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26th July 2016

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Ed Smith

Chair of Not-Monitor, or whatever it's called. In conversation with Roy L

Good conversation, networking and a glass of wine. What's not to like!

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News and Comment from Roy Lilley

There are some very tight regulations about how Big-Pharma engages with the NHS. Gone are the days when, in exchange for a new pen and a pad of sticky jotters, the prescribing habits of primary care could be influenced by a pharma-rep.

All entertainment is now hard-tac and water.

There are anomalies. It might be possible for a Rep' to take a GP to the opera to see a story of murder, deceit, theft and treachery. However, it is impossible to take a doctor to a strip club, to see anatomy in action...

Most of us will have a dependency on Big-Pharma. Either through the pills we swallow, or the income we receive from investments in their shares via insurance companies, pension funds and the like.

Their glass towers cast long shadows. They employ thousands and generate millions.

Nevertheless, Labour's Jeremy Corbyn, who was really having a pop at his leadership rival, Owen Smith, once a lobbyist for Pfizer, has had-a-bit-of-a-go at Pharma.

Corbyn started, innocuously enough; "...the NHS should be free at the point of use... and the NHS... run by publicly-employed workers." I guess that would mean good-bye Virgin Care?

My take; provided the care is good, reliable and free at the point of use, the public are less bothered than we might think.

Leaving that to one side; Corbyn went on to say;

"...medical research shouldn't be farmed out to big pharmaceutical companies like Pfizer and others but should be funded through the Medical Research Council."

This is bonkers.

The MRC, last year, spent �506 million on research grants. Pfizer, alone, spent �4.8 billion. The world's top 10 pharma-companies, together, �50 billion. Where would a Corbyn government find that kind of cash?

Medicines represent around 10% of NHS spend. The UK spends amongst the lowest on medicines as a percentage of GDP and has some of the lowest prices in Europe

There is a �12bn cap-deal limiting the spend on new medicines. If the NHS spends more than expected, companies pay the money back. The cap excludes generic medicines.

And, there is the no little matter of post-graduate education that would probably collapse without Pharma-funding.

The MRC was set up in 1913, primarily to distribute funding from the National Insurance Act 1911, as a result of recommendations from the Royal Commission on Tuberculosis.

There have been notable successes. Discovering Flu is a virus, the development of penicillin, role of folic acid, the genome-thing, lung-cancer link to smoking and in total, 29 Nobel Prizes.

In a world where pharma-R&D is costing the budget of a small country and research more and more, narrowly focused, is there still a role for the MRC?

Here's the problem; pharma is not going to discover a new aspirin. Pharma research is moving more and more into high-end, narrowly focussed territory of the MRC. Pharma has the money and the MRC does not.

So-minded folk will find reasons to criticise pharma, I get that. Some with good reason; their excesses, marketing budgets and global sprawl.

However, it is not quite black and white. Balancing costs, marketing, innovation and share-price is not easy to do, is easily misunderstood and more easily criticised.

Pharma is complex, plays an important role and is entwined with the commercial, health and academic life of the country. But, there is one thing I would urge them to try and change.

Pharma research is, in large measure, serendipity. Years of research may go into developing a molecule that may well come to nothing. The results parked in a cul-de-sac.

Such is the commercial secrecy Pharma is obliged to work in, it is entirely possible for another company to be working on the same molecule and find its way into a cul-de-sac of its own.

It should be possible for incomplete results to be anonymised and web-posted, publically; giving companies the opportunity to share results and look for missing pieces.

This might help reverse the research out of the cul-de-sac, turn it into a route-map for the benefit of the companies and most of all the prospective patients.

Pharma and Corbyn's bigger worry should be Brexit; The European Medicines Agency, that approves new drugs across the EU, will surely move from their London HQ and could mean companies having to seek individual approvals across member states, losing out on plans to harmonise clinical trials.

The message is; if you plan a new prescription for pharma be sure it's for something that works and you can afford.

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