Drug companies and charities accused of conflict of interest

http://www.sundayherald.com/25686

July 2002
Investigation: pharmaceutical giants pump millions into charities ... who
in turn campaign to get the firm's drugs prescribed
By Sarah-Kate Templeton, Health Editor

 

The latest campaign by Arthritis Care appears to be a straight- forward
battle by a charity to ensure the most effective drugs for the patients it
represents. It features a survey carried out by Arthritis Care which found
that only one in three GPs is prescribing a new type of arthritis drug
called COX-2 inhibitors which, according to the charity, are not associated
with the stomach complications caused by the older form of the drug. In
getting the message across that arthritis patients are losing out on the
most effective treatments, the charity also warns that 2000 patients die a
year as a result of gastrointestinal complications brought on by the older
medicines.

But the message becomes less clear cut when it emerges that the Arthritis
Care campaign is partly funded by Pharmacia and Pfizer, the companies which
manufacture the new COX-2 inhibitor drug celecoxib which costs up to 10
times more than the drugs it would be replacing.

There are also claims that the initial results of a trial, funded by
Pharmacia and showing that its new drug is safer than the cheaper ones,
were misrepresented.

The Arthritis Care study, published in September 2000 in the Journal Of The
American Medical Association , stated that COX-2 inhibitors were associated
with a lower incidence of complications than traditional anti-inflammatory
drugs. But by August 2001 letters published in the same journal drew
attention to the fact that complete information about the trial, available
to the United States Food and Drug Administration , contradicted these
conclusions. The authors had claimed that celecoxib was safer than older
drugs, with less gastrointestinal bleeding.

However, only six months of data was recorded in the paper. When results
for the entire 12-month period of the trial were analysed, critics claimed
the side effects were shown to be similar to those of older drugs.

But by this time the findings published in the original article were widely
distributed and believed. An editorial in the British Medical Journal
records that a total of 169 articles reported the initial results and this
coincided with the sales of the drug increasing from $2623 million (1752m)
in 2000 to $3114m (2080m) in 2001.

In July 2001, following the positive paper published in the Journal Of The
American Medical Association, the government's drug rationing body the
National Institute of Clinical Excellence (NICE) issued guidelines
recommending the drug for specific 'at risk' categories of patients. Armed
with these guidelines, Arthritis Care launched a campaign for wider
prescription of COX-2 inhibitors.

The campaign was funded by Pharmacia and Pfizer, who make the new COX-2
inhibitor drug. Both companies are listed on the Arthritis Care website as
donors, but exactly how much they donate is kept secret.

Dr Simon Maxwell, senior lecturer in clinical pharmacology and therapeutics
at the University of Edinburgh and a doctor at the city's Western General
Hospital, is deeply concerned about the conflict of interest.

'The data that was presented was skewed in favour of COX-2 inhibitors. I,
as someone who spends a lot of time looking at drugs, would say that these
are an advance -- they have benefits for some patients -- but the extent of
that advance has been over-hyped. The interest is in the fact that these
drugs cost about 10 times more than what they are replacing. What they are
replacing are among the most commonly prescribed drugs, and so it is easy
to work out the maths of what this would do to drugs bills. To insist that
all GPs prescribe these new drugs in preference to the older drugs is a
nonsense.'

Maxwell believes that when medical charities and patient groups campaign in
favour of a new drug, they should declare their interests.

'The pharmaceutical industry do this because they realise that the people
who can really have the strong political message are the patient groups
themselves.

'It is great to get patient groups' opinions but the pharmaceutical
industry knows that this is the lobby that has the power with the
government and with health professionals.

'This causes great concern. As a doctor involved in new drugs, I have to
declare all of my interests when I state an opinion about a drug. If I
travelled anywhere funded by the pharmaceutical industry then, quite
rightly, I would need to declare that. So, if these patient bodies state
their opinions, and they are perfectly entitled to do that, they should
make the same declaration that they have an interest in this.'

An investigation by the Sunday Herald has discovered that many of the
country's leading charities fail to make public details of the funding they
receive from pharmaceutical companies.

In the last financial year Diabetes UK received around 1m in funding from
the pharmaceutical industry. Around 7.5% of the charity's income consists
of such donations -- this is roughly the same amount as is raised by
community fund-raising. Although a page of the charity's annual report is
dedicated to community fund-raising activities, including the 300,000
raised by the charity's presence at the London Marathon, funding from the
pharmaceutical industry is not mentioned at all in the public document.

Last year, Diabetes UK received funding from 11 pharmaceutical companies
manufacturing diabetes drugs. A spokeswoman for the charity said: 'We don't
publish exact figures as often donors prefer us not to.'

Eight major pharmaceutical firms selling asthma medication are listed on
the National Asthma Campaign website as donating at least 10,000 a year
for three years. For this the companies are granted 'elite corporate gold
membership'.

Describing the rewards of 'gold membership' the website states: 'This is
the solid foundation upon which a long-term partnership, beneficial to both
parties, is then built. The scheme is targeted predominantly at companies
with a commercial interest in asthma. It enables them to raise their
profile in the asthma/health care market, and increase their understanding
of the needs of people with asthma through close contact with key staff
within the National Asthma Campaign.'

The National Asthma Campaign received 185,000 in the last financial year
from the pharmaceutical industry. Inhaler manufacturers Allen & Hanburys
donated 60,000. Another pharmaceutical company donated 40,000 towards
setting up a helpline.

Every year, the Patients Association, a national health watchdog standing
up for patients' rights, receives over 100,000 from the pharmaceutical
industry and health care companies. Pharmaceutical giants such as Pfizer,
GlaxoSmithKline and Pharmacia pay 5000 each to become platinum members of
the group's donation scheme. Donations from the pharmaceutical industry
contribute up to 20% of the group's income.

But Mike Stone, director of the Patients Association, insists the group is
open about its links. 'We as an organisation get funding from
pharmaceutical companies. There are a number of companies and we are quite
open about it -- in no way would we let them influence policy.

'We are a national organisation and for an organisation our size this is
just a percentage of our income -- about 15% to 20%.'

Some medical charities are now becoming increasingly aware of the potential
conflict of interest. In their most recent accounts the MS Society made a
point of listing exactly how much it receives from the pharmaceutical
industry. The charity lists all donations over 500, including one for
22,000 from Biomedical Research Ltd and another for 13,000 from Schering
Health Care which makes the expensive multiple sclerosis drug beta
interferon for which the charity campaigned to make more widely available.

The accounts state: 'The society is aware of public interest in the
financial relationship between medical charities and the pharmaceutical
industry.'

Similarly, Alzheimer Scotland has a strict policy to protect the charity's
activities from being influenced by the pharmaceutical industry.

Chief executive Jim Jackson said: 'We are aware that this is a sensitive
issue but we feel that we have got clear policies to protect the integrity
of the charity. We are aware of the narrow line that we have got to draw.

'On the one hand we are desperate to generate as much income as possible so
that we can do as much as possible for people with dementia and their
carers, but we are careful not to endorse particular products.'

Arthritis Care last night defended taking cash from Pharmacia and Pfizer to
fund its COX-2 drug campaign. Kieran Kettleton, director of communication
for the charity, said: 'NICE actively contacted Arthritis Care and said we
need you to promote our new guidelines to people with arthritis because it
is important to get the message to people with arthritis, particularly
those with gastrointestinal complications.

'We are a charity and money to do this does not come from anywhere. We
received a grant from Pharmacia and Pfizer for this campaign but we said
that the campaign would not mention any product and Pharmacia and Pfizer
make just one of the five COX-2 drugs available.'

Kettleton would not reveal exactly how much Pharmacia and Pfizer paid for
the campaign.

'They have agreed to contribute towards the costs and the campaign has not
finished yet. It is an expensive campaign,' he said.

Arthritis Care dismissed the study which found that the new, more expensive
COX-2 drugs were no better than older medicines. He said many other studies
found them to be an advance on the other drugs on offer.

Diabetes UK pointed out that it has a policy on the 'ethics of working
relationships' and a spokeswoman for the National Asthma Campaign said that
donations from the pharmaceutical industry form only 1.7% of the charity's
income.

Richard Ley, spokesman for the Association of the British Pharmaceutical
Industry, pointed out that the Long Term Medical Alliance, an umbrella body
for voluntary organisations for people with long-term illness, has
guidelines advising that charities should make public where funding comes
from.

'These organisations perform a valuable function and clearly they need
funding. In many cases the pharmaceutical industry is happy to do what it
can to help. This funding is without strings attached and it is always up
to the patient groups how they spend the money. It must be an equal
partnership with both sides benefiting.'

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http://www.sundayherald.com/25738
Drug firms' magic money circle


 

By Sarah-Kate Templeton, Health Editor

 

Medical charities which campaign for expensive new drugs receive millions
of pounds of funding from the pharmaceutical industry, a Sunday Herald
investigation can reveal.
One charity, Arthritis Care, has admitted that the pharmaceutical giants
Pharmacia and Pfizer fund their latest campaign, which calls for the wider
prescription of a new class of drug which they make called COX-2
inhibitors. But the charity refuses to say how much cash it received.

Health experts say the benefits of the expensive new drug have been
exaggerated. Results of a trial, funded by Pharmacia, showing the new drug
is safer than those they would replace, have been disputed in medical
journals.

Another charity, Diabetes UK, has admitted that last year it received about
1 million from the industry while the national health watchdog, the
Patients Association, receives up to 20% of its funding from pharmaceutical
companies.

But funding from the industry to charities is often kept secret. Now t he
extent of the funding has prompted leading medical experts to call for all
sums to be made public.

Dr Simon Maxwell, senior lecturer in clinical pharmacology and therapeutics
at Edinburgh University and a doctor at the city's Western General
Hospital, said: 'The pharmaceutical industry do this because they realise
that the people who can really have the strong political message are the
patient groups.

' The pharmaceutical industry knows that this is the lobby that has the
power with the government and health professionals.

'This causes great concern. As a doctor involved in new drugs I have to
declare all of my interests when I state an opinion about a drug. If I
travelled anywhere funded by the pharmaceutical industry then, quite
rightly, I would need to declare that. So, if these patient bodies state
their opinions, and they are perfectly entitled to do that, they should
make the same declaration that they have an interest in this.'

Professor Warlow, professor of medical neurology in the department of
clinical neurosciences at Edinburgh University, added: 'Medical charities
are an increasingly important source of advice and information for patients
and, if a company can influence that advice, then of course it may try to
do so.

'I have no idea how much all this actually does influence charity and
medical advice, but presumably the more money that is provided, the more
the advice could be changed.

'That is why I, and others, are keen to see exactly how much money is
involved in research grants, consultancy fees, and 'educational' meetings.'