Healthcare staff, who influence how the £12bn annual NHS drugs budget is spent, insist they are not swayed by hospitality. However, it has emerged that big firms such as Sanofi-Aventis, Napp and Cephalon all feature in reports by the industry's watchdog, the Prescription Medicines Code of Practice Authority (PMCPA), into alleged breaches in the rules on hospitality.
Cephalon, which makes drugs targeted at central nervous system disorders, pain and cancer, was criticised for providing inappropriate hospitality to 13 healthcare professionals during a medical congress in Lisbon, Portugal. The PMCPA found that the impression of a "general party atmosphere, recorded on camera, was wholly unacceptable".
The world's biggest drug companies could now find themselves the target of investigation by Britain's fraud watchdog over allegations that they have been influencing NHS staff with lavish travel junkets and hospitality. The Serious Fraud Office (SFO) will use new powers obtained this weekend to investigate a range of claims that doctors, nurses and NHS managers are being swayed in their drug-purchasing decisions by "excessive" wining and dining.
The SFO warned this weekend that it will use powers introduced in the Bribery Act – which came into force on Friday – to investigate any claims where the entertaining of doctors, nurses and NHS managers go beyond "sensible proportionate promotional expenditure".
Pharmaceutical industry representatives insist that companies followed a strict code to ensure their relationships with health professionals were "transparent, ethical and appropriate". Despite industry claims that the investment helps to drive up standards by broadening the experience of individual professionals, concerns about the largesse are increasing.
In one case, an official at Sheffield Primary Care Trust (PCT) questioned a payment of £3,000 by GlaxoSmithKline (GSK) towards a training event for doctors and nurses, saying: "There is a risk this event will lead to increased prescribing of products manufactured by this company, which will lead to increased costs in the prescribing budget, which may not be offset by reduced expenditure on patient hospital care."
Dr Richard Oliver, of NHS Sheffield, said yesterday: "GPs have been canvassed for their views on the use of pharmaceutical sponsorship for such events and many took the view that if it helps spread NHS money further then it is acceptable. GSK, like all companies, has to abide by the Association of the British Pharmaceutical Industry [ABPI] code – this means that they cannot be seen to push their products at events such as these."
At NHS Wiltshire, where managers launched an investigation into a two-night hotel stay taken by a member of staff last year, board members complained about "GPs and their acceptance of gifts/hospitality" during a discussion of a report on counter-fraud measures at the trust.
Professor Tim Kendall, of the Sheffield NHS foundation trust, said: "Using drugs reps and funding research is just part of a strategy to make money."
The ABPI recently changed its code of practice: from 2013, firms must collect and declare annually total amounts paid to health professionals and others for services such as speaker fees and participation on advisory boards. Companies will also be required to declare sponsorship for attendance at meetings organised by third parties.
The SFO has been in discussions with the ABPI and the PMCPA about controls over the hospitality. A memorandum of understanding between the three, released last month, highlights how the SFO is poised to act against breaches of the code.
It states: "The SFO and others agree that sensible proportionate promotional expenditure is entirely legitimate and not outlawed by the Bribery Act", but it adds that while the organisation "will not routinely intervene in matters covered by the code", it "reserves the right to take action if the issue is deemed serious enough to merit SFO investigation".
Companies that breach the code face public reprimand and, in extreme cases, can be suspended or expelled from the trade body. In one of the most serious breaches, the US-based firm Abbott Laboratories was suspended for six months in 2006 after it emerged that employees of the company paid for doctors to visit lap-dancing clubs, a greyhound stadium and Wimbledon. The company said a "narrow silo" within the company failed to uphold its ethical standards, and admitted that three employees had left the company.
NHS East Sussex Downs and Weald and NHS Hastings and Rother are among the bodies reviewing their policies in the light of the Act.
Dr Joanna Moncrieff, at the Department of Mental Health Sciences, University College London, said: "Any level of hospitality for doctors provided by drug companies is an issue because it is bribery – it's an inducement to prescribe a particular drug that has nothing to do with the therapeutic merits of the drug concerned."
British drugs companies do not disclose spending on hospitality and sponsorship, but figures from US company reports reveal that in 2010 Bristol-Myers Squibb spent £2.24bn on "marketing, selling and administrative" costs, and Merck spent £1.6m on grants, donations or payments to more than 146 health institutions and patient organisations in the UK.
The ABPI's chief executive, Stephen Whitehead, said: "Everyone, including patients, benefits from industry and medical professions working together to tackle healthcare problems and improve outcomes for patients."
A Department of Health spokeswoman said all public servants work under clear guidelines on the acceptance of gifts. She added: "In addition, the General Medical Council has guidance for doctors on financial dealings and conflicts of interest."
Concerns over the influence of drug companies had been raised in Parliament over several years, said Labour MP Paul Flynn, but successive governments had failed to rein them in. "If companies are being found to be in breach of their own code of conduct, but get nothing other than a public ticking-off, then self-regulation isn't working," he said. "These companies seek to influence at every level of society, so their behaviour must be controlled by the authorities themselves."
A spokesman for Bristol-Myers Squibb said: "Any hospitality that is provided by staff in relation to scientific meetings, congresses or continuing medical education, is strictly monitored and approved internally to ensure that it in no way breaches the [ABPI's] strict code of practice."
An Eli Lilly spokesman said: "As a member and an active voice within this trade body, Lilly supports the ABPI's response on behalf of the companies it represents." The company told the PMCPA inquiry that its own investigation had found the allegations over the meeting to be "unsubstantiated", and that there was a "legitimate business need" to meet the nurses.
A spokesman for GSK said: "All our actions are governed by strict codes of conduct and we believe educational events such as these advance doctors' knowledge and bring about improvements in patient care."
Pfizer said the company would not comment beyond the ABPI statement. Cephalon and Sanofi-Aventis were unavailable for comment.
Additional reporting by Tia Pennant-Lewis
PMCPA rulings on hospitality
Cephalon
Global Turnover
£1.74bn (2010)
Products
Fentora, Nuvigil, Provigil
Complaint Paid for delegates to attend a pain congress in Lisbon in 2009. "On one evening the group had watched fire-eaters ... the hospitality had been excessive," the report said.
Eli Lilly
Turnover
£14.35bn (2010)
Products
Prozac, Humalog, Cialis
Complaint In April a former employee reported a restaurant meeting in 2008 between three staff and two nurses. The hospitality "had been excessive".
Napp Pharmaceuticals
Turnover
£70.3m
Products
Adizem, MST Continus
Complaint Flew 17 delegates business class to a meeting in Canada last October. The company had reported the lapse, blaming it on "a breakdown in internal communication". The PMCPA described it as "wholly unacceptable".
Pfizer
Turnover
$67.8bn (£42bn)
Products
Lipitor, Enbrel, Viagra
Complaint Held a meeting to promote arthritis drug Celebrex at the five-star Gleneagles hotel in Scotland in March 2009. Report said this meeting at "a renowned, deluxe venue, including an overnight stay for most delegates", gave an "inappropriate" impression. Pfizer successfully appealed the ruling.
Sanofi-Aventis
Global Turnover
£27.45bn (2010)
Products
Taxotere, Apidra, Depakine
Complaint Claims of "excessive hospitality" at meetings in Paris and San Francisco. The PMCPA said the lack of detail from Sanofi-Aventis "was unsatisfactory". and so had to rule "no breach of the code" but was "extremely concerned" about "very serious allegations".
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