We like to think that the UK health service is uninfluenced by big money. That’s just not true | Margaret McCartney

SShouldn’t we be able to trust doctors to give us independent advice? Earlier this year there was a storm of outrage when it emerged that a doctor who appeared on TV frequently to talk about Covid vaccines was paid a significant amount of money by the pharmaceutical company AstraZeneca. The payment was to promote a flu vaccine, not the Covid vaccine. The response showed the discomfort many people feel about doctors taking money from the industry – and it also provides catnip for anti-vaccine conspiracy theorists. Independence matters.

This is just one of many monetary exchanges between the pharmaceutical industry and medics. Data published by the Association of the British Pharmaceutical Industry (APBI) shows that almost £42m was paid to UK healthcare professionals in 2023 – a mix of mainly consultancy, travel and conference fees. Pharma clearly thinks a huge spend is a good idea.

Money also flows into the NHS, often in the dark. Take screening for atrial fibrillation (AF), an irregular heartbeat that can lead to strokes. There is no controversy about testing for it in people with, say, palpitations or shortness of breath. But testing people who have no symptoms is a different matter. It can be helpful, or it can be harmful, leading to overuse of drugs to control heart rhythm in patients who may not need them. Rightly so, a big process is being carried out to find out.

In the meantime, the independent National Screening Committee does not recommend screening for AF. However, my research team analysed media coverage of atrial fibrillation screening. We found that it was almost always supportive and rarely mentioned that it was not evidence-based. When we analysed the sources of these positive recommendations, they almost always had a direct or indirect financial conflict of interest – which was often not clear. In effect, it meant that the NHS was carrying out tests, funded by pharmaceuticals, that its own independent advisors had advised against.

This is an architectural achievement – ​​bending the NHS to the needs of pharmacy, not the rigours of evidence-based medicine. Medical royal colleges – which exist to promote high standards in the profession – have received approximately £9m from pharmaceutical and medical device companies in the UK between 2015 and 2022. Much of this is used for “educational programmes”. A frequent argument is that it doesn’t matter where the money comes from, because colleges retain “editorial control”. But it still means the company can provide input and information to college programmes.

And in 2020 alone, almost £23 million was paid to UK patient groups by pharmaceutical industry sources, mainly where they were ‘in line with their portfolio or pipeline”. It is clear that many groups do great work for patients. Patient groups normally comment on the National Institute for Health and Care Excellence (Nice) assessments of new medicines, and research in 2019 found that the majority accepted financing of the technology, or a rival product, the same year they reported to Nice. This is a “back door” to influence – the concern is that groups dependent on pharmaceutical funding will be reluctant to criticise it. The result is a lack of independence.

This is concerning because doctors often have little insight into how they can be influenced. One of my favorite studies doctors requested whether they were influenced by the small gifts – pens and lunches – delivered by representatives of the drug unit. Most said no. But when asked whether their colleagues were influenced by the same small gifts? Most said yes. Of course, neither statement can be true.

In the UK, the principle of transparency is generally used to deal with conflicts, which I have argued for repeatedly. We now have a Voluntary arrangementrun by the APBI, which publishes pharmaceutical payments made to professionals who allow this, and to healthcare institutions and patient organizations. The Cumberlege Review investigated how conflicts of interest harmed patients through poorly tested surgical mesh that led to life-changing chronic pain, and recommended a Sunshine Law for the UK, where publication of industry payments to professionals would be made mandatory. But This may be limited in what it can achieve.

I’m not against transparency, but even with guidelines and a tremendous amount of effort, it’s difficult to be effectively transparent. I have been working on a study which found that many NHS transparency submissions were incomplete, inaccurate and difficult to understand. And how useful is this knowledge to average citizens? If a patient said on medical professionals reporting potential conflicts of interest: “It’s so incredibly difficult to know how relevant it is and whether it’s really something that’s affecting their judgment or not.”

The risk is that doctors think they have resolved their conflict through transparency, despite the ongoing conflict. Instead of professionals taking responsibility for not having avoidable financial conflict, the burden shifts to patients, who may not have the time, health, and resources to decide what to do with that information – if they even know it exists. The result is “baked-in” conflict with no incentive to stop it, because we think transparency will magically make it go away. In the US, the Sunshine Acts have failed to stop the proliferation of cash flows to medical professionals. In fact, one senior physician told me that open publication of payments has resulted in “willy-waving” – and competition for higher reimbursements.

But there is good news. Earlier this year, the Irish College of General Practitioners voted to phase out pharmaceutical sponsorship of educational events “to ensure patient care is guided by best practice and evidence, rather than influenced by the pharmaceutical industry”. This follows the College of Psychiatrists of Irelandwhich states: “While psychiatrists strive to improve the lives of patients and their families, the goals of the pharmaceutical industry are primarily commercial in nature. These goals do not always coincide.” We in the UK are lagging behind – and need to catch up.

Health Minister Wes Streeting has made clear that he wants to work more closely with pharmaceuticals, saying that the life sciences industry is integral to the British economy. Of course, the pharmaceutical industry does a lot of good, but marketing skills are no substitute for the checks and balances needed to ensure we don’t waste money and harm people. Almost 20 years agothe health commission has reviewed the workings of the pharmaceutical industry and said in a damning report that the “secretary of state for health cannot serve two masters. The department appears incapable of putting the interests of patients and public health ahead of the interests of the pharmaceutical industry.” It is still true, for them and for everyone. We need transparency – but that’s just the beginning of freeing ourselves from the influence of industry, not the end.