News from nowhere

Remember the sleepy seaside city a long way from London, the dubious surgeon and the independent inquiry in the last issue?

The surgeon remains in post, the city remains sleepy, and the enquiry team is exhausted. No dramatic headlines, no patient pickets outside the General Medical Council and no column inches of analysis in the serious dailies.

Only the drip feed of information from a journalist who knows more — much more — than he has disclosed. Only the mysterious but temporary removal from the inquiry team of their clerical and administrative support, apparently on instruction from the regional NHS Executive office; important documents faxed and lost in ‘pending’ trays for days on end; a sacked specialist tainted with suspicion of starting a vendetta; writs and injunctions against disclosure of information; a strange phone call to an inquiry team member late at night from a senior figure in the local NHS administration; the feeling among the inquiry team that they may be compromising their own careers by pressing too hard and making too many enemies further down those corridors of power.

Nothing much, then, to interest the media. Everyday life in a shadowy institution, in fact.

Why do they bother? The drug companies, that is. Last November the Association of the British Pharmaceutical Industry ran large adverts in national newspapers explaining how the drugs industry helps Britain: by employing 300,000 people, exporting £5bn worth of medicines, saving £10bn a year on hospital care and pumping £100m a year into medical education and research.

Worthy stuff, and worth a boast or two, but why did they need to tell us in November? Because the government’s review of the Voluntary Pharmaceutical Price Regulation scheme (VPPRS) was about to appear, amid hints that regulation was to become tighter.

The VPPRS ensures that the industry gets an agreed return on profit by controlling the prices it charges to the NHS. Prices for medicines can vary, but only within the profit limits agreed. Naturally enough, the industry wants more profit and less regulation, hence the positive advertising of its patriotism and economic largesse.

The medicines story is more complicated, of course. The pharmaceutical industry virtually defines the nature of medical care, promoting treatments that absorb huge sums of public money even when their value is uncertain, educating the medical profession to think of a pill for every ill, and shaping the research agenda so that the testing of medicines takes a high priority.

Far from saving the NHS money, it spends it in huge amounts. How much is spent by the NHS on medication that is not beneficial? How much drug company money goes on promoting teamwork and common professional education, or on researching health promotion? Strangely enough, the adverts did not say.