Tuesday, 28 June 2016

NHS Scotland needs a Sunshine Act: The Guardian 28Jun16: Dr Peter J Gordon

Scotland's NHS needs a Sunshine Act to make pharma links transparent 
28 June 2016, The Guardian, Dr Peter J Gordon, Consultant Psychiatrist, NHS Lothian, Scotland

PE1493: A Sunshine Act: Scottish Parliament
"There is a longstanding joke about the lack of sunshine in Scotland.

Three years ago, I began the process of raising a petition with the Scottish parliament to urge the Scottish government to introduce a Sunshine Act.

A Sunshine Act makes it a statutory requirement for all payments from commercial interests made to healthcare workers and academics to be declared publicly. The metaphor is that sunshine brings full light. Both the US and France have introduced a Sunshine Act. 

While a junior doctor in around 2000, a consultant handed me a several-hundred page document entitled Behavioural and Psychological Symptoms of Dementia. The consultant told me: “This is the way forward.” Some years later I realised that this document had been developed, funded and disseminated by the pharmaceutical industry.

After the dissemination of this document, the prescription of antipsychotics, sedatives and antidepressants for dementia patients in Scotland has been rising year on year. This mass prescribing is often long-term. Yet the evidence to support such prescribing is poor.

There is much promotion of partnership working between industry and healthcare. Yet we must remember that these two partners have different aims, and it is the responsibility of healthcare workers to follow the ethical approaches central to their professions. The General Medical Council is clear about what is expected of doctors in its Good Medical Practice document. The potential for conflicts of interest is recognised, and doctors are advised: “You must be open about the conflict, declaring your interest formally.”

Scottish government guidance has been in place since 2003 allowing the declaration of financial interests of NHS staff to their health boards. As a result of my petition, the Scottish government has confirmed that this guidance is not being followed.

One key area of concern is the mandatory continued professional education of healthcare professionals. In at least two NHS Scotland boards, continuing medical education relies entirely on the financial support of commercial interests.

National and international conferences may also form part of continuing professional education. Because of the Sunshine Act in the US, we know that a keynote speaker at a recent UK conference has been paid more than $3m (£2.3m) by the pharmaceutical industry since the Sunshine Act was introduced. There is currently no way of knowing the scale of any payment made to a UK speaker sharing the same platform.

My experience of trying to establish whether there is transparency about financial payments to healthcare professionals in Scotland has been revealing. I have encountered significant defensiveness from individuals and organisations. 

For instance, there has long been a body of evidence that prescribing behaviour is influenced by commercial interests, but doctors find it hard to accept this. This collective denial would suggest that the forthcoming (voluntary) ABPI (Association of British Pharmaceutical Industry) register is unlikely to work, as many will opt out, regarding it as inapplicable to them.

As part of its consideration of my petition, the Scottish government commissioned a public consultation exercise on whether a Sunshine Act is needed or not. The majority of participants believed that it should be mandatory for all financial payments to be declared on a single, central, searchable register. The outlook for Scotland may be cloudy for the moment, but there’s a chance of sunshine in the longer-term forecast."


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