield most certainly needs to provide evidence that reducing drug promotion promotes health. In what way is the promotion of drugs within their licence in line with evidence of their clinical benefit deleterious to health? Does he seriously suggest that there is an inverse relationship between promotional spend and the health of a nation? Do countries with a high promotional spend (such as the US) have poorer health than those where the promotional spend is low?…



As with many observers of the industry, Dr Mansfield fails to make any distinction between the terms “promotion”, “marketing” and “education” conducted by pharmaceutical companies. Just a few lines below his comments, a further news item in the BMJ reports that pharmaceutical companies “shoulder more than half the costs of formal continuing education programmes in medicine”. There way be a prid pro quo for companies in providing medical education, but the result is extended access to agents that have passed through a licensing process because they have demonstrable benefits for human health. For example, the active promotion of ACE inhibitors has resulted in substantial reductions in morbidity and mortality amongst patients with cardiovascular disease. In what way then has the promotion of ACE inhibitors been deleterious to health? Without the promotion and educational activities of drug companies, we would still be overcoming the inertia of practitioners and payors to use drugs that have clear benefits to patients.

Still, it appears that some sort of reform is still needed, according to this article, also in the BMJ, and this one from the New England Journal of Medicine.

The pharmaceutical industry may be facing the same kind of sea change in business practices and industry oversight that other segments of corporate America faced in the wake of Enron and other corporate scandals. In these cases, high-stakes, widely publicized government investigations exposed practices that passed neither ethical nor legal muster, provoking an intense regulatory response. The pharmaceutical and health care industries have the opportunity to maximize the extent to which they are leaders, rather than targets, of regulatory initiatives by continuing to develop and enforce stronger ethical standards regarding relationships between physicians and pharmaceutical companies. The increasingly long arm of anti-kickback law should remove any doubt that such proactivism is overdue.

Now if we can all just figure out what the right course of action might be…

Thanks to Debra, who pointed me toward these articles.

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