2 February 2022

It can’t schmooze GPs, so Big Pharma targets patients and politicians instead

Only doctors at the end of their careers can recall the lavish lunches, the balloon trips, the conferences at ski resorts. Now there's a new order for marketing medicine.

By Phil Whitaker

I unwrapped a new tourniquet the other day. I say new but it is 30 years old. Its green elasticated fabric has been perfectly preserved inside its plastic case, and the yellow letters spelling “Frumil” are as bright as the day it was made.

Frumil tourniquets were highly prized when I was a junior hospital doctor. Their perfectly judged stretchiness made them effortless to pull tight around an arm, and the soft material meant they never pinched the patient’s skin like inferior tourniquets did. Their stainless steel clasp was an example of design genius; a mere flick of a finger instantly released the entire apparatus once the blood-taking or IV cannula-siting was done. I inked my name in capital letters on mine to stop it getting lost and I also squirrelled a second one away for when I might need a replacement – which, remarkably, I still had three decades later when the original finally began to fray.

Frumil was a brand of diuretic or a “water tablet” – drugs that flush water and salt through the kidneys, drying out swollen legs and waterlogged lungs in patients with heart failure. I didn’t pay for either of my eponymous tourniquets; they were given to me by the people that made Frumil. Nice of them. The ulterior motive, of course, was to remind me – every day, pretty much – of their product, in the hope that, whenever I needed to prescribe a diuretic, it would be theirs that came to mind. I like to think I am impervious to such ruses. Research suggests I am deluding myself. The very fact that I can recall Frumil among the numerous, now-forgotten brand names common in that era tells me how effective a marketing strategy it was.

It has now been more than ten years since pharmaceutical companies were last allowed to dole out “freebies” – tourniquets, pens, post-it notes, clocks – bearing drug brand names to doctors. As for the lavish lunches, hot air balloon trips, conferences convened in ski resorts, these are something only doctors at the ends of their careers can now recall. The clean-up came in response to growing unease about the influence Big Pharma was exerting over prescribing decisions.

While drug companies’ ability to sway individual practitioners has undoubtedly been diminished, the industry has adapted cannily to new realities. Companies offering financial support to eminent researchers and opinion-formers has long been an issue, and the requirement to declare conflicts of interest in academic papers seeks to counter it. But new opportunities have appeared. One is the power of the “patient group”. There are many brilliant organisations founded by passionate patients using social media and the internet to help fellow sufferers of anything from arthritis to inflammatory bowel disease. But there are also apparently similar groups whose genesis and funding depends to a large extent on drugs companies that have financial skin in that particular game. If you can’t get to the prescribers, get to the patients.

And today’s culture of centrally dictated guidelines means there is a holy grail of prizes on offer for those who can lobby most effectively. Witness the enthusiastic adoption by NHS England of the anti-cholesterol injection Inclisiran, naively endorsed by the Health Secretary, Sajid Javid. We are still waiting for data on whether it actually prevents heart disease, yet it is being rolled out throughout the NHS.

I haven’t prescribed Frumil by brand name for decades. Virtually all prescriptions these days are written generically, meaning individual manufacturers don’t stand to benefit. Consider the national stockpiling of borderline useless drugs such as Tamiflu; the revelations over PPE procurement during the pandemic; the eye-watering sums spent on the largely ineffectual Test and Trace; to say nothing of the “gifts” and second-job salaries for MPs detailed in evidence to the recent enquiry by the Select Committee on Standards. It is inescapable to conclude that, just like medicine a generation ago, our politics is long overdue a thorough and vigorous expurgation.