18 The Drug Machine

	...the national health will not improve until patients demand a greater 	role in the provision of their own treatment. This will not be easy. 	Doctors, as we have seen, jealously guard their privileges. The drug 	industry jealously guards its profits..
	The health providers, doctors, the drug industry and government, use the 	shroud of secrecy to keep the public in the dark.
	Dr J Collier The Health Conspiracy: How Doctors, the Drug Industry and the 	Government Undermine Our Health

Give Us This Day Our Daily Soma

In The High Technology Holocaust James Bellini writes that in 1969 more than half the adult population and almost a third of children were taking some kind of medicine every day and three quarters of drugs were obtained by repeat prescription. The local doctor had abandoned all responsibility for monitoring the progress of the patients condition and some people were still getting repeat prescriptions as long as 5 years after their last consultation.
Modern medicine is founded on drugs and a visit to the doctor will often result not in a diagnosis but in something to treat the symptoms. This is partly because the patient expects a pill to instantly cure their complaint and partly because it is easier and a lot quicker for a doctor to dish out a drug than spend time and effort investigating just what is really wrong with the patient and then give detailed advice on how to cure or minimise the condition. As Dr Nyewood said in Gathorne-Hardy's book, "It's a nice way of getting rid of the patient: you scribble something out and rip the thing off the pad. The ripping off is really the "Fuck off"."
And as good advice will often include measures like stopping smoking, reducing alcohol intake, losing weight or changing eating habits and other lifestyle changes many patients would rather not inconvenience themselves. They would like to keep their unhealthy habits and have the unwanted effects removed with a magic pill.
Also many ailments are caused, or aggravated, by life circumstances like poverty, poor housing, polluted environments, life stresses and damaged, unhealthy or inadequate social relationships. The medical profession can do little or nothing about these factors and prescribes drugs to control physical sickness and tranquillisers to deaden anxieties.
This is good news for the drug companies who make vast profits on what are often dubious products. No drug is totally free of side effects or dangerous interactions and some of the most innocuous seeming have been the most deadly. For some diseases, such as steroid deficiency, drugs are life savers but the same drugs given for trivial complaints can produce unpleasant effects in healthy people. And 700 Britons given steroids for eczema, arthritis and asthma are now taking legal action against their GPs, alleging damage caused by negligent overprescribing.
In England side effects are supposed to be reported by sending a yellow card to the Committee on Safety of Drugs. The system was first introduced in 1964 and at first less than 3,500 cards a year were sent in. It has been estimated that no more than between 1 and 10% of side effects are filed by doctors and 90% of all cards are submitted by just 10% of all GPs.
When it was withdrawn from general use in 1977 an estimated 7,000 patients had suffered adverse effects from Eraldin, a heart drug; but in the first 4 years of its use the CSM received only 1 yellow card.
Fulder writes, "It may well be that the doctor doesn't believe that you have side effects, or doesn't understand how you feel. It is not always apparent to patients how much a doctor is subtly guided and influenced by drug companies who are always keen to play down their drugs' disadvantages. A survey recently pointed out that 11 out of 28 advertisements in the British Medical Journal on 17/11/84 were in breach of the UK Medicines Law. In other words your doctor too might be duped, even if he has the best intentions."
Or perhaps he just can't be bothered filling in the cards - especially as he is not paid for doing so. And, of course, if he hasn't even seen the patient in the last 5 years he will have no idea of what effect the drug is having on its recipient.
A report in 1992 examining 109 drug advertisements in 10 leading US medical journals found half were misleading and 90% violated Food and Drug Agency advertising standards. Arthur Yellin of the FDA said that "the vast majority" of promotional material submitted for consideration by the agency is "false and/or misleading" but the FDA is able to take action on only 5% of cases, mainly because of lack of resources.
In Understanding Doctors, Dr Gillian Rice tells us that her day begins with a meeting of the practice partners at which, once or twice a week, a drug rep gives a quick update on their company's products. If doctors' views of drugs are shaped by contacts with the company rep and drug company advertisements while side-effects noticed by patients are depreciated or ignored it's no wonder that they have an over-optimistic view of the real effects of drug treatment.
In fact concern about doctors relying on advertisements and reps was voiced as early as 1910 and it has been found that the fewer prescriptions a doctor wrote in a week the less likely he was to rely mainly on drug industry information of new drugs. As Lexchin explains in Pharmaceutical Promotion in Canada, "the more doctors rely on commercial sources for their information about drugs the less rational they are as prescribers; that is, they are more likely to prescribe the wrong drug in the wrong formulation for the wrong reason in an incorrect dosage for an inappropriate length of time".
Gould, author of Medical Mafia, believes that "for want of the right training" too many doctors are largely ignorant of the potentialities, dangers, and the proper techniques for administering and monitoring the effects of drugs and "fall easy prey to the seductive advertising and promotional gimmicks of the pharmaceutical industry" and relates that a former president of the Pharmaceutical Society described the prescribing habits of doctors as "diabolical". 
The promotional gimmicks of the drug industry have included competition prizes and free draws for trips to Paris, Seoul and Singapore, free economy US air tickets, the use of a personal computer and hospitality. One anti-arthritis drug was launched with an extravagent bun feast of medics, transported to Venice on the Orient Express. The drug was later associated with serious side effects and deaths.
During 1973 the Kennedy Senate hearings revealed that 20 pharmaceutical companies gave 12.8 million gifts to members of the health-care professions and over 2 billion samples of free drugs. In Corporate Crime in the Pharmaceutical Industry Braithwaite notes that the reselling of free physicians' samples is a common practice in most parts of the world. He writes of a rep telling of a doctor getting medicines out of him for "poor patients", drugs he later saw the doctor exchanging for other products at a local pharmacist.
One of J Gathorne-Hardy's doctors mentioned, "we get quite a lot of free drug dinners actually. We go out at least twice a month on a drug dinner. These are proper dinner jobs, plenty of wine, you know." This doctor also did his own dispensing and sent his son to public school on his drug profits.
In 1986 the Royal College of Physicians noted that doctors had been offered as much as ?100 per patient by companies to put their patients on a particular drug and monitor the results. The fees paid for these pseudo clinical trials are described by Gould as "thinly disguised bribes" as the real purpose is to get the doctors concerned into the habit of prescribing the new remedy. At one time half of all UK prescriptions written for the heart drug Enalapril came from a post-marketing study arranged by the drug manufacturer.
Another advantage of these studies is that the cost is put down to research rather than promotion. However the scientific value of these uncontrolled tests is frequently negligible and Dr J McEwen, head of the Australian Drug Evaluation Support Branch, said he "would rather the companies wouldn't do these trials, as they are little more than marketing exercises." In fact Bayer offered gifts and cash payments to British doctors in bogus trials designed merely to switch more patients on to its brand of heart drug. The forms doctors filled in were never even sent to the firm's headquarters.
It has been found that drug company promotion did not just encourage doctors to prescribe their advertised drug - they prescribed more drugs generally. And making profits from drug dispensing must be another incentive to overprescribe.
In the US another of these overprescribing incentives has been found in the investments made by doctors. In 1964 Texas doctors had a financial interest in 1 in 25 of the state's pharmacies and 26 of the 126 Texas-licensed pharmaceutical manufacturing firms. One small company had 244 doctors among the 466 stockholders.

There's Gold in Them Thar Pills

In fact Dr Richard Burack found that the wholesale price of Valium was 25 times that of gold. Drugs have ranked first or second in profitability among all industries in most years since 1955. While average pre-tax profits ranged between 5.3-8.9% during 1970-1984 the US drug industry profits were 15.6-19.3% and in 1988 the 10 most profitable drug companies in the world recorded profit margins on sales ranging from 29-66%.
High profits in the pharmaceutical industry are the product of minimal price competition. For 9 categories of drugs Schartzman found that the leading 4 firms controlled the bulk of the market; sedatives - 61%, analgesics - 66%, antibiotics - 69%, antihistamines - 76%, oral diuretics - 77%, psychostimulants - 83%, tranquillisers - 86%, antiarthritics - 96%. Also many bulk producers are monopolies. Nearly 500 of the 650 bulk medicinal chemicals sold in the US in 1975 were available from only a single domestic source and only 4 were sold by more than 4 manufacturers. Bulk producers are therefore able to control the extent of the competition.
Drug companies allege that they need high profits to pay for research. Yet Schering bought a drug used for menopausal disorders in bulk from Roussel. Doing no research on the drug, Schering repackaged the product with their own labels and sold a bottle containing 11.7 cents worth of the drug for $8.40, a mark-up of 7,079%.
And if a company gets doctors into the habit of prescribing a new product when the patent expires it can often keep selling at prices 5-10 times those of cheaper brands. The average price charged in the US by the four lowest suppliers of reserpine was $1.17. The leading brand, Serpasil, sold for $38.71, more than 30 times as much.
Moreover although about 10% of drug sales turnover is spent on research and development some US corporations devote as much as 35% of their income to marketing and promotion. And most of the promotion budget goes on medical reps. In the UK 55% of company promotional budgets for 1983 went on reps. And, like all reps, medical reps are trained to sell, sell, sell.
Merck's instructions to its sales staff claimed safety and efficiency far in excess of that approved by the FDA. Merck urged their reps to, "Tell 'em again, and again, and again." "Tell 'em until they are sold and stay sold." "Now every extra bottle of 1,000 Indocin that you sell is worth an extra $2.80 in incentive payments. Go get it. Pile it in."
Indocin was a highly toxic drug with side effects including gut, eye, and liver damage, coma and convulsions. Indicated only for moderately severe arthritis it was pushed in Australia for trivial complaints like tennis elbow and aching tendons.
No wonder a 1977, Finnish study of drug presentations to doctors found that side effects and contraindications were often neglected and concluded that a rep's success was measured by the "volumes of sales, and not by improvements in the knowledge of physicians".
The primary goal of every drug company is to make money and many do not care how they do it. Dr Bush, responsible for getting drug companies to make penicillin available during the Second World War effort found that the drug pushers did not make experimental results and manufacturing processes developments generally available. While penicillin was needed for sick soldiers (many of whom were incapacitated because of veneral disease) the drug industry was "too busy trying to corner patents on various processes in the production of penicillin to produce much of it".
In Britain the drug industry funds 68% of all research, 20% comes from government sources and 12% from charities. However only an estimated 9.5% of drug company Research & Development money actually goes on basic research. Most goes on development - clinical testing and market preparation. And what they develop is slight variations of patented drugs already on the market. They get round legal monopolies on drugs by patenting a "me-too" product, structurally slightly different but having the same effect as the original product. Research time and money are wasted producing dozens of similar chemicals with similar effects.
A US Senate inquiry found that of the 348 new drugs introduced by US manufacturers between 1981 and 1988, 292 made "little or no" contribution to therapy and only 12 (3.5%) were rated as providing an important therapeutic gain. A French study of 508 new drugs marketed in the world between 1975 and 1984 found 70% offered no therapeutic improvement over existing products. And an analysis by the UK Department of Health and Social Security found that 65% of new products were non-innoviative, concluding that research was "being directed towards commercial returns rather than therapeutic need".
The bad record of drug companies is revealed in Braithwaite's book, which concludes that the pharmaceutical industry has "a worse record of international bribery and corruption than any other industry, a history of fraud in the safety testing of drugs and a disturbing record of criminal negligence in the unsafe manufacture of drugs".
The records of the US Securities and Exchange Commission show the largest bribe to be an alleged $4.6 million paid by the American Hospital Supply Corporation mostly through a Liechtenstein trust, "for the benefit of persons in charge of the (King Faisal Specialist Hospital) project, persons in an affected Ministry of the Saudi government and persons of power and influence with the Saudi government".
Medtronic, a heart pacemaker producer, admitted $323,663 in questionable payments, most of it to doctors. Two doctors were paid $8,262 for research papers of no substance. Though a sales intermediary, doctors buying pacemakers were paid a total of $48,500 - 15% of the sales value.
A cholesterol reducing agent, MER/29, was withdrawn after a flood of side effects were reported. The FDA found that experimental animal data had been altered.
Morton Mintz also writes, in By Prescription Only, of fraud and deception in the drug industry, where data fabrication is so widespread that it has its own slang - "dry labelling" or "graphiting". A Dr Robin, convicted of supplying drug companies with fraudulent clinical results, had "tested" 45 products for 22 firms, supposedly on 6,400 patients. Statistical analysis of his papers by the FDA showed his results to be impossible. An FDA check of a psychiatrist, hired by 6 pharmaceutical companies between 1971 and 1978 to test at least a dozen psychotropic drugs, found that only 3 or 4 out of 60 patients listed as having been tested had actually been given the drugs. Another FDA spot check of one assistant professor of medicine found some of the test patients were dead - but not too dead to sign consent forms. Between 1977 and 1980 the FDA found at least 62 doctors who submitted manipulated or downright falsified clinical data.
Between 1957 and 1963 Americans spent $16 million on weight reducing tablets called Regimen. During investigation of the clinical data Dr Brown, fee $1,000, admitted that 30 of the 43 charts he had submitted were fabricated and Dr Roberts was paid $4,000 for a report "untrue in its entirety", with 57 of 75 charts being complete fabrications and the rest having only the patients initials and starting weights correct. 
In November 1982 a Japanese company admitted to paying 2.4 million Yen to Dr Harcio Sampei, chief of plastic surgery at Nippon University, to put his name to bogus data, which was then presented to the Japanese Government.
With as much as $1,000 per subject paid by American companies no wonder Braithwaite records that some doctors can "earn" up to $1 million a year from drug research.
Yet only careless doctors are rumbled such as Jerome Rotstein, whose patient, June Froman, died in early July 1978 after an experimental arthritis drug, Sudoxican, destroyed her liver. Her doctor had sent reports, showing normal results, to the manufacturers even though he could not possibly have done any monitoring as he was holidaying in Europe at the time.
Even when clinical testing is honest it may not be accurate. A FDA study found the level of compliance with Good Laboratory Practices regulations varied from 36% to 98% and contract labs were found to have a worse record of GLP violations than sponsor labs. But the worst record of all was with university laboratories, although university researchers are supposed to be less likely to cut corners on research standards.
When, between 1972 and 1974, the FDA did a survey of compliance among 155 clinical investigators working for 15 sponsors 74% failed to comply with one or more of the requirements of the law for clinical investigators; 45% failed to get proper consent, 50% failed to keep accurate records of the amounts of drugs used, 28% failed to keep to study protocols and 23% failed to maintain adequate patient records.
FDA tests have found nitroglycerin tablets with only 16% of the labelled amount, prednisone with 30%, reserpine with 25% and morphine with 68%; eye ointments were contaminated with metal particles, injectible vitamins contained fragments of metal and glass, sulfa-drugs were contaminated with mould and hormone solutions with unidentified fever inducers. And in 1971 the US Center for Disease Control blamed 50 deaths on contaminated intravenous fluids.

In 1980 Eli Lilly launched an estimated ?1 million promotion campaign to convince doctors that Opren, an antiarthritis drug, was a genuine breakthrough with "an outstanding gastric tolerance level". Within 2 years GPs wrote 1.37 million prescriptions, at a cost of ?13.5 million. At least 70 people are believed to have died in Britain after taking the drug and an estimated 4,000 suffered injuries which included gastrointestinal bleeding, kidney and liver failure, and extreme sensitivity to sunlight. Older people metabolise drugs more slowly and therefore require lower doses if they are not to suffer from side effects. At the doses given Opren was toxic as well as potent. Although arthritis is mainly a disease of the old Opren was not thoroughly tested on older people.
It is estimated that Lilly paid $50 million in compensation to its US victims, Clarence Borom being awarded $6 million for the death of his mother. The 1,300 British victims got ?2.275 million in total. British law has a much more realistic assessment of the worth of old crocks.
A drug company can still make a fat profit on an unhealthy drug. In the US the FDA estimated that Panalba caused 475,000 cases of blood dyscrasias, 9 million hypertensive reactions and 475,000 liver disturbances as well as at least 12 deaths. While lawyers delayed FDA attempts to get the unsafe drug withdrawn Upjohn was grossing $1.5 million every month from its sales.
Suppression of facts is widespread. Where there are conflicting studies only those favourable to the drug are reported to the regulator and facts such as drastic effects on a small number of individuals are masked by diluting the effect among many, such as dramatic falls in haemoglobin in some animals being concealed by reporting only the haemoglobin average.
In 1950 dues and subscriptions provided the American Medical Association with $5 million and advertising in its journals, which had to pass a Seal of Approval program, brought in another $2.6 million. As the advertising income of some journals increased by a half while their own rose only 3% the AMA investigated and found that drug firms did not like restrictions on their advertising claims. So in 1955 the Seal of Approval was scrapped. In 1957 advertising revenues exceeded dues and subscription and by 1963 nearly half of the AMA's total income of $22.5 million came from advertisements, with the Journal of the American Medical Association alone carrying 5,262 advertising pages. When an article about a study of 34,000 women that concluded that pill users had a higher cervical cancer rate than diaphragm users was submitted to JAMA the editors insisted that it could only be published if accompanied by a rebuttal statement. The authors published in the British Medical Journal. The AMA's advertising income is tax-exempt on the ground that it is promoting the "art and science of medicine and the betterment of public health."
Pressure has been put on journal editors by drug companies not wanting unflattering articles published and a Dr Bean told the Kefauver subcommittee that some American journals had "refused to publish articles criticizing particular drugs and methods of therapy, lest advertising suffer." Companies have planted letters from their experts in journals to refute any criticism of their products and US Representative Fountain found that several articles published in the medical literature, supposedly providing an unbiased, drug evaluation, were at least partly written by the manufacturer or its agents.
In December 1986 three senior cardiologists at St Thomas's accused a US drug company of attempting to harass and discredit them when, during clinical trials, they decided that their experimental heart drug was neither safe nor effective.
Medical broadcasters and journalists receive drug money in the form of annual prizes provided by various drug houses, or paid excursions.
Symposia and seminars for health professionals organised by drug companies are seldom balanced and sometimes misleading.
Drug companies also try to get their products used as frequently as possible. Chloramphenicol (chloromycetin) was promoted as a broad-spectrum antibiotic and prescribed for everything from sore-throats to acne. In its first year, 1949, sales amounted to $9 million and by 1963 they totalled $59 million, 31% of all company sales. During its first 11 years it was prescribed to 40 million people. As the incidence of aplastic anaemia among chloramphenicol users was "conservatively" estimated as 1 in 60,000 by the California State Dept of Public Health it would appear that during this time over at least 666 chloramphenicol users developed this condition, which has a 50% death rate.
In 1962 a California woman was awarded $334,000 after her doctor prescribed chloramphenicol for a sore gum after tooth extraction and again for a bronchial condition. Some doctors realising that they might be sued over their prescribing habits concealed the evidence. Dr Watkins, whose son died after his father gave him chloramphenicol, experienced great resistance when investigating deaths due to the drug and found victims of aplastic anemia listed under such headings as brain hemorrhage.
A California father testified that when his 5 year old daughter died of aplastic anemia the doctor who used chloramphenicol on her said the death probably resulted from some toxic household product. The chloramphenicol prescription was found on file in the drugstore. This sounds like a particularly nasty attempt to "blame the victim" for medically caused damage.
Because of the uncommon chance of developing this lethal complaint the FDA warned that chloramphenicol "should not be used indiscriminately for minor infections". But manufacturers continued to push sales. In 1976 it was found that 3.5 to 4 million Americans were dosed with it each year. Had it been given only to those who truly had an indication for it the figure would have been no more than 10,000.

Even "charitable donations" are strategies for selling, with funds coming from marketing budgets, and being tax-deductible as business expenses. As Fortune magazine wrote, "When cleverly planned, they not only produce a charity-begins-at-home increase in sales, they also seem to encourage brand loyalty". However after the Bay of Pigs fiasco American drug companies even made a profit on their "charitable" contribution to the ransom paid to Cuba. Because the drug companies were allowed to claim tax on the selling price of the drug, which was many times the manufacturing cost, according to the New York Herald Tribune, Merck netted an estimated $300,000 on its donation and Pfizer $120,000.
On January 1963 Merck's president, J T Connor, said "Without the tax rulings absolutely nothing would have happened. The men would still be in prison."
Much research is a comparison of the effect of different doses of a drug or comparisons of a number of drugs. Drug companies are only too pleased to underwrite research which may show that their drug is effective at producing a desired effect. And they may provide free supplies of the drug involved. They are not interested in underwriting vitamin or mineral treatment research which will not bring in plump, patented profits. And naturally they do not want to investigate a disease and maybe find out that dietary changes will alleviate a disorder or simple health measures will prevent its development, and the need for subsequent drug treatment.
Dr Morrow Brown noticed that the possible association between diet and serious mental disorders was regarded with little interest by researchers. However such research would bring no profit to, and therefore no backing from, the drug industry, and researchers wanting financial support for the research that will make their reputation, and ensure their promotion, will choose drug orientated subjects to study.
Even the charities are influenced by the drug obsessed, medical profession and hope for some magic pill to make their particular ailment vanish.
Investigations of the causes and development of disease are less easy than a drug trial. These are organised by health organisations and may be undertaken over decades. And are usually disputed when they do appear.

Drugs and the Third World

Projects supported by drug money involve high tech Western remedies like hospital research, university research and professorial chairs, and research subjects are on Western ailments like heart disease and cancer. Although drug companies make 20% of their profits out of the Third World their ailments are largely ignored.
In 1963 a Brazilian inquiry found that local subsidiaries of drug companies were paying 5 to 10 times the international market price for raw materials from the parent company. Between 1968 - 1970 the degree of overpricing in Columbia ranged from 3.5 to 6.5 times international market prices.
Western companies may take out patents on their products in Third World countries to prevent anybody from manufacturing locally, ensuring that the patented products are imported at prices set by the patent holder.
In some developing countries there is a drug rep for every 4 doctors and drugs condemned as unsafe, or past their expirary date, are available on the open market, frequently inadequately or inappropriately labelled. When governments attempt to control the flood of dangerous, ineffective or inappropropriate drugs there is a howl of protest from the international drug companies, followed by threats of aid withdrawal from their home countries.
Neil Boyer of the US State Dept said it was the USA's "strong position that the World Health Organisation should not be involved in efforts to regulate or control the commercial practices of private industry, even when the products may relate to concerns about health. This is our view regarding infant food products, and pharmaceuticals and tobacco and alcohol".
The capitalist's creed, whatever they're selling, is, as the author of The True and Barbaric History of the Benighted States of Amnerica noted, "If it's good for business, it's good". For there are few morals or scruples in the market place - only profit and loss. A state of health is unhealthy for the drug industry since manufacturers rely on the frequent, preferably continuous, consumption of their products to maintain their profits. The ideal consumer is a permanent patient. No wonder the female has been medicalised. She can be dosed with the birth control pill in her fertile years and HRT during and after the menopause. Without even suffering any ailment she can provide the pharmaceutical industry with profits throughout her adult life. 
Meantime back in the Third World a family starves for the week when the parents are sold magic, Western syrups containing anabolic steroids to put flesh on their children's malnourished bones.
The grotesqueries of inappropriate Western high tech medicine (sometimes forced on the Third World as "aid") are illustrated by the tale told by Erik Eckholm, in The Picture of Health, of a Colombian hospital possessing a well-equipped, expertly staffed unit for care of premature infants. The immediate survival rate of these expensively salvaged babies was as good as those of North American special clinics but within 3 months of going home 70% were dead - victims of contaminated water supplies, inadequate sewage, overcrowding, dirt and disease.
In Costa Rica a programme of primary health care, immunisation, oral rehydration, improved water supply and sanitation and improved education reduced the infant mortality rate from 61 per 1,000 in 1970 to 19 per 1,000 in 1980.
It is a strange fact but the engineer has probably saved many more lives than the doctor.

Drugs in the UK 

Most of the available information on corruption, bribery and "graphiting" in the drugs industry comes from the US. This not because American companies are more corrupt but because the FDA is one of the more effective regulatory agencies and the US Freedom of Information Act enables citizens to get information hidden under the protection of "trade secrets" in other countries. Rules not enforced by active, powerful agencies are dumb, toothless watchdogs. Braithwaite tells of one business man who said that relying on a code of ethics was "like society issuing the ten commandments but not bothering to have a police force".
Regulation exists on paper only in many countries and one of the reasons why so many transnationals have drug manufacturing plants in Guatemala is because their product registration is rapid and really only a formality.
Mintz noted that while Parke Davis was obliged to include a long list of warnings, precautions, contraindications and side effects for Chlormycetin in an advertisement in the Journal of the American Medical Association at the same time it said nothing (because of non control in England) about those risks in the British Medical Journal, where the company claimed what it could not in the US - usefulness "in a wide variety of infections".
The FDA is required to publish a Summary Statement of Approval which explains in outline why a new product has been given a license. Publication of drug data in England was dismissed as being "uneconomical". Patients have no right to know why a drug was approved for sale, on what evidence it was considered safe and effective or what exactly it contains.
Drug manufacturers have less stringent requirements than food manufacturers. Those still using tartrazine are not obliged to reveal the fact even though some people can suffer severe allergic reactions to it.
Drug study raw data, which may reveal distortions or lies, is concealed by confidentiality clauses in the Medicines Act. Company secrecy is much more important than patient safety.
UK ethical committees may sit at centres where trials are conducted but they can be ignored, and even where they exist they may be inconsistent and ineffective.
Drug company profits, paid out of national insurance contributions, are treated as a national secret.
The Advisory Committee on Drugs, set up to run the limited list, operates in obscurity. It publishes no report of its activities and its members keep everything quiet under the Official Secrets Act. Even the work of the Medicines Commission is secret and its advice to ministers in the Department of Health remains confidential.

A large dose of market mentality is said to be just the solution for NHS problems. After Tory health reforms were introduced the number of health bosses rose from 390 in 1989 to 11,670 in 1993 and the pay bill for NHS general and senior managers swelled fourfold, from ?156 million to more than ?602 million. As more NHS money went on managers the infirm old and mentality disordered were thrown out, hospitals and wards closed, ward nursing staff reduced and anxillary services farmed out to anybody who could get the job done at the lowest cost, regardless of labour exploitation or corner cutting on safety or quality. Day operations became very popular as a way of bloating the numbers of operations done while reducing costs per patient. Long operations with long hospital recovery times were unpopular. No wonder waiting lists for hip operations (except for the rich of course) have lengthened.
As operating times were cut back by the NHS, frequently through lack of money for operating staff, increasing numbers of people decided to pay to get to see a specialist, or get an operation, next week instead of next year. Not only has private medicine increased 3 times in the last 10 years but Dr J Yates found that private payers hog more of the operations done, since although 10% of the population are privately insured 20% of all planned operations are now private.
I can't help wondering if this is a "final solution" for nationalised medicine. Yet ultimately private medicine relies on the NHS. Even when it does not directly use NHS beds and operating theatres it is staffed by doctors and nurses trained in NHS hospitals and medical schools and turfs out any uneconomic patients back onto state care.