The payments have raised concerns that doctors could be influenced to favour specific drugs or prescribe them over talking therapies and lifestyle changes
NHS mental health medics have accepted nearly £1m from pharmaceutical companies in the past three years, raising concerns about the potential influence of firms on treatment decisions, The i Paper can reveal.
Major manufacturers of medications for depression, anxiety and ADHD were among firms paying healthcare professionals for a range of things such as contracted services and related expenses. Six of the 10 biggest spenders also paid for registration fees, travel and accommodation.
For example, a consultant psychiatrist may be paid by a pharmaceutical company to speak at a medical conference in order to educate others or share research, and the NHS allows medics to do this in addition to their job in the health service.
But the payments have raised concerns that doctors could be influenced to favour specific – more expensive – drugs for mental and neurodevelopmental disorders, or prescribe them over non-pharmaceutical interventions such as talking therapies and lifestyle changes.
The NHS healthcare professionals who were beneficiaries of the payments included doctors, psychologists, consultants, therapists and nurses – some of whom work with children.
Experts pointed to the opioid crisis in the US as a cautionary tale for how financial incentives can affect patient care.
Dr Simon Opher, a Labour MP, GP, and head of the cross-party group on health, called the pharmaceutical company payments “totally immoral” and said they should be banned.
It comes as growing numbers of Britons are taking medication for mental health and neurodevelopmental disorders such as depression, anxiety and ADHD.
Some 8.7 million Britons are taking antidepressants – 1.2 million more than in 2018, according to the NHS.
Some 280,000 are taking ADHD drugs, having more than doubled since 2018-19. The number of children taking ADHD tablets rose 10 per cent in the past year to 120,000.
Meanwhile, the Government has announced sweeping work and welfare reforms, including cuts to certain benefits, aimed at reducing spending and getting more people into employment.
Health Secretary Wes Streeting said in March that he believes there is an “overdiagnosis” of mental health conditions and “too many people being written off” work as he defended cuts to personal independent payment and universal credit.
An investigation by The i Paper found data from Disclosure UK – a database compiled by the Association of the British Pharmaceutical Industry (ABPI) to track payments to doctors – that shows the number of payments received has grown steadily over the past three years.
NHS healthcare professionals specialising in psychiatry and psychology accepted £390,000 in 2023 – the most recent data available. This rose from £356,000 in 2022 and £229,000 in 2021, for a total of £975,000 over the three-year period.
There is no suggestion of rule-breaking by healthcare professionals or pharmaceutical firms. Companies said the payments abide by the ABPI’s code of practice, which says they must not be used as inducements to prescribe.
The code is enforced by the Prescription Medicines Code of Practice Authority, a self-regulatory body.
The data did not cover GPs but included those working for NHS hospitals, trusts and healthcare boards.
How pharma firms ‘influence’ doctors
“There is the risk,” said David Rowland, director of the Centre for Health and the Public Interest, “that if you give ‘financial incentives’ to doctors, they will provide unnecessary treatment which can end up harming patients.”
He said this was one of the “most important lessons” that came out of the opioid scandal in the US – doctors prescribing the drugs had received payments from pharmaceutical companies.
Rowland said the payments could lead to patients being “pushed down or encouraged to go down a pharmacological route to treat their condition, as opposed to other interventions like talking therapy or different types of care”.
“The money is used often to buy influence and to encourage people to look favourably on a particular pharmaceutical company or on a particular product,” he said. “That’s what’s driving that kind of behaviour from pharmaceutical companies.”
Dr Margaret McCartney, a GP and senior lecturer in medicine at the University of St Andrews, warned of a “massive conflict of interest” and called for these types of payments and additional earnings to be banned.
“There’s lots of information, lots of research, that tells us that the more interactions that healthcare systems and professionals have with the pharmaceutical industry, the more likely it is for healthcare to be more expensive and poorer quality,” she said.
She said pharmaceutical companies will often pay for doctors to speak at conferences with the view of making them into key opinion leaders who then give talks and educate other doctors.
The rules on second jobs are relaxed in the NHS. For example, it is currently possible to work as a consultant for the pharmaceutical industry while also being in the position of commissioning or designing NHS services, Dr McCartney said.
She said pharmaceutical companies are keen to work with doctors but it would be far safer for patients for healthcare professionals to avoid working with the industry altogether.
“When we get information from the pharmaceutical industry it’s biased in favour of the products they make,” she said. “Sometimes these biases can be quite obvious, and sometimes they’re just more subtle.”
An example of a subtle bias could be emphasising the importance of what doctors can prescribe quickly, which can tilt the balance in favour of pharmaceutical treatments for mental health conditions rather than other interventions, which can take months due to long waiting lists, she added.
Patients ‘put on more expensive drugs’
Dr Opher, the Labour MP and GP, warned that patients may be needlessly taking more expensive versions of the same medication.
He said he is seeing people getting discharged from hospital on the newest version of a particular antidepressant rather than a cheaper version of the same drug which has the same efficacy, and suspects this is due to the influence of these payments.
Dr Opher said he believed such payments “will always cause undue influence on the clinician” and their prescribing decisions, and agreed with calls to ban them.
He said: “It’s totally immoral. There should be no real interaction between the pharmaceutical companies and doctors.”
Concerns over patient safety
Payments by medical companies to doctors have been linked to one medical scandal in the UK. Some women were left with chronic pain after being given vaginal mesh implants to treat pelvic organ prolapse and incontinence after childbirth. It later emerged that doctors who were promoting them had received payments from the companies making them.
In a 2020 report on medical safety commissioned by the government following the scandal, Baroness Cumberlege recommended the mandatory disclosure of payments by medical firms to clinicians, hospitals and research institutions, and said the information should be publicly available in a central register of interests.
The previous government said mandatory reporting would be fully implemented in 2023, but this has not yet happened.
Who are the firms?
The biggest payments were made by Takeda UK, Janssen-Cilag, Lundbeck, Eli Lilly and Roche.
Takeda UK, a subsidiary of Japanese drug giant Takeda, spent a total of £270,000. The company is one of the main manufacturers of ADHD medications in the UK. These include lisdexamfetamine (marketed as Elvanse), methylphenidate (Equasym) and guanfacine (Intuniv).
Janssen-Cilag, which is owned by American firm Johnson & Johnson, made payments worth £150,000. The firm produces the ADHD treatment methylphenidate (sold as Concerta), the antidepressant esketamine (Spravato) and the antipsychotic drug paliperidone palmitate (Invega Hafyera).
Lundbeck, a Danish pharmaceutical company, spent £50,000. The firm produces the depression and anxiety drugs escitalopram (Cipralex, Lexapro and others), vortioxetine (Brintellix and others), brexpiprazole (Rexulti), citalopram (Cipramil), flupentixol and melitracen (Deanxit), nortriptyline (Noritren) and amitriptyline (Saroten).
American-owned Eli Lilly, which made payments of £47,000, makes the antidepressants fluoxetine (Prozac) and duloxetine (Cymbalta) and the antipsychotic medication olanzapine (Zyprexa).
Swiss drugmaker Roche spent £37,000. The firm manufactures the depression and social anxiety treatment moclobemide (Amira) and benzodiazepines such as chlordiazepoxide (Librium) and diazepam (Valium), which are often used to treat anxiety.
Child psychiatrists received payments from a number of firms making ADHD drugs, including Takeda UK and Pfizer.
Pharmaceutical firms defend payments
Dr Amit Aggarwal, medical director at the ABPI, said: “Any company payments or benefits in kind to NHS and other healthcare professionals must come with no expectation of prescribing that company’s medicines, and must be transparently declared by companies through Disclosure UK – as it appears these have been.”
Takeda UK said it works with healthcare professionals, the NHS, and other organisations to share knowledge, support healthcare initiatives, research, and education, and these efforts “are aimed at improving patient outcomes”.
Eisai Europe said it only has licensed medicines in the gastrointestinal, oncology and neurology therapeutic areas in the UK, which includes epilepsy and Alzheimer’s disease. The firm said it does not “currently work in the depression, anxiety and ADHD therapeutic areas”.
Sanofi said its payments to healthcare professionals are not linked to the prescribing of specific medicines and its partnerships were to support healthcare, scientific research, or education to help improve outcomes for people with healthcare needs.
Pfizer said its payments are “in no way related to, or contingent upon, the healthcare professional prescribing or recommending the use of Pfizer’s medicines or vaccines and this is made clear in all our contractual agreements” with them.
Eli Lilly said its work with the NHS supports clinical service delivery and an understanding of how new medicines can benefit payments.
Janssen-Cilag, Lundbeck, Roche, Boehringer Ingelheim and Gilead did not respond to requests for comment. The Department of Health and Social Care declined to comment.
Have you been affected by anything in this story? We’d love to hear from you – please email alexa.phillips@theipaper.com
What do the rules say?
The 2012 Human Medicines Regulations state that a person may not, in connection with the promotion of medicinal products to people qualified to prescribe or supply them, supply, offer, or promise any gift, pecuniary advantage or benefit – unless it is inexpensive and relevant to the practice of medicine or pharmacy.
They say firms may not provide hospitality at a meeting or event held to promote a medicinal product – unless the hospitality is strictly limited to the main purposes of the meeting or event and the person receiving it is a healthcare professional.