The Drug Monopolies

Scan page 6

Since 1948 and the beginning of the NHS there have been massive advances in pharmacology, the study of drug action in animals and humans, and resultant developments in pharmaceutics, the technology of drug production.

By 1969 it has been estimated (by Sir Derrick Dunlop, chairman of the Medicines Commission and Committee of Safety on Medicines) that 95% of all the drugs in common use both Practice tad bend general introduced in the preceeding 20 years since 1949.

With the capitalist mode of production and the patent laws, this has meant that all new drugs have appeared under a manufacturer's brand name.

Branded name

When a prescription is written, drugs are described either by their approved (or proper pharmaceutical name or by their branded (or drug company trade mark) name.

The chemist is bound to dispense the cheapest available alternative or substitue when the approved name is given.

But if the branded name is given on the prescription, then that drug and only that drug may be dispensed.

The prescription is then sent to the DHSS pricing office and the chemist is paid according to the price negotiated with the supplier.

Chemists obtain their stocks at an agreed wholesale price.

Predominance

Since there is a predominance of branded drugs on prescription chemists do not always have the cheaper alternatives so that up to 10% of prescriptions indicating the approved name are filled with the expensive patented branded alternative that the prescriber may have been trying to avoid.

All doctors and hospital workers are trained to use approved names and it makes for unnecessary extra work outside hospital to learn the branded alternatives.

Patent rights generally last over a period of 15 sales General Medical Hospital pharmacies Not on NHS Prescription Total sales years so that any companies can effectively hold the NHS to ransom during this period and hold off any competition until patent rights lapse.

In 1965 the drug industry as a whole was scrutinised by the Sainsbury Committee, commissioned by the 1964-66 Labour government when Kenneth Robinson was Minister of Health.

The findings were that the pharmaceutical industry in Britain employed about 70,000 workers with a value of total output set at £250 million; this figure included non-prescription items that could then be bought at the chemist.

Lucrative market

This lucrative market was shared out between 50-60 firms ranging in size from giants like ICI, Beechams and Glaxo (Distillers) to much smaller firms, very often offshoots of the chemical dye stuffs and fertiliser industries; most of the middle ground was, and still is, occupied by the subsidiaries of. foreign owned companies.

In 1965 the market Britain was divided as The way that the size the market has grown indicated in table 2.

It can be seen from table 3 •that no section • ot capitalists were doing badly and that the British section must have increased the rate of exploitation of its workforce between the years 1961 and 1965.

Many stages The profits earned in this country by foreign owned subsidiaries has fallen in this period; this is explained as in the case of all the multinationals by the fact that the maximum rates of profit are earned in countries with the lowest and therefore the most favourable taxation. 1949-50 1955-56 There are many stages in the production of pills, tablets, capsules and other medicines: through crude raw materials to partially finished intermediates and the final product and its packaging-all essential stages:

Hoffmann la Roche make Diazepan in Switzerland and market it in Britain under the brand name Valium, through their subsidiary Roche Products Ltd.

This is a typical example.

US-o subsi 49%. about ½ the world's pharmac As a result of a government inquiry into the trading practice of kocne 1: - 10 two years ago, following continued high pricing, the parent company repaid £4-5 million on the NHS contract for Valium alone. The Labour government in 1965 set up the Sainsbury Committee to look into the questions: Were prices too high? Were profits 'fair"? Was research adequate? Was duplicated?

It was to look into selling methods, marketing, advertising and the activities of drug company representatives. 1965-66 Swiss owned 14% Bri Est. 1977-78 [450] [75] [225] [750] It was also to give an assessment of the implications of nationalisation of the industry under a state board and state intervention into sections of the Rejected Nationalisation was rejected-on the grounds that the cartels provided an "adequate" service to. the NHS, that in general profits were "fair" and that, given Other European owned 10% British owned ical industry is US owned. certain powers over the licensing of products, the control of marketing and selling methods, there was no danger of excessive NHS spending.

State intervention-the setting up of a government drug company that would have to start its research and production effort from scratch-was also dismissed as being far too expensive.

"Fair".

No, thought the committee, provided competition • was maintained as "fair" , there would be no continuing dangers.

Hospitals continue to be c The committee made a number of recommendations. There would be an overall medicines commission; this would operate a series of subcommittees; the Committee of Safety on Medicines (which would issue product licences), and the Standing Joint Committee on the classification of proprietary preparations.

A committee would approve the clinical trials of drugs being introduced.

Advertising would be controlled • by a code of practice set out by the capitalists themselves (the British Pharmaceutical Association) subject to control documents approved by the Medicines Commission.

And the Commission would also monitor the methods of representatives who call on GPs and hospital departments to promote their companies' products.

The Sainsbury Committee's one major proposal was that in the interests of "healthy competition" and to control prices brand names should be abolished and drugs only sold or promoted on the basis of their approved or proper names.

Blockade

This was met by a complete blockade from the capitalists who saw the threat to their exclusive rights to profits from a new and accepted drug, during the period of a patent.

The Labour government never implemented the recommendation.

Thirteen years later, what safeguards do we have against the exploitative interest in the NHS that the drug companies have been able to maintain unchecked except by their own appointed bodies?

Very few.

The Committee on Safety of. Medicines produces regular reports on adverse drug reactions.

The drug companies agree data sheets with the commission and pay handsomely for clinical trials to be conducted on their new products.

They have begun recently try and persuade GPs, particularly, to prescribe their products, altering patients' treatments and collecting their subjective assessments of the effect of a new preparation -calling this a 'clinical trial' Drug reps are used to bribe doctors and pharmacists with free lunches and dinners where films are shown of the latest developments in drug technology and advances in treatment.

: Continuous pressure The DHSS, in a timid defence of the drug budget, issues comparative price lists of equivalent drugs-while recognising that doctors should have clinical 'freedom' to prescribe what they think appropriate.

Is it surprising, therefore, that many GPs have their prescribing habits reviewed by DHSS officials when subject to continuous pressure from reps and advertising coupled with an endless tide of free hand outs?

It is estimated that on average £750 per year of every GP's surgery time is taken up by drug reps.

For 24,000 GPs that amounts to a current figure of £l8 million per year as one of the hidden costs of maintaining the drug companies on the back of the NHS. • This article has looked in some detail into the Sainsbury Report as it is representative of a reformist perspective for. the drug supply of the NHS.

The substitution of cheaper drugs-which was the main object of recommending the abolition of brand names by legislationhas totally failed.

Justifiable

Because of the continuing and rapid introduction of new drugs or improvements in their effectiveness (bio-availability), very often the only drug of choice is that most recently produced by a particular company's research effort.

Disallowing longwinded attempts to prolong the life of an ageing patient, it is therefore often justifiable to prescribe the new drug.

The only way therefore controlling the price of

Scan page 7

SOCIALIST PRESS, Heinesda! Il October, 19:8 11 Octob 1y.