Public Private Partnerships

‘Partnership’ or manipulation?
Translated from Rev Prescrire March 2014; 34 (365): 216
The various individuals, organisations and companies involved in the healthcare sector do not all have the same objectives and interests. This is very clearly illustrated by the recent failure of a coalition of UK healthcare stakeholders.

Good bedfellows? A coalition of healthcare stakeholders was formed in the UK in 2011: the ‘Ethical Standards in Health and Life Sciences Group’ (ESHLSG) (1,2). The stated aim of this group was to promote best practice, mainly in terms of interactions between healthcare professionals and the pharmaceutical industry, and clinical trial transparency. Two guidelines on these topics were thus endorsed by a number of medical journals and organisations representing healthcare professionals, the Association of the British Pharmaceutical Industry (ABPI) and representatives from the English, Scottish and Welsh governments (1,2).

Some observers were surprised to see how pro-industry these guidelines were, in which the following statements were left unchallenged: ‘industry plays a valid and important role in the provision of medical education’; ‘medical representatives can be a useful resource for healthcare professionals’; and ‘information about industry-sponsored trials is publicly available’ (1,2). All of these assertions are refuted by numerous studies and are strikingly at odds with current international debate on these issues (1,2). Alerted by an academic, The Lancet was the first to withdraw its support for these guidelines, in February 2013 (2). Amid mounting criticism, the coalition disbanded in September 2013 (1). Some observers requested documents under Britain’s Freedom of Information Act to find out how government representatives came to endorse these guidelines. Some did not want to feel left out. Others had signed after numerous insistent calls from the ABPI, despite their reservations about the process and the guidelines (1).

Don’t be naive about ‘partnerships’. The various stakeholders involved in the healthcare sector — patients, healthcare professionals, the pharmaceutical industry, government, and health insurance providers — have partly divergent and sometimes contradictory interests. It is better that they each defend a clear position, rather than entering into unequal partnerships in which the most influential party is often able to manipulate the others (3). This experience also shows that someone with a mind to it can put a spoke in the wheels (2). It is an inspiration to never give up, and to remain vigilant in safeguarding patients’ interests.

Selected references from Prescrire’s literature search.
1- Arie S ‘Working with the drug industry. How a marriage with big pharma ended in divorce’ BMJ 2013; 347: f6062, 4 pages.
2- Horton R ‘Offline: falling out with pharma’ Lancet 2013; 381: 358.
3- Prescrire Editorial Staff ‘Attitudes must change if we are to avoid another Mediator° scandal’ Prescrire Int 2012; 21 (123): 21-23.

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