One of the most critical concerns in medicine is the massive influence of the pharmaceutical industry over the medical profession. Our antivirals series has shown this pervasive action.
Bias exists when professional judgements from registered medical practitioners concerning a primary interest, such as the welfare of patients, may be influenced by secondary interests, such as financial gain or loss. Conflicts of interest can affect how healthcare professionals use, see and interpret evidence. Conflicts of interest, perceived or real, can also cause a huge loss of public trust in medicine, healthcare and government.
When it became clear that TV doctors Ranj Singh, Nighat Arif and Philippa Kaye had all received thousands of pounds in contracted service fees from AstraZeneca, there was, unsurprisingly, an outpouring of concern. All three doctors had been vocal in their public support for COVID-19 vaccines, of which AstraZeneca’s Vaxzevria was one of the first to become available and widely used in the U.K.
All three have insisted, via X, that their payments were for promotional work relating to AstraZeneca’s nasal flu vaccine in winter 2021 only and not their COVID-19 vaccine. The Human Medicines Regulations state that celebrity endorsement of drugs is not allowed, so it is unclear how this campaign stayed on the right side of the legislation.
Whether an individual doctor’s paid promotion of a vaccine for a respiratory disease should be considered a conflict of interest when publicly recommending other vaccines for respiratory disease is probably a debate for another day.
According to the Association of the British Pharmaceutical Industry (ABPI)’s Disclosures U.K. database, AstraZeneca’s payment of £12,500 to Dr. Philippa Kaye was declared in 2020. Since then, Dr. Kaye has publicly supported AstraZeneca’s COVID-19 vaccine and downplayed side-effects generally from all COVID-19 vaccines, saying the side-effects “are a good thing” and “your body showing you that its immune system is working”.
Also listed on the ABPI’s Disclosure U.K. Database is Dr Ranj Singh’s payment of £22,500 by AstraZeneca, declared in 2022. He appeared on BBC Morning Live on May 7th 2024 to discuss legal action over injuries and deaths linked to AstraZeneca’s vaccine. In both cases, as the doctors failed to declare their previous paid work with AstraZeneca, we assume they must be in breach of their contracts due to Clause 24 of the ABPI’s Code of Practice, which deals with Contracted Services. It states that all contracts for such services must include a requirement that the contractor declares his involvement with the contracting pharmaceutical company whenever he speaks publicly about any matters related to that pharmaceutical company.
If the declaration of interest was not included in AstraZeneca’s contract with the TV doctors, then the pharmaceutical company would be in breach of the ABPI Code and must self-report these incidents to the Prescription Medicines Code of Practice Authority (PMCPA) as breaches of the code.
Concerns about payments from pharmaceutical companies are not confined to these three TV doctors. The ABPI Disclosures database also reveals that AstraZeneca declared a payment of £5,892 in 2022 to Jonathan Van-Tam, the former Deputy Chief Medical Officer for England and member of the U.K.’s Vaccine Task Force – a payment which Van-Tam has not declared as a potential conflict of interest in academic work such as this SARS-CoV-2 study. This is not the only time that concerns have been raised over Van-Tam’s close connections to industry, with his appointment in 2023 by Moderna as a consultant causing controversy around the so-called ‘revolving door’ between public and private sector jobs.
In 2017, Tom warned: ‘The U.K. turns to Witty, Vallance, and Van Tam for leadership. Revolving doors‘? The consequence was predictable: the solution to every illness is more pharmaceuticals.
Meanwhile, another U.K. Government adviser and frequent media commentator on the benefits of COVID-19 vaccinations, including for children, Professor Peter Openshaw, was paid £2,251by Pfizer and £6,012.78 by Moderna in 2022. On September 14th 2021, Openshaw stated on BBC Today that, in relation to younger age groups having the vaccine, “If you want myocarditis, get Covid. Although there is a signal from vaccination, the signal from catching the virus is much greater in terms of inflammation of the heart.” At the time, a pre-print study put the risk of 12-15-year-old healthy boys experiencing cardiac adverse events such as myocarditis after vaccination at around four times higher than after being admitted to hospital for COVID-19.
It’s also worth noting that an individual practitioner’s obligation to declare involvement with a pharmaceutical company starts when the contract is signed, not when actual payment is made. Furthermore, the exact payment date to individual practitioners is not currently disclosed. Disclosure to the ABPI needs only to be made within six months of the end of the year in which payment was made. Meaning actual payment could be up to 18 months after the actual payment and even longer after the contract was signed. Therefore, we need much greater clarity about the exact timing of payments to highly influential doctors and the timings of when the negotiations started.
Arbitrary time limits severely hamper research into payments made by the pharmaceutical industry for disclosure imposed by the ABPI. Currently, its code of practice only requires data to be published for three years, after which they are deleted. As pointed out in a comprehensive article about the ABPI’s Disclosure U.K. database, written by retired pharmaceutical physician Dr. Alan Black, the life cycle of a medication, from preclinical phases to active marketing, can run into decades, so “time-limited transparency is not genuine transparency at all”.
Healthcare professionals are also free to refuse consent for a payment to be attributed to them in the Disclosure U.K. Database. In addition, any payments made to journalists are not required to be attributed to specific individuals; instead, they are included in an aggregated amount paid to all journalists in a given year.
Serious reform is needed and has been for a long time. Not much seems to have changed even since the ‘First Do No Harm: Independent Medicines and Medical Devices Safety Review of 2020‘, which declared the need for “a statutory requirement similar to the Physician Payments Sunshine Act 2010 in the U.S.” to properly deal with the thorny issue of “transparency of interests”.
As two registered medical practitioners, we urge Parliament to pass urgent legislation considering non-disclosure of any relationship between medical practitioners, media, pharmaceutical industry and Government a crime.
As the consequences of what has been going on for decades become more evident through the magnifying glass of the Covid panic, there is an urgent and vital requirement to salvage what is left of the credibility of medical practitioners.
Dr. Carl Heneghan is the Oxford Professor of Evidence Based Medicine and Dr. Tom Jefferson is an epidemiologist based in Rome who works with Professor Heneghan on the Cochrane Collaboration. This article was first published on their Substack, Trust The Evidence, which you can subscribe to here.
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