Ghost of Xmas past

It's been a funny old year. Tiger Woods found himself in a hole. President Obama did his best to dig himself out of an altogether different hole (aka Afghanistan). The UK Toy Fair attracted 8,000 visitors and Gordon Brown wished us all a merry Christmas, and that he wasn't the Prime Minister.

Everybody seems to have an iPhone, nobody seems to have caught Swine-Flu and nobody cared that Andre Agassi admitted taking drugs and didn't like tennis.

TV chef, Keith Floyd, died, as did Farrah Fawcett, David Carradine, Patrick Swayze, Bobby Robson and a protester at the G20 summit.  

English wine makers had a good year, but it was a bad year for Workington, in Cumbria, who lost their bridge and their village Bobby.

At the culmination of such a year we might all have wanted to cheer ourselves up a smidge and a good night out would have done the trick. There was a time when the local pharma rep might have obliged with a quiet dinner, a few glasses of claret, a brandy or two, and a ride home in the back of a comfy BMW. Perfect. A West-End show would also have been on the cards – just the thing to get you in the mood for Christmas.

Of course, none of that is on the agenda anymore. The happy-police at the ABPI have put-paid to it all and a rice-cake and a glass of water are now about the limit. Can you imagine what their Christmas party was like? When they'd got over enjoying the collective present of a new office stapler, they shared a tin of mandarin oranges and went home on the bus.

It was with thoughts of seasonal excess on my mind that a recent survey caught my eye. My friends at Doctors.net.uk are at it again. In November they sent a poll to all their members via an e-mail bulletin. Six hundred and fifty two members, in total, responded, over half of which were GPs.

The aim of the doctors.net poll was to find out whether the ABPI Code was fully understood by the GPs and their staff – practice managers and the like. The ABPI is not going to like the answer they got, especially since it has spent a fortune on leaflets, websites and PowerPoint presentations to assure us that it is as pure as a melting glacier.

It seems that few doctors take the ABPI and its Code seriously. But then again why should they?

The ABPI represents the pharmaceutical industry, which is not nearly as influential as it once was. There was a time when the prescribing habits of the nation's GPs could be influenced by a sticky note-pad and a coffee mug. Real influence was yours for a Mont-Blanc pen and pharma-share-price could be built on promises after a decent conference in Barcelona. I spoke at a pharma conference in South Africa once. Goodness knows what that resulted in. Ah, those were the days.

The days when the patients of well-dined, wined and much travelled doctors could expect to be treated with the most up-to-date drugs on the market are gone. No sooner was it licensed than Mrs Smith, with her tricky symptoms, could expect to be prescribed the wonder drug and cured. At the stroke of a pen, patients rallied almost as much as the pharma-share-price. Pharma-warriors sent their children to decent schools and profits were ploughed back into more research, to produce more pills, which required more marketing and promotion. A commodious merry-go-round. Pharma spent more money on marketing than it did on research.

And, why not? Good for patients, good for dividends and good for jobs.

Now, we are in the grip of austerity. Doctors may not receive any incentive to prescribe, NICE has taken over the world and the future looks bleak for patients who might benefit from a new therapy. Not only will they not get it, the chances are they will not know it even exists.

Even more important, their GP may not know that it exists. Pharma sales teams have been reduced to little more than professional visitors. Indeed, some companies have started to cull them.

We now live in a world where anonymous people called formulary committees decide what to buy and who gets what.

The fact that so few GPs know anything about the poor-old ABPI's much vaunted code-of-practice speaks for itself. They don't need to know. They know there is no chance of a night-out, studying anatomy at the local pole-dancing establishment, never mind a trip to Wimbledon or the Rugby. Doctors cannot influence anything anymore. They are only worth a branded USB stick and a sandwich. In fact, in terms of return on investment, they may only be worth a pencil and a Rivita.

The world has moved on. We have to ask: what is the ABPI for? Telling people where they can and can't have a night out? You don't need the ABPI for that – just ask your mother.  

Do they influence the NHS? Nothing influences the NHS. The NHS floats, stately on, in a bow-wave of money. It might just get beached this year. Saving money is the name of the game. Life jackets are required, not life-extending mega-expensive drugs.

Most pharma companies who have a new drug know they have to do battle with NICE, the Treasury and public opinion. Many of them will not bother with the UK market. The ABPI can't help with any of that.

I think the ABPI has an image problem; partly snake-oil, partly mother-in-law, partly Billy-no-mates. It's been a bad year for the ABPI and I can't see it getting much better next year either.

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster.

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