Review

Facts, but no feelings

REGULATING THE PHARMACEUTICAL INDUSTRY FOR THE BENEFIT OF ALL
David Taylor and Andrew Tucker
King’s Fund, 2000, £7.99

This is an extremely informative guide to the evolution and current practices of the pharmaceutical market in the UK. The tone is authoritative and factual, with much to interest the reader and much that provides a useful basis for critical debate about what kind of pharmaceutical industry should exist in an egalitarian society.

But perhaps that is also a limitation of the book: despite the obvious knowledge and expertise of the authors, there are no conclusions, merely pragmatic suggestions about what may need to be taken into account in the future. Nor is ‘community benefit’ clearly defined — an analysis of just who stands to gain and lose is never really addressed.

The focus is almost exclusively on the UK situation, although a necessary acknowledgement of the global nature of the industry is made. While this approach offers the opportunity to explore the national picture comprehensively, and to put that in a historical perspective, it has to be questioned whether national regulation can adequately protect a population’s interests, particularly given the current debate about GATT (General Agreement on Tariffs and Trade) and the recent legal challenge to pharmaceutical company power posed by the South African government.

Within the parameters set for this admittedly very small study (only 58 pages), the book covers both supply-side regulation, such as price and advertising controls, and demand-side innovations, such as GP prescribing budgets, the expanding roles of pharmacy and nursing, and the new NHS strategy and NICE agenda.

Policy conflicts are clearly identified. For instance, the authors provide evidence that Britain has one of the world’s largest pharmaceutical balance of trade surpluses, without which, they claim, ‘the funding of adequate public services could become increasingly problematic’.

As a resource, then, the book is valuable and easy to use. But it sits firmly on the fence in its cursory consideration of ‘regulatory regimes’ in relation to the ‘pursuit of world-wide health and welfare improvement’, particularly in the context of intellectual property protection and global access to medicines.

While acknowledging that this issue is of ‘vital interest’, the book steadfastly disdains any ethical standpoint – and without this context, the facts and figures seem alarmingly adrift.