My Lords, I note with interest that much of our debate so far has been about costs. My perspective in this debate is a little different again, and I think I ought briefly to explain why.
I speak largely as a patient, as did my noble and learned friend Lord Brightman, most of whose concerns I share. Having, over many years, exhausted the resources of mainstream medicine, I was compelled, as many are, to turn to the world of unconventional therapies. As a result, I have developed a profound respect for much that goes on there. I found myself serving for a while on the Research Council for Complementary Medicine, and I am currently chairman of the British Acupuncture Accreditation Board and also (jointly) of the Parliamentary Group for Alternative and Complimentary Medicine.
Quite early on I became intrigued by one particular question, and this is. If there is so much of value in acupuncture, homoeopathy, chiropractic, healing, massage, nutritional and herbal and environmental medicine, why are we not all aware of it? Many surveys, which I have quoted on other occasions, demonstrate that millions of people are benefiting, so it cannot just be a matter of my own experience. Here we come to the subject of the present debate.
Like other speakers, I want to take nothing away from the great benefits that mankind has received from a wide range of therapeutic drugs, even if more is sometimes attributed to them in the eradication of disease than evidence will bear. But it is my belief - and not just mine - that the immense financial power of the pharmaceutical industry is now distorting our whole perception of medicine to a degree that is positively unhealthy. This happens in a number of ways, some of them even more fundamental, I believe, than those referred to by the noble Lord, Lord Ashley, whose speech I listened to with great interest.
The influence of drugs companies, with their multi-billion pound turnover, now reaches into every corner of mainstream medicine. They have been involved for years in the funding of medical schools, of journals, of conferences. It is not possible that so much money should be put in and that outcomes should not, however subtly, be influenced. I am not talking here about sinister motives - merely the unavoidable influencing of attitudes and priorities. The majority of the members of the Committee on Safety of Medicines have links to the pharmaceutical industry. The Medicines Control Agency is wholly funded by fees from product licences. And then there is research. Without the drugs companies, whole areas of research would simply not be covered. But it is product-orientated research: it has to be, because these companies are not in it for their health. And other kinds of research are being squeezed out.
Drugs company money has gone into Healthwatch, the body that has set itself up to expose unacceptable practice in medicine (but unacceptable, one may ask, according to whose agenda?). In the world of AIDS, nearly all the voluntary groups are substantially funded by pharmaceutical companies, and AIDS patients have been almost exclusively snapped up and recruited into trials of the drug A7-T. Even the All-Party Parliamentary Group on AIDS receives a five-figure sum from the drugs industry.
The chief implication of this is that we suffer the dangers of a virtual monoculture. And one of the principal dangers of a monoculture is that you are not even aware that you are in it. It is easy, for example, to fool ourselves that AZT, or something like it, is the only worthwhile approach to AIDS. If we believe this, it is more likely because AZT is virtually all that we have been presented with. Whenever there is a medical problem, the cry goes up, "We must find a drug!" or, "We must find a vaccine!" The agenda is severely distorted when only one view is being heard. And it is heard everywhere because of the overwhelming power of one of the players.
I know of examples where highly promising lines of research into complementary medicine are being stifled by the influence of drugs company funding of the department concerned. In another area of medicine, Linus Pauling, the Nobel Prize-winning scientist, has told of the difficulty in getting good research on the benefits of vitamin C published in medical journals, because of the editors' fear of losing drugs company advertising. Vitamins and minerals cannot be patented - nor can foods - which explains why so little research effort is put is put into these areas.
In yet another field, I know of a distinguished scientist who took a lone stance on a medical issue, and was questioned by a friend of mine as to how he could be the only scientist to oppose the general view. "0h", he said, "I'm not the only one at all. I know eight other senior scientists who believe as I do. But I am the only one who is free from financial attachment. None of the others is in a position to speak out because of the strings attached to them".
If we are to see and judge clearly, it is crucial that we should be aware of the power of financial attachments. You do not need to be a conspiracy theorist to have serious questions about the large commercial interests in the field of healthcare policy.I want to tell briefly of a research project in the AIDS field published in I992. It was conducted by the Bastyr College of Natural Health Sciences in Seattle, Washington. It was a one year open trial of I6 men with AIDS-related complex on a regime that comprised dietary and lifestyle counselling, nutritional supplementation, psychotherapy and hydrotherapy, with the alternative of homoeopathic or herbal treatment. The results, with no patients progressing to AIDS, no patients dying, and in fact some clinical improvement observed, compared more favourably with anything that had been achieved in the orthodox, pharmaceutical field. It was not in any way a tightly controlled trial, and the numbers were small. But does anyone imagine that if the agent involved had been a drug it would not, in the present climate, have been pursued by pharmaceutical money for all it was worth? Leads have been followed up on far less when the incentives were there. So far as I am aware, the Bastyr College is still looking for funds to proceed with stage 2.
In the field of cancer, I am aware of a number of approaches that have yielded
good, not to say dramatic, results in some cases. The US Congress Office of
Technology Assessment has listed no fewer than five in its detailed report two
and a half years' ago on the unconventional cancer treatments: behavioural/psychological;
herbal; dietary; biologic/pharmacologic; and immuno-augmentative. So far as
I know, there are no major trials underway on any of these. For the most part
they are not money-spinners. They are not even part of the medical agenda. In
the field of heart disease, the position is not much different.
At a deeper level still, the grip of the pharmaceutical view exerts an equally unfortunate influence. There are two doctrines which I believe will eventually come to be seen as unhelpful in medicine, if not actually pernicious. The first is a doctrine of specific aetiology, which arises from the germ theory of disease and leads to the mirage of the magic bullet, and, incidentally, to the view that HIV equals AIDS - a hypothesis, as one distinguished critic has remarked, that has yet to save a single life. Drugs seldom get to the root cause of the disease, in any case.
The second is the notion, so firmly entrenched in the medical mind and so laughable
to the practitioner of natural medicine, that you cannot have benefit without
risk. This has led, among other things, to the easy acceptance of a situation
where some 10% to 15% of hospital beds are occupied by people who, among their
own complaints, have been injured by their treatment - not all pharmaceutical,
but mostly so. The dominance of the drugs-based approach to medicine helps to
underpin both these doctrines.
I have said enough to show why I believe that the role of the pharmaceutical industry does not always serve the best interests of patients. But I should like to take the case briefly one step further and beyond what I might term the intrinsic consequences of an over-concentration of power in the therapeutic field.
I spoke the other day to a man who was the inventor of a device which was proving very successful with migraine. In a search for funding, he was visited by a senior manager in a major drugs firm who flew over to inspect the device. The man said, in front of witnesses, that he believed that approach had a major future in medicine, and that his firm were going to do everything in their power to see that it did not see the light of day for 50 years. There was an interesting sequel to this. Some time later a merchant bank offered to back the device. After protracted negotiations, my contact was on the point of signing a not very favourable agreement when a director of the bank rang him strictly off the record and said that he thought he ought to know that behind the deal was the self-same drugs company, whose plan it was to buy up the rights to the device from the bank and suppress it. There are some who see a pattern in events of this kind. I do not know about that; but I have heard of other examples.
Having said as much, I ought to say that it is the inherent dangers of the monocultural view that worry me more and more. A conscious abuse of power is serious, indeed, criminal. The unconscious distortion of the whole way a society sees its system of medicine is much worse, not least, as I said earlier, because it may lie too deep to be seen. Unless you step outside the system, even if only in imagination, I do not believe you will get it in perspective.
There are two maxims which can stand as a summary of what I have been trying to say, and I think we ignore them at our peril if we wish to get things in proper focus:
• power tends to corrupt; and
• he who pays the piper calls the tune.