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Department of Health

I agree absolutely with the hon. Gentleman, and I shall deal with another point relating to COX-2 inhibitors in a moment. On the explosion of new drugs, several of our report’s recommendations pointed out that prescribers must share part of the blame; we cannot put it all on to the pharmaceutical companies. In this respect, local drug formularies are vital. Prescribing should possibly be limited to certain groups of doctors, and they certainly should have better education on these matters. Both the British National Formulary and the Drug and Therapeutics Bulletin are absolutely essential in that education process. I am rather worried by a communication that I received just yesterday from the Drug and Therapeutics Bulletin, in which it pointed out that it is in discussions concerning its contract with the Department of Health to supply the bulletin free to 117,000 health professionals. At the moment, the Department of Health takes out a bulk subscription for doctors, nurses and other people who prescribe drugs. This little publication consists of just four pages. It can be folded, fitted into the pocket and read in the lift or on the tube, but it is incredibly important and valuable. A survey has shown that 89 per cent. of its readers find it either ““very”” or ““quite”” influential. It is in the top three of the most-read of such publications. The vast majority of respondents—86 per cent.—cited its independence as a very important factor. So I ask the Minister to examine the question of the withdrawal of that bulk subscription very carefully. The bulletin is extremely valuable to the 117,000 people who receive it. I emphasise that the restricted prescription of new drugs is automatic when advances are made with drugs. Examples of that would include the new treatments for cancer or rheumatoid arthritis, for instance, as such drugs would be prescribed only by consultants. The recommendation mainly applies to the more popular drugs, such as those in the Vioxx group and, as usual, a balance must be struck between the pharmaceutical industry’s need to get a return on its huge investment and the requirement to ensure patient safety. I do not know whether the hon. Member for Newport, West saw last week’s British Medical Journal, but it contains a most interesting report on a large group of patients who took one of the Vioxx group of drugs. The results throw into doubt suggestions that the drugs in that group are safer than the ordinary non-steroidals used for the gastrointestinal tract. The article is very interesting, and shows that we cannot win in this respect. I was trained by wise and experienced physicians in the good old Westminster hospital, only about half a mile from here. One of them was practising when cortisone was invented and he had seen patients who were crippled with rheumatoid arthritis be cured absolutely for six weeks—the so-called cortisone honeymoon—but who had to come off the drug as soon as the side effects became evident. I was brought up to be extraordinarily careful with new drugs, because doctors do not, and cannot, know what they do. For example, thalidomide was introduced just after I qualified, and I am ashamed to say that I probably prescribed that drug for some people when I was a houseman at Westminster hospital. The first duty of a doctor is not to cause harm. With reference to that, I came across the marvellous proverb:"““A merry heart doeth good like a medicine.””" Sadly, that needs to be brought up to date so that it says ““like a good medicine””, as I am sorry to say that some medicines are not good, contrary to initial appearances. I also came across a quotation from Sir William Osler, as follows:"““The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.””" The drug industry therefore has an extraordinarily favourable market right from the beginning: people want to take medicines as they do not believe that other types of treatment work. That brings me to the need for regulation, a matter that has been covered extensively by several hon. Members already. I am sorry that the Government have not agreed to an independent review. I am hoping against hope that the four-yearly cycle review will be independent, that it will cover the ground set out by the right hon. Member for Rother Valley and so go some way towards removing concerns about the independence of the MHRA. Just yesterday, concern was expressed to me that the replacement organisation for the Committee on Safety of Medicines, which was abolished on 31 October, is not yet in place. The Minister will correct me if I am wrong, but I understand that the expert advisory groups that will take the place of the CSM in advising the MHRA have not been set up yet. During that gap, are patients more at risk? I believe that the groups will not be in place until February, and they will not be functional immediately, so for how long will there be a gap during which patients are probably vulnerable? On post-marketing surveillance, which has also been covered quite well, let me quote recommendation 29, which was our paragraph 45:"““We recommend that the extent, cost and implications of illness resulting from the use of medicines be systematically investigated by the Department of Health in conjunction with the MHRA.””" It is known, as the Government’s response states, that the burden of adverse drug reactions on the NHS is high, with 6.5 per cent. of hospital admissions due to it. Why is that still happening? Many statements in the British National Formulary, which many doctors carry, will enable the sort of side effects that lead to illness to be avoided. A classic side effect of SSRIs—selective serotonin reuptake inhibitors—particularly in the very old, is to cause a drop in the sodium level in the blood, which can be extraordinarily dangerous for the elderly. Three people in my area have suffered that side effect, which is mentioned in the British National Formulary. These are matters of education to be considered. I look forward tremendously to electronic prescribing, which has also been mentioned, as the electronic system, when it is really working, will be able to flag up immediately side effects with other drugs or a contraindication with the age of the patient, and could make a tremendous difference. When the Committee visited Australia, we were impressed by the production of a series of lovely little pocket books of well-organised therapeutic guidelines across many subjects in the whole of medicine. We are lagging behind on that. The only disappointment was that it did not appear that the Australian authorities had done a trial on hospital admissions due to drug-induced illness, to see whether those guidelines, which were being used widely, were making a difference. Possibly one of the most controversial recommendations, which has been mentioned, related to the Department of Health’s concern to represent the interests of patients, the NHS and the drug industry, which was described by some of our witnesses as ““cross-dressing””. One of the recommendations, which was responded to but in a negative way, referred to the Department of Health’s role, which, because of those wide responsibilities, perhaps does not serve the public as well as it should. I agree with everybody that we must retain a viable pharmaceutical industry. If we consider rough figures, however, 90 per cent. of the world’s research is targeted at illnesses affecting only 10 per cent. of the world’s population. We would love to see some guidance given to the major pharmaceutical industries to give some help to those huge numbers of the world’s population who are not being thought of. In Australia, we came across one small firm making a microbicidal gel for the prevention of HIV/AIDS. That would be relatively cheap and a huge advance. I would love the Minister to comment on whether the Government can try to influence the industry in that way.