Second drug firm found guilty of "switching" patients to new drugs
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《英国医生杂志》
A second drug company has been forced to abandon a programme of switching patients on GPs' lists to a new drug, after a ruling from the drug industry's regulatory body.
GlaxoSmithKline was found to be in breach of a clause of the code of conduct of the Association of British Pharmaceutical Industry for paying for a third party or practice staff to switch asthma patients who used both salmeterol (Serevent) and beclomethasone (Becotide-100) to Seretide, a dual action inhaler containing salmeterol and fluticasone (Seretide). Beclomethasone is available in generic form, while the other two products are available in the United Kingdom only as branded drugs.
Information drawn up by GlaxoSmithKline to promote the product stated that in a practice of three GPs and 4500 patients switching patients to Seretide would result in typical savings of ￡9789 ($17 600; 14 200) a year.
The authority rules that although "companies could of course promote products on the basis of cost... the difficulty was when the company paid directly or indirectly for those changes to be made, because then the company's actions amounted to it paying to boost the prescription of a specific medicine."
Des Spence, a GP in Glasgow who reported the scheme to the association, said the practice of switching patients from an older product to a newer one with a longer patent was widespread and a means for drug companies to maintain profitability.
In June the association made a similar ruling against Wyeth for paying for "GP system specialists" to identify patients on GPs' list who would be suitable to change from Zoton (capsules of lansoprazole) to Zoton FasTab (orodispersible tablets of lansoprazole) ( BMJ 2004;328: 1515).
Dr Spence, who heads the campaigning group No Free Lunch, said that another problem with switching was that patients were not being asked to consent.
"It is our perspective from No Free Lunch that this ruling on Seretide reinforces that the widespread practice of `switching' breaches the ABPI code and should stop," he said. "In general terms it is our view that most or all of the `support' offered for general practice is in fact merely marketing by the back door. We call for more regulation and better guidance for general practice on what is acceptable industry activity."
A spokesperson for GlaxoSmithKline said: "GSK accepts that the materials used to introduce its Airways Integrated Management (AIMS) service to practices were, although unintentionally, in breach of the Code of Practice and has agreed to withdraw these materials. However, it is important to note that the AIMS service was not found in breach of the ABPI Code of Practice and GSK remains committed to this service, which offers both potential patient and practice benefits.
"The AIMS service is designed to assist doctors in transferring patients receiving both inhaled corticosteroid (ICS) and inhaled long acting beta2-agonist bronchodilator (LABA) as separate inhalers to a therapeutically equivalent combination formulation, if, after review by the doctor, this is considered to be the most appropriate treatment for the patient. The GP identifies the profile of patients who they feel may benefit from either a therapy change or asthma review and determines whichever combination inhaler they feel is most appropriate for the patient. This offers potential clinical benefits to the patient and potential cost-saving benefits to the practice."
Dr Spence will be presenting evidence next week to the House of Commons Health Committee's inquiry into the influence of the drug industry.(Zosia Kmietowicz)
GlaxoSmithKline was found to be in breach of a clause of the code of conduct of the Association of British Pharmaceutical Industry for paying for a third party or practice staff to switch asthma patients who used both salmeterol (Serevent) and beclomethasone (Becotide-100) to Seretide, a dual action inhaler containing salmeterol and fluticasone (Seretide). Beclomethasone is available in generic form, while the other two products are available in the United Kingdom only as branded drugs.
Information drawn up by GlaxoSmithKline to promote the product stated that in a practice of three GPs and 4500 patients switching patients to Seretide would result in typical savings of ￡9789 ($17 600; 14 200) a year.
The authority rules that although "companies could of course promote products on the basis of cost... the difficulty was when the company paid directly or indirectly for those changes to be made, because then the company's actions amounted to it paying to boost the prescription of a specific medicine."
Des Spence, a GP in Glasgow who reported the scheme to the association, said the practice of switching patients from an older product to a newer one with a longer patent was widespread and a means for drug companies to maintain profitability.
In June the association made a similar ruling against Wyeth for paying for "GP system specialists" to identify patients on GPs' list who would be suitable to change from Zoton (capsules of lansoprazole) to Zoton FasTab (orodispersible tablets of lansoprazole) ( BMJ 2004;328: 1515).
Dr Spence, who heads the campaigning group No Free Lunch, said that another problem with switching was that patients were not being asked to consent.
"It is our perspective from No Free Lunch that this ruling on Seretide reinforces that the widespread practice of `switching' breaches the ABPI code and should stop," he said. "In general terms it is our view that most or all of the `support' offered for general practice is in fact merely marketing by the back door. We call for more regulation and better guidance for general practice on what is acceptable industry activity."
A spokesperson for GlaxoSmithKline said: "GSK accepts that the materials used to introduce its Airways Integrated Management (AIMS) service to practices were, although unintentionally, in breach of the Code of Practice and has agreed to withdraw these materials. However, it is important to note that the AIMS service was not found in breach of the ABPI Code of Practice and GSK remains committed to this service, which offers both potential patient and practice benefits.
"The AIMS service is designed to assist doctors in transferring patients receiving both inhaled corticosteroid (ICS) and inhaled long acting beta2-agonist bronchodilator (LABA) as separate inhalers to a therapeutically equivalent combination formulation, if, after review by the doctor, this is considered to be the most appropriate treatment for the patient. The GP identifies the profile of patients who they feel may benefit from either a therapy change or asthma review and determines whichever combination inhaler they feel is most appropriate for the patient. This offers potential clinical benefits to the patient and potential cost-saving benefits to the practice."
Dr Spence will be presenting evidence next week to the House of Commons Health Committee's inquiry into the influence of the drug industry.(Zosia Kmietowicz)