The UK pharmaceutical industry’s regulatory watchdog has ruled that Merck violated the industry’s code of practice by altering guidelines on hypertension treatment to give greater prominence to one of the company’s own drugs.
The “ABCD” algorithm is intended to inform decisions on prescribing for high blood pressure in the guidelines of the British Hypertension Society, which were first published in the BMJ in March 2004 (BMJ 2004;328:634–40).
The letter A refers to angiotensin converting enzyme inhibitors and angiotensin receptor blockers, and the two types of drug are listed in the guidelines in that order. The guidelines specify that “all things being equal and when there are no compelling indications for treatment with a specific class of drugs, the least expensive drugs should be used.”
But in a wall chart published by the British Hypertension Society with support from Merck and distributed to British GPs, the order was reversed, with the newer and more expensive angiotensin receptor blockers in first place. The poster also displayed a prominent advertisement for Merck’s angiotensin receptor blocker losartan (Cozaar).
The Prescriptions Medicines Code of Practice Authority, the self regulatory arm of the Association of the British Pharmaceutical Industry, confirmed that it had ruled against Merck last week but said that the details of the ruling would not be published until 7 February. A spokesman refused to comment on the origin of the complaint.
A spokeswoman for Merck Sharp & Dohme (MSD), Merck’s UK subsidiary, said that the company had received an adverse ruling and would not be appealing.
She added: “When the materials in question were produced, MSD believed it had the approval of the BHS [British Hypertension Society] to alter the position of all the ‘A’s on the chart, as the BHS information service considered the two classes of drug to be equal partners in the absence of compelling indications. However, MSD now understands that this course of action has resulted in the production of misleading materials. MSD withdrew all offending material in December 2005.”
The British Hypertension Society printed about 20 000 copies of the revised guidelines, which appeared on computer mousepads and cards as well as a poster.
Des Spence, a Glasgow GP and spokesman for the health professionals’ group No Free Lunch, which monitors doctors’ links with the drug industry, said the guidelines’ authors should fully disclose their links to industry.
“The BHS guidelines say that ‘all authors have received honorariums from a number of pharmaceutical companies,' but how much? There’s a big difference between £500 and £5000,” he said. “Seventy five per cent of the society’s corporate sponsors have an angiotensin receptor blocker on the market. We’ve written to them asking for more transparency on these matters, but they’ve stopped answering our letters.”
Morris Brown, incoming president of the British Hypertension Society, said the transposition of the two drug classes was “obviously something that should never have happened.”
The society is currently in discussions with the National Institute for Health and Clinical Excellence (NICE) to develop a new set of unified hypertension guidelines, Professor Brown said. A draft should be available for public consultation at the end of this month, and the guidelines could be finalised by April.
“One of the reasons we’re working with NICE is to ensure that this sort of thing doesn’t happen again,” said Professor Brown.