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Department of Health

I do not think that there was any hard evidence that that merger had produced an increase in research, but I do not think that we asked the question, so regrettably I cannot help the hon. Gentleman. The one thing I remember only too well about the Glaxo merger with SmithKline is that I had to sell my shares so that I would not have to declare an interest. Several Members mentioned ““me-too”” drugs, the duplicates or near-duplicates of existing drugs, which are relatively cheap for companies to produce. We were rather down on them because of the number available. Three or four beta blockers will provide all that is needed in terms of variety, as will a small number of non-steroidal anti-inflammatory drugs. We issued a plea for a wider distribution of really effective local drug and therapeutics committees working over acute and primary care trusts to introduce some control to prescribing of that kind. Clinical trials have already been mentioned briefly and several recommendations in the report refer to them. We wanted an independent register and records kept of negative trials and of drugs that were terminated due to side effects. We wanted to ensure that comparator drugs were used and that the particular comparator drug was the right one to choose. We wanted drug treatments to be compared, where possible, with non-drug treatments. It is not clear from the Government’s response whether they have taken all those details into account; they seem rather to hide behind European rules. I feel very strongly about the promotion of new drugs. Our recommendation 5, which was not answered, stated:"““The aggressive promotion of medicines shortly after launch, the sheer volume of information that is received in its many forms by prescribers and the ‘promotional hospitality masquerading as education’, in the absence of effective countervailing forces, all contribute to the inappropriate prescription of medicines.””" I thought that that was a powerful recommendation. I am interested to hear other hon. Members’ comments on the Association of the British Pharmaceutical Industry code of conduct. I am slightly less dismissive of it than others. I agree that there may be an element of window dressing, as mentioned by the hon. Member for Newport, West, but I hope that it is at least a first attempt at self-regulation. In other inquiries, such as the one into obesity, the Health Committee has recognised that self-regulation of the food industry was probably a more practicable measure to aim for than strict regulation from outside. I will study the code of practice carefully. I am not sure whether it covers either ghost writing or fees to experts, which are important matters. Returning to the intensive promotion of new drugs, I would like to refer to another recommendation. To avoid confusion, it was our recommendation 33, though it appears as recommendation 6 in the Government response. Our recommendation stated:"““The intensive marketing which encourages inappropriate prescribing of drugs must be curbed. Present methods of supplying independent information, as described by Lord Warner, are inadequate.””" We went on to recommend that"““the promotional material for a new product””" should be ““pre-vetted by the MHRA””. I believe that that is going to happen. We further recommended that"““consideration be given to limiting those who can prescribe a new drug in the two years following launch. Drug and Therapeutics Committees would be well-placed to implement this.””" That provides another function for such committees. In their response, the Government agreed that there should be proper controls, but they subsequently lost the plot completely, saying:"““There is no indication that the measures currently in place are not effective. The fact that generic prescribing has risen to nearly 78 per cent. (in 2003) clearly indicates that clinicians are writing prescriptions generically and not by individual company product.””" One cannot write a prescription generically for a drug that is new and under patent because it effectively does not yet exist. I was not very impressed with that aspect of the Government response. An example of the rapid uptake of a new drug causing problems is of course Vioxx. It has been referred to by several Members today, but I will go over some of this ground again because it is so important. Vioxx was launched as an answer to all the upper gastrointestinal problems that undoubtedly occur through the use of existing anti-inflammatory drugs for various forms of arthritis. It was introduced in 1999 and withdrawn in September 2004 when work in America showed how dangerous it was from the point of view of causing heart attacks and strokes. To express a slightly different view, we lost what was thought to be a potentially useful drug due to the unpredictable side effects brought to light by very widespread, very rapid prescribing. I have spoken to drugs firms about this and they claim that in fact, it was a good thing that Vioxx was prescribed so widely, because doing so brought the side effects to light much more quickly. I do not quite follow that argument. During the inquiry, we visited University College London hospital to hear about its Use of Medicines Committee. We were incredibly impressed with its drug formulary, which is used not only by the hospital trust but by the nearby primary care trusts. Because members of those trusts are on the committee, it is also well accepted by the GPs in the area. Its prescribing levels of Vioxx—surprise, surprise—were lower than the nationwide average because it had careful guidelines. It took the view that this is a new drug and no one knows entirely what is going to happen, so we should be careful with it, please.