THURSDAY 16 DECEMBER 2004

MS MARGOT JAMES, MR MIKE PALING, MR RICHARD HORTON, MS JENNY HOPE AND MS LOIS ROGERS

  Q516  Chairman: Good morning. Can I welcome you all to this session of the Committee? Welcome to our witnesses. You must just be able to see us from that distance; we could do with binoculars to see you. It is not the best of rooms to be in I am afraid but I hope you will be able to cope. We are very grateful to you for being willing to come before the Committee this morning. Could I ask you to briefly introduce yourselves to the Committee, starting with you, Ms James?

  Ms James: Good morning. My name is Margot James and I am Regional President for Europe for Ogilvy Healthworld, a company which carries out public relations, medical education and advertising services for the pharmaceutical industry. Formerly I have been a non-executive director of an NHS trust and a mental health manager.

  Mr Paling: Good morning. My name is Michael Paling. I am Managing Director of Paling Walters. We are an advertising agency specialising in healthcare. Healthcare from our perspective is prescription medicines controlled by doctors, consumer medicines and any product with an interest in health that is consumer product.

  Dr Horton: Richard Horton. I edit The Lancet.

  Ms Hope: Jenny Hope. I am a medical correspondent with The Daily Mail. I write about health and medical matters for the news section.

  Ms Rogers: Lois Rogers from The Sunday Times. I am the medical editor and I cover the whole area of medicine and health related issues.

  Q517  Chairman: Thank you very much. Can I begin by asking Dr Horton a question arising from your evidence—and we are grateful for the evidence which was interesting evidence—where you concluded, if I can quote from your last paragraph: "Modern medicine needs a dynamic, innovative, and robust pharmaceutical industry. But it is also the case that the for-profit motive of the pharmaceutical sector clashes with the public health values of NHS clinical care and independent scientific research." You go on to say: "The compromised integrity of medicine's knowledge base should be a serious concern to politicians and public alike. It is surprising and disappointing that this danger does not seem a serious priority within medicine itself." Could you expand on that?

  Dr Horton: Perhaps I should start by saying that it goes without saying that we do need a dynamic, innovative industry and it has been a huge success in the last 20 years or so as we have been able to see medicines delivered that have really transformed the practice of medicine. I know you have had examples of that presented to your Committee. Indeed, it is also true to say that there are many common conditions—such as high blood pressure, high cholesterol, asthma, diabetes—that remain chronically under-treated and we need to do better at getting effective medicines to those patients. However, it is also correct to be critical because industry does not just provide an armamentarium of drugs. It also, because of this armamentarium, contributes significantly to the morbidity and mortality of the population. In a study that was done in the late 1990s looking at American data—a study of adverse drug reactions—adverse drug reactions were found to be the fourth commonest cause of death in the United States after heart disease, cancer and stroke. With progress come huge risks which are often underestimated. In addition, the pharmaceutical industry has been enormously successful at inter-digitating itself in the usual process of health care in the UK. It provides people; it provides equipment, services, buildings, facilities and, of course, hospitality. At almost every level of NHS care provision the pharmaceutical industry shapes the agenda and the practice of medicine. The question then is: what is the nature of that shaping, that relationship? It hovers somewhere between symbiotic and parasitic. It is possible perhaps to explore some of that. I guess I feel that the relationship has tilted too much towards the parasitic rather than the symbiotic because of the way we have our regulatory structure for drugs still with MHRA despite the proposals for reform. We are seeing the population taking part in a largely unregulated experiment in the way drugs are provided through the NHS and I think that is something we had not had a serious enough debate about in the public domain.

  Q518  Chairman: In an editorial in 2002 you wrote: "How tainted has medicine become?" and you concluded: "heavily and damagingly so". You qualified medically in 1986, at what stage in your career did you come to this conclusion? Is it something you believed in all the way through or do you feel that something profound has happened during your time since you have qualified that leads you to this pretty strong conclusion?

  Dr Horton: This is not something I have thought for a long time at all. It is only since I have worked at The Lancet which is a strange environment to work in. It gives you an insight into many of the practices that we may talk about this morning.

  Q519  Chairman: To clarify the point then, your thinking of this has been concentrated by the work you are doing now.

  Dr Horton: Exactly.