Pharma: Not So NICE

The Guardian (UK) just reported that "multinational drug companies have been lobbying ministers in an attempt to subvert the independent appraisal process and get their expensive new medicines approved for large-scale use in the NHS...."

The Guardian documented how "over the eight months from October to May this year, senior executives from 10 drug companies met ministers to press for favorable decisions on their products. The executives were highly critical of the National Institute for Clinical Excellence (NICE), an independent expert body set up to decide which drugs are cost effective for use in the NHS."

For example, "manufacturers, led by Pfizer, have been complaining to ministers about NICE's position on their controversial Alzheimer's drugs." So, "at a meeting in October with the minister, Pfizer executives made it clear that they 'were unhappy with the NICE decision... and thought their processes were flawed." Later, "Pfizer executives warn[ed] the minister, it could always take its business elsewhere. 'Pfizer ... noted that there is a complacency in some quarters of Whitehall regarding their continued investment in the UK. Pfizer asked for more public support from the government for a robust pharmaceutical industry in the UK and more consultation/dialogue with government.'"

The Guardian documented that executives from other companies, including Eli Lilly, Johnson & Johnson, and Bristol-Myers-Squibb [link]. About the latter meeting, which included former BMS CEO Peter Dolan, who was since let go by the company, BMS director of external affairs Richard Marsh said, "companies have a legitimate interest in getting the best for their products and getting a positive appraisal by NICE." On one hand, "I don't think the NICE process is necessarily undermined." On the other hand, "he added that companies want to invest in countries with a 'favourable environment.'"

The actions recounted in this article seem to conflict with public pronouncements made by some pharmaceutical companies. For example, the Pfizer Inc. statement of vision and values includes,

We demand of ourselves and others the highest ethical standards, and our products and processes will be of the highest quality.

We play an active role in making every country and community in which we operate a better place to live and work, knowing that the ongoing vitality of our host nations and local communities has a direct impact on the long-term health of our business.

How did the suggestion to the UK minister not to have too much "complacency" about Pfizer's continued investment in the country, coupled with their criticisms of NICE's processes as "flawed" square with this vision?

The Guardian's account suggests that however much apparent public respect some pharmaceutical companies declare for the scientific method, evidence based medicine, and rational decision making, they will make end runs around them to "get the best for their products." Furthermore, clearly a few companies were willing to pressure the UK government with veiled threats to make their investments elsewhere should they no longer perceive the environment as "favourable."

This is a reminder to be skeptical the next time a pharmaceutical company pledges its faith in clinical science, and to be more skeptical when it is such a company that is controlling the design, implementation, and dissemination of clinical research.