Scottish doctors are to launch a new movement to stop NHS staff taking cash and hospitality from drug companies.

Organisers of the campaign say doctors are prescribing medicines according to which pharmaceutical company pays for their lunch rather than what's in the best interest of patients.

Doctors will be asked to sign up to the group, No Free Lunch, by taking a pledge to accept no money, gifts, or hospitality from the pharmaceutical industry at the Glasgow launch later this month.

The move comes as an investigation by the Sunday Herald reveals that NHS trusts are failing to keep meaningful registers of support that staff receive from the pharmaceutical industry.

Despite senior NHS directors stating that registers of interests should be made public, none of Scotland's hospital trusts disclose details of how much their doctors are paid from pharmaceutical companies. Four trusts admit not holding a register of staff interests while two say the expenses paid to doctors for travel and hotel accommodation by pharmaceutical companies are not included on the list. Three trusts said there was nothing on the register for the last financial year -- a claim doctors say could not possibly reflect the true situation.

Dr Simon Maxwell, senior lecturer in clinical pharmacology and therapeutics at Edinburgh University and a doctor at the city's Western General Hospital, said: 'This is a nonsense. There isn't a hospital in the country that doesn't have an active pharmaceutical industry providing lunches and money to consultants to travel to conferences, etc.

'I take a keen interest in this area and I had no idea of any register of this sort. I was not aware of a general register that I have to make a declaration to.'

Maxwell would like to see a register of interests for doctors similar to the one held for MSPs. Anyone can find out how much MSPs have received in travel, accommodation and dinner costs from commercial organisations just by looking up the Scottish parliament website.

'I believe we should have a voluntary register of interests for doctors and I think this should be open,' he said. 'I think we would be better knowing where everyone involved in sensitive decisions is coming from.'

Fife NHS Trust stated that it did not maintain a register because staff were not allowed to receive gifts or incentives. Forth Valley Acute Hospitals NHS Trust guessed that around 10 doctors had received travel expenses and accommodation costs from pharmaceutical companies while Ayrshire and Arran Acute Hospitals NHS Trust disclosed that 13 doctors had declared receiving hospitality from drug firms in the last financial year.

Directors of Greater Glasgow NHS, the health board for the whole of the city, are among those who now believe payments doctors take from drug companies should be made public.

Catriona Renfrew, director of planning and community health with Greater Glasgow NHS said: 'We would regard access to this sort of information as legitimate for the public to request.'

Nicola Sturgeon, shadow health minister, added: 'I think transparency is very important. The public want to know that drugs are prescribed for the right reasons, not because a GP has a particular relationship with a drugs company.'

Health economist Dr Andrew Walker, senior lecturer in health economics at Glasgow University's Robertson Centre for Biostatistics, calculated that the pharmaceutical industry spends £10,000 on marketing on each doctor every year.

This, says Dr Des Spence, a Glasgow GP who will lead the No Free Lunch movement in Scotland, influences the medicines doctors prescribe.

'Currently each GP spends roughly £150,000 of public money on medications per year. Unlike any other public sector budget, the doctors are largely unrestricted on which medications they choose to prescribe and how this money is spent. I wonder how the public would feel if teachers or the police had such financial independence? Pharmaceutical companies market heavily to influence prescribing by doctors and marketing budgets far outstrip research and development spending. This often involves free lunches, weekend educational meetings in hotels, trips to international conferences, educational 'grants' to doctors and some inexpensive 'gifts'. This marketing process is highly effective at changing prescribing patterns. None of this 'soft entertainment' is illegal and it's governed by a voluntary code of practice.

'We'd argue that doctors and nurses have a public duty not to take any form of promotion from the industry. However, this may be 'wrapped up' as education.'

Spence, who has refused offers from pharmaceutical companies of trips to Dublin, Stobo Castle near Peebles, Gleneagles and St Andrews, added: 'In some of the health centres, a meal is provided most days and people go along and see the reps. A lot of people don't see any problem with that.'

Dr Malcolm Macleod, a neurology registrar at the Western General Hospital in Edinburgh, is opposed to pharmaceutical companies paying for doctors to attend scientific conferences, but says under the present system, medics are obliged to take their cash. Macleod admits that, on a recent trip to America for a conference, a drug company paid £250 towards his fare.

'I was going to America for a conference and the total cost was £1400. I was £250 short and approached the drug company,' he said. 'There might have been other non-pharma sources around if I'd looked hard enough, but not as easy to get hold of.'

Macleod was also offered a trip to Copenhagen by a drug company and was told that he would have plenty of time to go shopping. He points out that as the NHS spends around 20% of its budget buying drugs from the pharmaceutical industry and as the drug companies spend around 12% of their budget on marketing drugs to doctors, the NHS is indirectly paying for drug reps to take doctors out to lunch.

The No Free Lunch movement is already running in the US. Doctors and nurses are asked to 'just say no to drug reps'. To join the group they must pledge to receive no money, gifts or hospitality and not to rely on medical information handed out by drug companies.

The Association of the British Pharmaceutical Industry says it does not see the need for NHS staff to join up. Spokesman Richard Ley said: 'There shouldn't be any occasion when hospitality is offered to doctors when it is not part of a seminar or workshop. It's more about doctors making sure that everything is seen to be above board.'

The Scottish Executive passed the responsibility for a register of doctors' interests on to individual trusts. A spokeswoman said: 'It's for trusts and NHS boards to implement procedures which guarantee the maintenance of high standards in public life. It's for them to determine the need to keep a record of hospitality received from the drug industry.'

 

Anything to declare? The records hospitals keep

 

Argyll and Clyde Acute Hospitals NHS Trust Holds a register but nothing on it in last 12 months

Ayrshire and Arran Acute Hospitals NHS Trust 13 doctors declared receiving hospitality from drug firms in last financial year

Borders Acute Hospitals NHS Trust Refuses to answer questions on doctors' interests

Dumfries and Galloway Acute Hospitals NHS Trust Secret register, does not include travel and accommodation paid by drug companies

Fife Acute Hospitals NHS Trust No register

Forth Valley Acute Hospitals NHS Trust No register, guesses 10 doctors received travel expenses from drug firms

Grampian University Hospitals NHS Trust Holds a secret register

Highland Acute Hospitals NHS Trust Holds a secret register, does not record amounts of cash received

Lanarkshire Acute Hospitals NHS Trust Register does not include payments for travel and hotel accommodation paid by drug firms

Lothian University Hospitals NHS Trust Holds a secret register

North Glasgow University Hospitals NHS Trust Holds a register, nothing on it for last two years

South Glasgow University Hospitals NHS Trust No register

Tayside University Hospitals NHS Trust No register

West Lothian Healthcare NHS Trust Secret register

Yorkhill NHS Trust Holds a register, nothing on it in last 12 months