Don't let them kill off the NHS

“As long as you’ve got your health.” It’s a refrain I remember my mother sharing with her friends and relations as we were growing up in the 1950s, in the days when the National Health Service, established in 1948, was new.

Socialised medicine, offering universal access to tax-funded health care, free at the point of delivery was as good as a revolution for the majority in the UK. Well, almost.

The history books show that the NHS, as part of the welfare state, was conceived of partly in response to the revolutionary aspirations brewing amongst the victorious fighters returning from action in the Second World War.

Now at 65, having reached pensionable age, the NHS is itself ailing.

The A&E unit at Trafford General Hospital, from where the NHS was launched in July, 1948, is to shut. Eleven more hospital trusts have joined Mid Staffordshire in “special measures” due to concerns over unusually high death rates and poor care.

From worldwide acknowledgement as the healthcare model to be admired, providing the best care at least cost, the NHS is now falling back in terms international ratings.  

Amongst the biggest and most complex organisations in the world, employing 1.3 million people, the NHS has been through many reorganisations as it grows and changes to meet the needs of the now aging population, and to take advantage of new technologies.

But the causes of its current sickness are more external than internal.

Since its inception the NHS has been subject to exploitation by private sector for-profit suppliers of drugs, medical equipment, information systems, you name it.  The news that Big Pharma company Pfizer is party to a legal price-fixing scam exploiting loopholes in the cosy Pharmaceutical Price Regulation Scheme that has set “acceptable” profits for years, is just the latest example.  

In 1992, Conservative prime minster John Major’s introduction of the Private Finance Initiative into public sector projects was a key moment in the transition from welfare state to market state. This was taken forward after 1997 by Blair’s New Labour.

Through 30-year leasing contracts with private sector developers, the NHS and other public sector services, deliberately starved of direct funding, became saddled with monstrous debts and are now conduits for the transfer of wealth.

Taxes are collected and passed through the public sector to the private sector organisations. On its way through, the labour of those who work in the public sector become the source of the profits distributed to the shareholders in the private corporations.

New Labour’s introduction of business-type foundation trusts, which set hospital against hospital in competition for private patients, leading inevitably to financial calamity in some cases, was another moment in the transition to the market state.

It seems the previous government turned a blind eye to mounting problems. Now the ConDems are opening up whole swathes of the NHS to the private sector in a further twist of the knife.

In the 10 years leading up to the current great recession, health spending in the United Kingdom grew in real terms by 5.7% per year on average. This came to an abrupt halt in 2010 as health spending dropped by 1.9%, in real terms, with a further 0.4% fall in 2011.

Now there’s talk of an end to the ring-fence protection in England, following the example of Wales, where the health budget has already been cut by more than 20%. Hospitals are shutting, jobs being slashed, services disappearing.

Throughout its 65 years, the NHS has co-existed with capitalist social relations. As in most countries, expenditure on health care has been predominantly through the public sector. The deepening global crisis is rapidly undermining that uneasy co-existence.

Socialised healthcare is a model for a society motivated by the needs of the people. Rather than watch the wrangling over the blame for its decline, we should build new forms of democracy that can convert the rest of the economy to its principles. With goods and services like the NHS under the direct control of producers and users, we could achieve the type of society we need.

Gerry Gold

Economics editor

Big Pharma more of a threat than a cure

The absurd notion that taxpayers should give money to the drugs industry as an incentive to develop a new generation of antibiotics demonstrates how a handful of corporations have their proverbial fingers round society’s throat.

Using fairly sensational language to set the alarm bells ringing, the government's chief medical officer Professor Dame Sally Davis says the threat posed by antibiotic resistance is on a level compared to global terrorism. Actually, the threat posed by Big Pharma is worse.

Big Pharma – the handful of corporations that control the global industry – haven’t produced a new range of antibiotics for 20 years because there’s little profit in selling this type of drug.

During that time, the over-prescription of antibiotics by health practitioners and their intensive use in livestock farming to make meat cheaper has spawned new bacterial strains that are immune to existing drugs. Others have become so difficult to treat that they kill some 25,000 Europeans yearly.

So Professor Davis is warning that without new antibiotics routine operations could become endangered by infections that cannot be treated, for example. But leaving it to Big Pharma will prove as dangerous as the new bacterial infections themselves.

In 2010, the top 10 pharmaceuticals had astronomical revenues totalling over $500 billion. Much of it comes from drugs we don’t need and from denying developing countries the right to sell generic equivalents at lower prices.

Ben Goldacre’s book Bad Pharma reveals how companies run bad trials on their own drugs, which distort and exaggerate the benefits. Data that doesn’t support the results is buried. Meanwhile, the medical profession is beholden to the same corporations and, he argues, are actually educated by the drugs industry.

As far back as 2002, an article in the British Medical Journal accused the industry of extending the boundaries of treatable disease to expand markets for new products. A decade later, the BMJ has launched a campaign entitled 'Too Much Medicine', saying: “There is growing evidence that many people are over-diagnosed and overtreated for a wide range of conditions, such as prostate and thyroid cancers, asthma, and chronic kidney disease.”

Former editor Richard Smith, who now works for a health care group, says that

only 11% of 3,000 health interventions have good evidence to support them, with 80% of new drugs copies of old ones.

When it comes to holding on to patents to enforce monopolies, Big Pharma has an appalling record. Dylan Gray’s film “Fire In the Blood” documents how the corporations and governments blocked access to low-cost AIDS drugs – causing millions of unnecessary deaths.

He says: “At the industry's behest, governments in the US and Europe use a dizzying variety of trade mechanisms, threats of sanctions and so on to curtail supplies of affordable medicine in the global south. The potential impact of these measures in human terms is nothing less than cataclysmic.”

There are solutions we could pursue if the profit motive was not the main driver. First, over-prescribing has to stop. Doctors have to put patients first instead and abandon the quick-fix approach as well as misplaced loyalties to drug firms.

Secondly, we should note that  84% of worldwide funding for drug discovery research comes from government and public sources, against just 12% from pharma companies. Apparently, researchers have already discovered new antibiotics but haven’t got the funds to develop them.

So the science is there. However, the technology and capacity to turn knowledge into products is in the hands of the top 10 – Pfizer, Astra Zeneca, Johnson & Johnson, Novartis, Bayer, F Hoffman-La Roche, Merck, Sanofi, GlaxoSmithKline and Abbot.

That’s what has to change. Global health cannot be determined by a handful of profit-driven corporations. Giving them funds, especially at a time when austerity is cutting key services, is a shocking idea. Instead, Big Pharma has to come into common ownership and no effort spared to develop drugs that benefit the sick and not shareholders.

Paul Feldman

Communications editor

Big Pharma talks patent nonsense

Big Pharma never ceases to surprise but the demand from Novartis that the NHS uses one of its expensive products rather than a cheaper one really takes the biscuit.

In a bid to reduce drug costs, four NHS areas in the south of England are using a cheaper alternative to Lucentis to treat a common cause of loss of vision known as wet AMD.

Lucentis, which costs around £740 per injection, is the treatment officially recommended to the NHS in England by the independent advisor NICE.

Avastin, also made by Novartis, is not officially approved for eye conditions, but is being used when it is prescribed by a qualified opthamologist. It costs around £60 per injection.

"Avastin is internationally recognised as an effective treatment for AMD, and for example over 50% of AMD patients in the United States are treated with Avastin," the NHS trusts say.

Novartis is now going to court to claim that the hospitals are putting hospital patients at risk by using Avastin instead of Lucentis, which, coming from an industry known for all sorts of data manipulation, is really too much.

In the end, it’s about the corporation’s profits, much of which comes from supplying drugs to the NHS. The health service’s annual drugs bill is £12 billion, almost double the total cost a decade ago.

The judicial review launched by Novartis comes as the corporation renews its challenge in India against a law which prohibits indefinite extension of patents. For over six years, it has challenged a clause that prevents “evergreening”, a practice in which companies continuously extend the life of a patent by slight modifications.

This prevents generic manufacturers from producing the drug. India is a major exporter of generic medicines to developing countries, including 80% of the medicine now used to treat over 6.6 million people living with HIV/AIDS.

According to Nature magazine, Novartis is also seeking a 20-year patent on a new version of its 11-year-old anti-cancer drug Gleevec, which costs roughly $30 for one 100-milligram pill. A generic version of the drug can cost as little as $3.

Leena Menghaney, campaign coordinator of Medecins Sans Frontieres in India, who is leading the fight against the Novartis challenge, says the country is also facing a diplomatic offensive from the European Union and the United States. They want India to give into Big Pharma’s demands.

When India signed up to the World Trade Organisation's agreement on trade-related aspects of intellectual property rights (TRIPS) in 2005, the country won a clause that states that a drug must show a marked difference in efficacy from previous versions to be patentable. “Whereas US patent offices often grant frivolous patents on routine pharmaceutical improvements to a drug, India's law is more stringent,” says Menghaney.

With final hearings in the Supreme Court scheduled for July, she warns: “If Novartis wins, many other medicines, even those that show no increased therapeutic efficacy, will be patentable in India, and the availability of affordable medicines will be threatened… Abusive “evergreening” practices, where drug companies maintain artificially high prices on medicines well beyond the original patent period by securing fresh patents on minor modifications of existing drugs, will become rampant in the future.”

Big Pharma – the top 20 corporations have an estimated $150 billion in resources – is more interested in protecting patents than developing new drugs against common diseases, or in persuading people to buy “lifestyle” drugs they don’t really need.

Scientists say that little new has come out of the industry over the last decade. Meanwhile, universities are starved of resources and money devoted to research. Big Pharma has an unhealthy grip on society’s collective throats that requires a strong dose of revolutionary medicine to get rid of.

Paul Feldman

Communications editor

Big Pharma is not good for your health

Swine flu is big business for pharmaceuticals like Roche, the manufacturer of the antiviral drug Tamiflu and the other giant corporations now producing vaccines to sell to desperate governments. Whether the products actually work is another matter and getting the trial data is nigh on impossible.

Big Pharma is effectively a secret society that owes its gigantic profits to the National Health Service in Britain and its equivalent in other countries. Take Roche and Tamiflu. Doctors say that are unable to assess how effective the anti-flu drug is because the company will not release evidence obtained from trials.

In fact, an independent review published by the British Medical Journal (BMJ) has found no evidence that Tamiflu can prevent healthy people with flu from suffering complications such as pneumonia. Although the drug may cut a day or so off the illness, it is impossible to say without access to Roche’s data. "Governments around the world have spent billions of pounds on a drug that the scientific community now finds itself unable to judge," said Dr Fiona Godlee, editor of the BMJ. Sales of Tamiflu have netted Roche sales of £1.6bn this year alone. The British government has stockpiled enough for half the population.

A second review was carried out at Birmingham University by Professor Nick Freemantle and Dr Melanie Calvert. Freemantle said he was surprised to see such a widespread use of Tamiflu and added: “But I suppose that once you've gone and bought lots of doses, then it's a bit like the situation with gun control in the US. If you have a gun in the house, it is much easier to use it. But it does not mean it's the right thing to do."

But it’s not just Roche who are cashing in. Other Big Pharma corporations are doing nicely out of producing vaccines directed at the H1N1 swine flu virus. Swiss pharmaceutical giant Novartis has opened a large-scale, cell-culture manufacturing plant in America – backed by $487 million in federal funding. The plant will be able to produce 50 million doses of seasonal flu vaccine and 150 million doses of pandemic vaccine.

One of the reasons that vaccines are back in fashion is that patents are running out on the industry’s core prescription drug business. Some $135 billion in prescription drug sales will lose patent protection in the next five years, and there's little in drug companies' pipelines to replace those sales, according to health industry analysts like Alan Sheppard of consultants IMS.

Big Pharma’s claim that it is a socially responsible industry that has to make huge profits to fund research into new drugs that are then made available to the public belongs in the realm of fantasy. For example, a study by two York University researchers last year estimates the US pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry's claim. The study found that the industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales.

Big Pharma is a cash rich industry – the top 20 corporations have an estimated $150 billion in resources – that is now more interested in protecting patents than developing new drugs against common diseases, or in persuading people to buy “lifestyle” drugs they don’t really need. Scientists say that little new has come out of the industry over the last decade. Meanwhile, universities are starved of resources and money devoted to research has fallen in real terms. Big Pharma has an unhealthy grip on society’s collective throats that requires a strong dose of revolutionary medicine to loosen.

Paul Feldman
Communications editor

Milking the NHS

So even the chair of the government’s own drugs watchdog has had to acknowledge what everyone else working in health has always known – the pharmaceutical corporations milk the NHS for all its worth and patients in need are the biggest losers (along with taxpayers).

Professor Sir Michael Rawlins launched his tirade against drugs companies after the National Institute for Health and Clinical Excellence (Nice) was accused of “barbarism” for refusing to approve new kidney drugs for NHS use because of their cost. Rawlins said it was common knowledge that some companies charged what they thought they could get away with. “We are told we are being mean all the time, but what nobody mentions is why the drugs are so expensive,” he said. Kidney cancer drugs could be produced for about a tenth of their current cost, Rawlins claimed.

Rawlins cited three key factors in the cost of drugs. One was the fact that many older drugs were soon losing patent protection, allowing rivals to produce cheaper versions. Secondly, the price of shares was paramount. Rawlins insisted. “Pharmaceutical companies have enjoyed double-digit growth year on year and they are out to sustain that, not least because their senior management's earnings are related to the share price. It's not in their interests to take less profit, personally as well as from the point of view of the business. All these perverse incentives drive the price up.” The third factor was the cost of marketing.

This is not a new story. In 2005, the Commons health committee reported that the pharmaceutical industry “has been left to its own devices for too long” and added: “The Department of Health has for too long optimistically assumed that the interests of health and of the industry are as one. This may reflect the fact that the Department sponsors the industry as well as looking after health.”

The committee heard allegations that clinical trials could be designed to show the new drug in the best light – and sometimes failed to indicate the true effects of a medicine on health outcomes relevant to the patient. They were informed of several high-profile cases of suppression of negative clinical trial results and of selective publication strategies and ghost-writing. The committee lambasted the intensive promotion of medicines to prescribers, especially GPs. Promotion of medicines to patients and links between drug companies and patient organisations may add to this problem, said the report, which added:

“The most immediately worrying consequence of the problems described above is the unsafe use of drugs. Over-prescription of the COX-2 inhibitors, Vioxx and Celebrex, has been linked to thousands of deaths and many more cases of heart failure. These cases illustrate a series of failures. Manufacturers are known to have suppressed certain trials for these drugs in the US and may have done the same in the UK. In addition, there were inadequacies in the licensing and post-marketing surveillance procedures and excessive promotion of the drugs to doctors.”

The NHS drugs bill has doubled under New Labour to over £11 billion a year, 80% of which goes on prescribed medicines. The real question is, if 1.3 million people can work in the not-for-profit NHS, with the majority of basic research done in publicly-funded universities, why can’t drugs be produced in the same way? The answer is that the market state acts as a guarantor for the drugs companies instead of the needs of the sick and is a barrier to the comprehensive socialisation of health care.


Paul Feldman
Communications editor

The hidden unholy alliance

The backlash from senior religious figures against the human fertilisation and embryology Bill before parliament should not be allowed to obscure their medieval, anti-science viewpoint on the one hand and the government’s close connection with biotech corporations on the other.

Cardinals and bishops throughout the land used Easter to launch ferocious attacks on the government for refusing – so far - to allow a “free vote” in the Commons. Cardinal O'Brien, Scotland's most senior Catholic cleric denounced what he called "Frankenstein" experiments and called the Bill’s proposals a "monstrous attack on human rights, human dignity and human life". The Church of England joined the fray in the form of Tom Wright, the Bishop of Durham. He saw fit to denounce the government for “pushing through, hard and fast, legislation that comes from a militantly atheist and secularist lobby”.

Cardinal Cormac Murphy-O'Connor, the Archbishop of Westminster, has called for Labour MPs to be granted a free vote, saying: "I think Catholics in politics have got to act according to their Catholic convictions, so have other Christians, so have other politicians.” Three Catholic cabinet ministers are taking their cue from the Pope’s man in Britain - Welsh Secretary Paul Murphy, Transport Secretary Ruth Kelly (a member of the highly secret, far-right Opus Dei sect) and Defence Secretary Des Brown – and are threatening to leave the government.

They oppose the Bill because it allows the use of cloned embryos in the very early moments after fertilisation, which they claim is a form of murder. The Catholic Church’s opposes abortion on similar grounds. In fact, the use of stem-cell therapies, which is what the tiny balls of cells (which in no-way can be called human beings) are used for, has already been proved beneficial in treating Parkinson’s disease. The Catholic Church and other opponents of scientific knowledge want to cash in, as always, on people’s fears and ignorance of the hidden processes by which a human being arises from just those clumps of cells.

There is an entirely justified fear and distrust of another unholy and hidden alliance – that between politicians of all parties and the global corporations whose interests dominate scientific and medical research of all kinds. Brown’s main concern is that biotech corporations will be left behind by their competitors if the Bill doesn’t go through. How they steal an advantage is another thing. Only recently GlaxoSmithKline was forced to admit that it had covered up the fatal effects of Prozac on young people by refusing to place internal research in the public domain.

The secrecy surrounding patents of new medicines, the use of wide swathes of the population as guinea pigs for new drugs, the premature prescribing of new products due to pressures from corporations on the medical profession – in short, the wholesale entry of market forces into the National Health Service have all contributed to fears of unchecked experimentation.

In our book, A World to Win, we document the way in which the Biotechnology and Biological Sciences Research Council is dominated by commercial interests, in particular companies like GlaxoSmithKline, Astra-Zenica, Unilever and United Biscuits.

At present, the choice is between leaving the questions of scientific research to a toothless parliament in hock to corporate interests, who will secretly experiment on people, or endure new forms of moral intolerance and anti-science, parading under the banner of “freedom of conscience”. There has to be another way. The row over this Bill shows the urgent need for a science that is financed and controlled with the interests of society as a whole at the centre of research rather than the balance sheets of Big Pharma.

Corinna Lotz
AWTW secretary

London NHS review smokescreen

Radical proposals for revamping the capital’s health services intended to meet the needs of Londoners, include far more than the widely-reported intention to move the majority of care from old-style general hospitals to polyclinics and urgent care centres closer to people’s homes. Few would argue with the need for more and better services provided through community-based facilities designed to overcome inequality, complemented by an integrated network of specialist hospitals.

But deep in the report, and destined to disappear, are links with the Mayor’s Health Inequalities Strategy and acknowledgement of the long-forgotten Wanless reviews carried out in 2002, 2003, and 2004 which concluded that the "fully engaged scenario’" was the cheapest option and delivered the best health outcomes. In this scenario, the level of public engagement in relation to health is high, life expectancy goes beyond current forecasts, health status improves dramatically, use of resources is more efficient and the health service is responsive with high rates of technology uptake.

Professor Sir Aru Darzi, author of the new report, commissioned by London’s Strategic Health Authority, is a high achieving, and internationally-respected surgeon soon to become a life peer. Having completed his report, Professor Darzi has been drawn into Gordon Brown’s government as a junior minister and is charged with yet another review of the NHS as a whole. And the image of high-tech surgical incisiveness is being used to replace the messy business of democratic participation.

Brown’s enthusiastic adoption of Professor Darzi’s clinically-led, needs-based approach is a cynical smokescreen designed to bring the influential doctors onboard. The NHS infrastructure consists of an ageing stock of buildings being replaced by privately-financed millstones of debt. But the debt remains, and Brown’s commitment to the voracious needs of the City of London will ensure that the doctor’s enthusiasm for science is subordinated to it. Whilst Darzi is careful to say that the PFI-funded old-style hospitals can be reused in his revamped integrated service, he also offers up surplus land as a means to finance development. Estate agents and speculators will be rubbing their hands in glee.

Darzi’s claim to have sought the views of Londoners can hardly be described as comprehensive, nor did its methods match up to the Wanless "fully-engaged scenario" it references. Ipsos MORI conducted just 20 minute of telephone interviews amongst 7,036 London residents between 22nd September and 27th November 2006. Londoners’ health and social needs must be based on a fully-participative democratic process, involving residents, managers, doctors, paramedics and nurses, whose members in England in an historic move are about to launch a formal ballot on industrial action over the government’s below inflation pay offer.

Gerry Gold, economics editor

Bird flu: a bonanza for Big Chicken

A corporate vision of globalised, full-integrated factory farms and slaughterhouses churning out standardised birds for supermarket shelves is being drilled into decision makers using the threat of a bird flu pandemic. The corporate bonanza is destroying traditional poultry systems and poultry biodiversity that hundreds of millions of people depend on for their food security and livelihoods. In the wake of the recent bird flu outbreak at Bernard Matthews’ turkey factories in Norfolk, Big Chicken – the group of huge and powerful corporations that have grown to dominate global poultry production in recent years – are rampant. A new report shows that agribusiness, Big Pharma and international agencies are using avian influenza to maximise corporate profits and push forward even deeper changes that will further squeeze the poor. It was produced by GRAIN, an organisation that promotes sustainable management and agricultural biodiversity. The report reveals that local resistance is gradually building, producing tensions between small producers, governments and UN agencies like the Food and Agriculture Organisation where corporate lobbies are entrenched. GRAIN’s report shows that although authorities are finally acknowledging the role played by the poultry trade in spreading the virus, the message to poultry farmers is still, "Get big, really big, or get out".

In Indonesia, Russia, India and Egypt, as well as in the UK, governments and the international agencies are rushing to the industry's defence, turning the bird flu crisis into an opportunity for the larger corporations to consolidate their control. GRAIN’s report says that the company that probably first brought bird flu to Vietnam is ready to take advantage of the latest crisis. "Charoen Pokphand (CP) will succeed in turning a crisis into an opportunity of development," says Sooksunt Jiumjaiswanglerg, president of CP Vietnam Livestock. The giant Thai-based transnational corporation, which supplies fast-food chains in Asia like KFC, controls around 80% of Vietnam's industrial chicken production and anticipates its growth in the country to soar by 30% per year. "Yet in a nation where an estimated 80% of the country's poultry production was at least until recently in the hands of small scale producers and over 70% of Vietnamese households keep poultry, it is no wonder that many independent poultry raisers are simply taking their chances and going underground," GRAIN reports.

The conflict over avian flu is widening to bring some countries into confrontation with the pharmaceutical giants. Indonesia, following China, has cut the supply of local H5N1 (bird flu) virus samples to the World Health Organisation, in an attempt to prevent big pharmaceutical manufacturers accessing the information to produce proprietary drugs. As GRAIN says, the whole power imbalance cemented into this system is grotesque. Poor countries supply "raw materials", for free, to a global pharmaceutical industry that concentrates market power and reaps huge profits through monopoly privileges called patents. Meanwhile, it is the poor countries that are facing the biggest public health problems. Indonesia has been calling for the WHO and others to help them develop the capacity to produce vaccines for themselves. But pharmaceutical corporations like Syngenta, Novartis and Pfizer are fighting ferociously in India, Thailand and the Philippines to prevent compulsory licensing and generic manufacturing. Any vaccine against a bird flu pandemic and the technology to produce it, should be shared and made available for free. The patent system serves little purpose in the health field except to enrich drug companies and their shareholders and is a barrier to tackling threatened pandemics like Avian flu, which themselves have their origin in industrialised agriculture.

Gerry Gold, economics editor