The pharmaceutical industry’s web of influence in the UK

Abstract

Background: Pharmaceutical companies are an integral part of modern life. However, despite manufacturing life-changing and life-saving medicines, the industry’s reputation is highly tainted as one that prioritises profits over patients through unethical marketing practices, pushes exorbitantly high and unjustified drug pricing, and exerts undue influence over the medical profession and beyond. This thesis makes a unique contribution by focusing on the complexity of the pharmaceutical industry’s influence strategies in relation to policy-making and different policy stakeholders. The overarching aim and research question of this thesis is to explore how the pharmaceutical industry engages with health policy decision-making and healthcare delivery processes through different policy actors and stakeholders, and at different levels of governance in the UK.

Methods. In Paper I, I conducted a cross-sectional study spanning a decade of pharmaceutical industry meetings with government ministers. I use descriptive and social network analysis to generate insights into how the industry engages with the top level of the UK government. In Paper II, I conducted a cross-sectional analysis of All-Party Parliamentary Groups, situated within the legislative branch of the UK government, and analysed the pharmaceutical industry’s direct and indirect connections within this context. I focused on identifying financial conflicts of interest and the distribution of funding across different policy areas. In Paper III, I conducted a follow-up study to Paper II, tracking the connections between the pharmaceutical industry and the legislative policy landscape. In Paper IV, the focus switches from policy decision-making settings to policy delivery decision-making settings. I conducted a comparative cross-sectional and social network analysis on pharmaceutical industry payments across the four UK countries to identify trends, distributions and targeted funding patterns. In Paper V, I focused on the transparency of the pharmaceutical industry’s financial relationships with key policy actors – patient organisations, assessing their disclosures of payments against devised indicators of transparency. The final study was a case study, focusing more in-depth on one pharmaceutical company’s disclosure practices. This chapter is based on a formal complaint I submitted to the pharmaceutical regulatory body having identified unreported, inaccurately reported, and misreported payments across the healthcare landscape.

Findings. I found that the pharmaceutical industry's extensive lobbying efforts targeting the UK's political executive and legislature demonstrate a strategic approach in attempts to shape health policy. Increased lobbying activities, particularly during the COVID-19 pandemic, reveal the industry's capacity to adapt to political and social dynamics. Larger companies with more financial resources had broader access to policymakers, emphasising the impact of economic power on political engagement. The importance of trade associations in these lobbying strategies further underlines the collective approach to influencing policy outcomes. Beyond direct lobbying, the industry also appears to participate in more covert forms of influence, engaging third-party organisations like patient organisations, universities, and think tanks. This indirect approach reinforces the idea of a network of connections that have the potential to influence policy subtly and even insidiously by infiltrating the broader agenda-setting landscape. In this thesis I also identified strategic targeting of payments to healthcare organisations tailored to regional health system designs, suggesting a nuanced commercial approach to influence. This regional variation indicates the industry's adaptability and raises ethical concerns about the impact of these financial relationships on healthcare decision-making. The diversity in funding priorities across the UK's health systems calls into question the integrity of these systems and the ethical standards of the pharmaceutical industry. Finally, I identified significant shortcomings in the transparency of relationships between the pharmaceutical industry, patient organisations, and healthcare organisations. Inconsistencies and gaps in disclosure reports indicate a broader issue of compromised transparency. These lapses in transparency not only conceal the extent of the industry's influence but also pose risks to the independence and objectivity of patient and healthcare organisations.

Conclusion. The findings collectively highlight the complex and multi-dimensional nature of the pharmaceutical industry's interactions with the UK's health policy landscape, encompassing direct lobbying, indirect activity through third-party networks, strategic regional targeting, and issues surrounding transparency and ethical standards.

Date of Award	11 Dec 2024
Original language	English
Awarding Institution	University of Bath
Supervisor	Emma Carmel (Supervisor), Piotr Ozieranski (Supervisor) & Jordan Tchilingirian (Supervisor)