The latest campaign by Arthritis Care appears to be a straight- forward battle by a charity to ensure the most effective drugs for the patients it represents. It features a survey carried out by Arthritis Care which found that only one in three GPs is prescribing a new type of arthritis drug called COX-2 inhibitors which, according to the charity, are not associated with the stomach complications caused by the older form of the drug. In getting the message across that arthritis patients are losing out on the most effective treatments, the charity also warns that 2000 patients die a year as a result of gastrointestinal complications brought on by the older medicines.

But the message becomes less clear cut when it emerges that the Arthritis Care campaign is partly funded by Pharmacia and Pfizer, the companies which manufacture the new COX-2 inhibitor drug celecoxib which costs up to 10 times more than the drugs it would be replacing.

There are also claims that the initial results of a trial, funded by Pharmacia and showing that its new drug is safer than the cheaper ones, were misrepresented.

The Arthritis Care study, published in September 2000 in the Journal Of The American Medical Association , stated that COX-2 inhibitors were associated with a lower incidence of complications than traditional anti-inflammatory drugs. But by August 2001 letters published in the same journal drew attention to the fact that complete information about the trial, available to the United States Food and Drug Administration , contradicted these conclusions. The authors had claimed that celecoxib was safer than older drugs, with less gastrointestinal bleeding.

However, only six months of data was recorded in the paper. When results for the entire 12-month period of the trial were analysed, critics claimed the side effects were shown to be similar to those of older drugs.

But by this time the findings published in the original article were widely distributed and believed. An editorial in the British Medical Journal records that a total of 169 articles reported the initial results and this coincided with the sales of the drug increasing from $2623 million (£1752m) in 2000 to $3114m (£2080m) in 2001.

In July 2001, following the positive paper published in the Journal Of The American Medical Association, the government's drug rationing body the National Institute of Clinical Excellence (NICE) issued guidelines recommending the drug for specific 'at risk' categories of patients. Armed with these guidelines, Arthritis Care launched a campaign for wider prescription of COX-2 inhibitors.

The campaign was funded by Pharmacia and Pfizer, who make the new COX-2 inhibitor drug. Both companies are listed on the Arthritis Care website as donors, but exactly how much they donate is kept secret.

Dr Simon Maxwell, senior lecturer in clinical pharmacology and therapeutics at the University of Edinburgh and a doctor at the city's Western General Hospital, is deeply concerned about the conflict of interest.

'The data that was presented was skewed in favour of COX-2 inhibitors. I, as someone who spends a lot of time looking at drugs, would say that these are an advance -- they have benefits for some patients -- but the extent of that advance has been over-hyped. The interest is in the fact that these drugs cost about 10 times more than what they are replacing. What they are replacing are among the most commonly prescribed drugs, and so it is easy to work out the maths of what this would do to drugs bills. To insist that all GPs prescribe these new drugs in preference to the older drugs is a nonsense.'

Maxwell believes that when medical charities and patient groups campaign in favour of a new drug, they should declare their interests.

'The pharmaceutical industry do this because they realise that the people who can really have the strong political message are the patient groups themselves.

'It is great to get patient groups' opinions but the pharmaceutical industry knows that this is the lobby that has the power with the government and with health professionals.

'This causes great concern. As a doctor involved in new drugs, I have to declare all of my interests when I state an opinion about a drug. If I travelled anywhere funded by the pharmaceutical industry then, quite rightly, I would need to declare that. So, if these patient bodies state their opinions, and they are perfectly entitled to do that, they should make the same declaration that they have an interest in this.'

An investigation by the Sunday Herald has discovered that many of the country's leading charities fail to make public details of the funding they receive from pharmaceutical companies.

In the last financial year Diabetes UK received around £1m in funding from the pharmaceutical industry. Around 7.5% of the charity's income consists of such donations -- this is roughly the same amount as is raised by community fund-raising. Although a page of the charity's annual report is dedicated to community fund-raising activities, including the £300,000 raised by the charity's presence at the London Marathon, funding from the pharmaceutical industry is not mentioned at all in the public document.

Last year, Diabetes UK received funding from 11 pharmaceutical companies manufacturing diabetes drugs. A spokeswoman for the charity said: 'We don't publish exact figures as often donors prefer us not to.'

Eight major pharmaceutical firms selling asthma medication are listed on the National Asthma Campaign website as donating at least £10,000 a year for three years. For this the companies are granted 'elite corporate gold membership'.

Describing the rewards of 'gold membership' the website states: 'This is the solid foundation upon which a long-term partnership, beneficial to both parties, is then built. The scheme is targeted predominantly at companies with a commercial interest in asthma. It enables them to raise their profile in the asthma/health care market, and increase their understanding of the needs of people with asthma through close contact with key staff within the National Asthma Campaign.'

The National Asthma Campaign received £185,000 in the last financial year from the pharmaceutical industry. Inhaler manufacturers Allen & Hanburys donated £60,000. Another pharmaceutical company donated £40,000 towards setting up a helpline.

Every year, the Patients Association, a national health watchdog standing up for patients' rights, receives over £100,000 from the pharmaceutical industry and health care companies. Pharmaceutical giants such as Pfizer, GlaxoSmithKline and Pharmacia pay £5000 each to become platinum members of the group's donation scheme. Donations from the pharmaceutical industry contribute up to 20% of the group's income.

But Mike Stone, director of the Patients Association, insists the group is open about its links. 'We as an organisation get funding from pharmaceutical companies. There are a number of companies and we are quite open about it -- in no way would we let them influence policy.

'We are a national organisation and for an organisation our size this is just a percentage of our income -- about 15% to 20%.'

Some medical charities are now becoming increasingly aware of the potential conflict of interest. In their most recent accounts the MS Society made a point of listing exactly how much it receives from the pharmaceutical industry. The charity lists all donations over £500, including one for £22,000 from Biomedical Research Ltd and another for £13,000 from Schering Health Care which makes the expensive multiple sclerosis drug beta interferon for which the charity campaigned to make more widely available.

The accounts state: 'The society is aware of public interest in the financial relationship between medical charities and the pharmaceutical industry.'

Similarly, Alzheimer Scotland has a strict policy to protect the charity's activities from being influenced by the pharmaceutical industry.

Chief executive Jim Jackson said: 'We are aware that this is a sensitive issue but we feel that we have got clear policies to protect the integrity of the charity. We are aware of the narrow line that we have got to draw.

'On the one hand we are desperate to generate as much income as possible so that we can do as much as possible for people with dementia and their carers, but we are careful not to endorse particular products.'

Arthritis Care last night defended taking cash from Pharmacia and Pfizer to fund its COX-2 drug campaign. Kieran Kettleton, director of communication for the charity, said: 'NICE actively contacted Arthritis Care and said we need you to promote our new guidelines to people with arthritis because it is important to get the message to people with arthritis, particularly those with gastrointestinal complications.

'We are a charity and money to do this does not come from anywhere. We received a grant from Pharmacia and Pfizer for this campaign but we said that the campaign would not mention any product and Pharmacia and Pfizer make just one of the five COX-2 drugs available.'

Kettleton would not reveal exactly how much Pharmacia and Pfizer paid for the campaign.

'They have agreed to contribute towards the costs and the campaign has not finished yet. It is an expensive campaign,' he said.

Arthritis Care dismissed the study which found that the new, more expensive COX-2 drugs were no better than older medicines. He said many other studies found them to be an advance on the other drugs on offer.

Diabetes UK pointed out that it has a policy on the 'ethics of working relationships' and a spokeswoman for the National Asthma Campaign said that donations from the pharmaceutical industry form only 1.7% of the charity's income.

Richard Ley, spokesman for the Association of the British Pharmaceutical Industry, pointed out that the Long Term Medical Alliance, an umbrella body for voluntary organisations for people with long-term illness, has guidelines advising that charities should make public where funding comes from.

'These organisations perform a valuable function and clearly they need funding. In many cases the pharmaceutical industry is happy to do what it can to help. This funding is without strings attached and it is always up to the patient groups how they spend the money. It must be an equal partnership with both sides benefiting.'

 

 

 

News: Drug firms' magic money circle

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