Madam, – As a GP, I frequently see patients discharged from hospital on more than 10 different medications.
Overprescribing is certainly contributing to the State drugs bill, but there is another major contributor which is rarely highlighted or discussed.
I am referring to the subtle way drugs are added to the “prescribing pool” and become commonly used, even though these drugs may offer no real advantage over cheaper existing drugs. This is an area which did not receive much attention in the recent Barry report commissioned by Government to look at ways of reducing drug costs.
In British Columbia, a place with a healthcare system which our Minister admires, there is a state body which is charged with seeing if new drugs offer real advantages, or are just expensive "me too" versions of older, cheaper drugs. Their work was reported in a paper published by the British Medical Journalin 2005 and they concluded that 80 per cent of the increase in drug expenditure between 1996 and 2003 in British Columbia was explained by the use of new patented drugs that did not offer substantial improvement on less expensive alternatives available before 1990.
So just how do these drugs enter the prescribing pool? This is a question which bears scrutiny. In Ireland, almost all medical education for prescribers is funded by the pharmaceutical industry. Typically for GPs it takes the form of a talk by a paid “key opinion leader”, followed by a chance for the industry representative to promote the new drug, followed by a meal in a nice restaurant.
Many national colleges of medical specialities rely on pharmaceutical sector sponsorship to run their activities.
Patient support groups are also sponsored by the industry. Usually they will raise awareness of a condition, thereby indirectly increasing sales of their product.
Currently The Irish Timesis hosting a series of public debates about our health service, chaired by Fintan O'Toole and sponsored by a pharmaceutical company. As these debates are taking place, the British Medical Journalreported that this same pharmaceutical company agreed to pay a record €2.3 billion to settle charges of fraud and civil and criminal liability over its promotion of off-label use of four drugs. As part of its settlement the company agreed – for the fourth time – not to do it again.
The fine would have paid the total expenditure of the Community Drug Schemes in Ireland in 2007, but as the New York Timespointed out, $2.3 billion amounted to less than three weeks of the company sales.
While not wanting to knock the importance of the pharmaceutical industry to the Irish economy, or the many fine and ethical people who work in the industry, we have undoubtedly allowed a system to evolve which needs radical reform.
The relationship between the pharmaceutical industry and the medical profession needs to be overhauled urgently if we wish to curb drug costs and if the profession wishes to retain any professional integrity. – Yours, etc,