Sunday Times: "Nurses earn bonuses for use of latest drugs"

March 5, 2006 -- Today the Sunday Times (U.K.) ran a short investigative piece by Jon Ungoed-Thomas and Sarah-Kate Templeton reporting that "nurses on the payroll of the pharmaceutical industry are earning bonuses...by identifying NHS patients who can be put on costly drug regimes." The piece appears to say that the nurses are employed by private agencies, with drug company funding. The nurses reportedly review the records of general practitioners in order to identify patients with conditions that may be treatable with their pharmaceutical funders' products. Sales teams then "close the business." The piece cites a Royal College of Nursing prescribing advisor who suggests that nurses who get bonuses to promote certain products are in breach of nursing ethics. Given its length, the piece is fairly good, though it might have explored some of the issues it raises in more depth. These include how and why the nurses actually get access to the medical records, how their conduct fits into the overall scheme of U.K. drug marketing, and why giving the nurses performance bonuses is a bigger ethical problem than simply paying them a flat rate to do the same job. In both cases, the nurses would appear to be promoting the products of the drug companies that pay their salaries.

The piece reports that the nurses are "provided free to GPs' surgeries where they are given access to patients’ medical records to check whether they are on the most up-to-date drugs." These "audits" are designed to "identify patients with conditions such as asthma or diabetes who may benefit from a new drug." The piece does not explain why the nurses receive this access--why the drugs are not simply marketed to the practitioners, who presumably could be expected to be familiar enough with their own patients to assess whether a medication change made sense (which we believe would stand a good chance of also violating ethics depending on the marketing approaches). Nor does it discuss whether there are ethical issues with the provision of this access to the confidential records. The piece does explain that the nurses are employed by "agencies" but "paid by the drugs companies, including GlaxoSmithKline, Pfizer and Wyeth." Providing context, the piece notes that the National Health Service spends more than £7 billion a year on medicines, 80% of which is spent on "branded products," and that GPs report "no incentives" to control drug costs. The piece might have explored whether in some cases the branded or newer products might be more effective, and what alternative ways there might be to make patients and prescribers aware of them. As for the apparent practice described in the piece, do practitioners feel more pressure to put a patient on an expensive new drug she may not need (or that may actually be less appropriate than her current one) when the sales person actually has the name of the patient and details about her condition? Would that be because the practice essentially injects an aggressive, well-informed drug company advocate into the practitioner-patient relationship? Where should we draw that line?

The piece focuses on the bonus element of the nurses' compensation. It reports that although the nurses are "barred from promoting their drug firms' products, 15% of their pay is linked to the number of patients or records they see," and that "promotional literature" claims the nurses can "'influence' new prescriptions for the benefit of their drugs companies." The piece reports that the agencies say the nurses are "rewarded" for the number of surgeries they visit. It also says that a recruitment consultant source told an "undercover reporter" that the nurses' job is to identify patients with specific conditions, which "opens the doors" for sales people who can "come in and close the business." The piece quotes RCN joint prescribing advisor Matt Griffiths as saying that he "believed any nurses who were given bonuses to promote certain products were in breach of the Nursing and Midwifery Council’s code of conduct." The piece does not explain how the nurses are promoting the products more by receiving performance bonuses than by simply being paid a flat rate to do the same work, since the only difference would seem to be the amount of compensation. In either case, they would appear to be getting paid to help drug companies sell more drugs. Agency Innovex, which reportedly employs about 200 of the "nurse advisors," is quoted as saying that it has "always complied with the industry code." The piece does not explain what that means. The article might have tried to find someone to counter Griffith's specific argument that the practice violates nursing ethics.

Despite the failure to pursue some of the issues it raises, the piece is fairly good overall. We commend the Times for exploring these important issues, and particularly for citing the RCN advisor, which tells readers that nurses are professionals who are expected to follow codes of ethics.

See the article "Nurses earn bonuses for use of latest drugs" by Jon Ungoed-Thomas and Sarah-Kate Templeton from the March 5, 2006 edition of the Sunday Times of London.