Pharmaceutical companies opting in to a code of practice are having details of their payments to healthcare professionals made public – but does the database go far enough?

Pharmaceutical firms currently pay about £40m every year to healthcare professionals, including doctors and pharmacists. These payments could be for anything from expert advice to sponsoring a healthcare professional’s medical education. Now, the Association of the British Pharmaceutical Industry (ABPI) has created a central database, going live in June, on which its member companies, and others that have signed up to comply with the ABPI code of practice, will disclose who these payments are made to, and for what. At the same time, Jeremy Hunt’s “sunshine rule” will make it mandatory for NHS staff to declare gifts received from drug companies.



How will this new transparency affect the complex matrix of relationships between health professionals, pharmaceutical firms, the NHS and, most importantly, patients? That was the underlying question under discussion at a seminar hosted by the Guardian and sponsored by the ABPI.

Experts from all sides of the debate made up the panel, which was followed by a keynote address by George Freeman, minister for life sciences.

Sarah Boseley of the Guardian kicked off the discussion by pointing out that the ABPI database has already come in for some criticism: the Academy of Royal Medical Colleges says it doesn’t go far enough. But should disclosure be mandatory? Only 69% of healthcare professionals say they would agree to have their relationships with pharmaceutical companies disclosed on the publicly searchable database.

Virginia Acha of ABPI said that 69% was an encouraging figure and stressed the need for education and understanding for those who choose to opt out. “If people are worried about disclosure, addressing the payments made is key,” she said. “I would be pleased to see my GP have up on his bulletin board that he’d been involved in clinical studies, or was pursuing training in his own time, as that’s reinforcing to me that the care he’s giving me and my family is the best in the world. We need to help people feel more confident in this disclosure environment and explain what the money is for.”

Disclosure of payments from pharmaceutical firms

Ash Soni of the Royal Pharmaceutical Society agreed that disclosed payments need to be seen in the right context to be of value. “It’s important that there is an ability to respond and react to some of this disclosure. Sometimes people are doing things in the best interests of collaboration, but then something gets published or something comes out which means people are tarred with the brush of accepting money from someone for something. But you don’t get the opportunity to say why, what the purpose was, what it was designed to do, why the engagement was there.”

The panel members were in broad agreement that increased transparency is a good thing, whether it’s disclosing payments or publishing clinical research data – but, like Soni, Nikki Yates of GlaxoSmithKline (GSK) stressed the need for education around its issues. “The way I’ve embraced it [disclosure and transparency issues] is to take a step towards ensuring that whoever we are working with has a full understanding of why this is an important thing to do,” said Yates. Since 2014, she said, GSK has had a disclosure clause in its contracts. Thus far, it has had more than 90% agreement for disclosure of payments to healthcare professionals. “And we’ve gone a bit further and said if we can’t agree on disclosure, then we won’t work with those individuals.”

However, it’s vital to keep the end goal of transparency in mind, said Dr Graham Jackson of NHS Clinical Commissioners. “What’s our point? What’s our outcome? If our outcome is to provide service design, workload design, research and products that lead to better outcomes for our population across the NHS, then it’s fine to have this relationship [with pharmaceutical companies] and I’m much happier with this relationship within a transparent environment.”

Eric Low of cancer charity Myeloma UK agreed: “The reason that we collaborate, the reason that we speak to each other, the reason that we educate, the reason that we compete internationally to get clinical trials to the UK is because we care about our patients. And it would be unthinkable for me, as leader of a patient organisation, to not work with industry in such a critical role.”

Collaboration on clinical trials

He added that he’s “not frightened at all” of disclosure. Myeloma UK collaborates with industry in clinical trials, and gets free drugs from industry to use in those trials. For one trial, that might be £6m to £7m worth of drugs. “If you look at that as a proportion of our turnover, that could raise some eyebrows. But we should celebrate it. There’s nothing inappropriate about that relationship.”

But GP Dr Margaret McCartney pointed out that talking about shared goals, partnership and collaboration is all very well – but what are the shared goals and who decides what they are? She cited the pharmaceutical researcher who had approached her practice to do clinical research. When McCartney asked him if results would be published no matter what they showed, she was told no, and that McCartney herself would not be allowed to make them public. “How can I trust a leadership that says it will not guarantee published results, no matter what they show?” she asked.

She went on to highlight “morally distressing” practice around patient data. Drug companies, she said, are paying for independent pharmacists to go into GP surgeries, audit patient notes and make recommendations for treatment. Their patients have not given consent for this. “Many GPs seem to be happy with this. As a patient, I am not happy with this. Patient groups are not happy with this. I think we should fund the NHS to do this work. I do not think we should allow external people, who have a vested interest in prescribing and medication, freedom of access to your notes. I think that’s wrong, and that debate hasn’t been had.” This kind of poor practice, the panel agreed, is unacceptable and should be reported to the appropriate authorities such as the Prescription Medicines Code of Practice Authority (PMCPA), which operates the ABPI Code of Practice for the Pharmaceutical Industry.

So should disclosure be required by law? McCartney said she was pleased with GSK’s advances in making clinical data public, but believed that the process has to be “enshrined in law”. Others were not so sure: Jackson was concerned with “over-sterilisation” of the system. There are conflicts and competing interests in many areas, he pointed out, not just in pharmaceutical company funding, and a certain amount of competing interests are inevitable. “It’s human nature, and if we legislate, and go too far, then we could end up stifling the system by not allowing it to breathe.”

Comments from the audience expanded on the theme of drug companies versus doctors: Joe Taylor, a medical doctor by training and a lecturer at the University of Oxford, said that, like most doctors, he wasn’t up to date on every single study, and that incentivisation from pharmaceutical companies could force him to re-evaluate his prescribing practice. “Could it be that incentivisation is a positive thing and could be misinterpreted by patients?” he asked. McCartney disagreed, saying doctors didn’t need incentives from drug companies to do their job well.

But a general belief that drug companies are the bad guys could actually make people reluctant to disclose, said Robert Miller, chief medical officer and managing partner at Artemida Pharma. “I applaud full disclosure but I think one of the reasons why people are probably not prepared to fully disclose in some areas is because of the vilification of the pharmaceutical industry,” he said. “If we can work with pharma and not think of them as an evil empire, then people will be much happier to disclose.”

Transparency in the interest of patients

But times are changing, said Soni. “The industry did have a very bad reputation and there is no doubt that it earned it. Some of the things it did were not in the interests of patients or for the best interests of care. However, the industry has changed – it’s had to. It had to realise some of the things it was doing were not of a suitable standard. And I think this is helping us to move further and further in the right direction.”

Freeman took up this theme in his keynote address, praising not just the “extraordinary” NHS but also the contribution made by pharmaceutical companies to both the economy and to patient care. For him, transparency is right at the heart of the challenges and opportunities faced by the NHS – the “oil” of the 21st–century healthcare landscape. And he painted a picture of a future NHS driven by what Jeremy Hunt calls “intelligent transparency”, free of paper and cardboard, and using its own daily data footprint to improve its own performance and improvement.

He sensed, he said, great opportunity and excitement around transparency. “We have a choice between historically justifiable conspiracy theory, distrust and legislation as the only solution – the law or the threat of law, which I think drives defensiveness – or an approach based on mutual respect for others’ perspectives. [That approach] will accelerate us into this landscape of a more transparent healthcare ecosystem, which I think is genuinely in the interests of all of us.”

On the panel

Sarah Boseley (Chair) Health editor, the Guardian



Health editor, the Guardian Virginia Acha Executive director, research, medical and innovation, ABPI



Executive director, research, medical and innovation, ABPI Dr Graham Jackson Co-chair, NHS Clinical Commissioners



Co-chair, NHS Clinical Commissioners Eric Low Chief executive, Myeloma UK



Chief executive, Myeloma UK Dr Margaret McCartney GP and broadcaster



GP and broadcaster Ash Soni , President, Royal Pharmaceutical Society



, President, Royal Pharmaceutical Society Nikki Yates General manager, GlaxoSmithKline

