A little bit on the side

Recently there has been considerable agitation, both in the press and elsewhere, regarding experiments on animals to assess the usefulness and possible side effects of new drugs. However, whereas probably a good case can be made out against the use of inoffensive animals unable to protest, it is strange that there has been no similar outcry following an article in the Sunday Times on 29th January 1978, headed “Patients put at risk as doctors aid drug firms in sales drive”. In this, two of the paper’s medical correspondents give a frightening insight into the use of human beings who, not only are not consenting, but usually are unaware of the fact that they are being used as guinea pigs.

We have heard before of the amount of ‘bumph’ pushed through doctors’ and dentists’ letterboxes, advertising and sometimes sampling, the latest offerings of the major drug companies. Indeed it could be argued that, being grossly overworked, doctors do not have time to read all the medical trade journals and this is one way in which they become aware of new treatments available. However, this is not where the matter rests.

In order to persuade doctors to prescribe their drugs, major manufacturers offer inducements—‘a little bit on the side’. This may take the form of presents— stethoscopes, digital clocks, bottles of whisky—flat cash payments of £5 or £10 per patient, or payment by results. In one case a company pays doctors £2 for recruiting a patient, £3 if the patient stays on the drug for a week and £4 if he continues for a month. Bearing in mind that if the patient stays on the drug at a prescription cost of £50 to £100 a year, it means that for an investment of, say, £100.000, a drug company has created a market of £1 million a year.

Of 39 doctors interviewed by the Sunday Times, 4 admitted they had not told patients that drugs had been changed, 27 said that taking part in the ‘trial’ had influenced their choice of drugs; some of the remainder stated they would not have prescribed the drug if they had not been asked to ‘test’ it. When questioned the medical director of one drug company said it never occurred to him that the increasing scale of payment offered might induce some doctors to keep patients on drugs for longer periods, in order to qualify for the increased payments! As far as these prescriptions are described as ‘tests’ or ‘trials’, senior medical opinion is agreed that, as minimum information (if any) is requested from doctors and they are discouraged from enquiring about efficacy or side effects, these ‘trials’ are clinically worthless.

The enormous profits made regularly by the major drug companies are consistently defended on grounds of necessity to plough back funds into development of new lines. When tragedy like the Thalidomide babies occurs the ‘ethics’ of their operation are discussed under banner headlines, but the consistent abuse of National Health patients—members of the working class—to make these profits ‘on the cheap’ goes unnoticed.

Eva Goodman