Who's Watching the Drug Watchdogs?

It is nowadays fashionable to question everyone in authority, and there is no shortage of self-appointed watchdogs who aim to make sure that things that happen are happening as they should. The drug industry and drug regulatory authorities have been among the most conspicuous targets of this intense monitoring, on everything from questionable payments to promote drug sales to suspicions of bending too easily to the whims of manufacturers.

Many of these challenges have come from organizations which already have with a perceptible and even an avowed agenda: politicians, health activists, consumer and patient organisations, the liberal media… A surprising recruit to the ranks of ipsos custodies was that bastion of the Establishment, the UK Daily Mail (whose more typical territory is represented by one of its headlines today: “Feeling Sad? Then Hit the Shops… it Really Works!). A recent front-page lead story in the Mail leveled accusations of massive abuse of public funds at the British National Institute for Health and CareExcellence, the body that decides on which drugs may be prescribed under the national health service.

NICE had, said the Mail, “racked up $190,000 on taxpayer-funded credit cards in the past two and a half years, including over $8,000 on luxury hotels”. In a frenzy of righteous indignation, the story went on to list alleged excesses as far afield as Japan and Santa Monica, claiming “officials rule out use of life-saving drugs due to cost but spend thousands on five-star hotels and shopping sprees.” The story was immediately contested by NICE, and days later, the Mail published (on page 2) a correction. “An article about spending by officials of NICE, the NHS drugs’ watchdog on January 11 said that $5,500 was spent at a chain of champagne bars. We have been asked to make clear that this sum was for room hire and catering for committee meetings on two occasions at the Royal College of General Practitioners and at the Commonwealth Club.”

NICE has presented a detailed breakdown of the alleged spending sprees. The $865.30 identified by the Mail spent at the five star Ritz Carlton in Osaka, Japan was for accommodation during a government-led delegation to Japan. The $2287.21 at the Hotel Melia in Berlin was for accommodation for staff at a conference on clinical guidelines in Berlin, and the $1,308 at the Miramar luxury hotel and spa in Santa Monica, California was similarly for accommodation during an official visit to US-based life sciences companies. A bill of $1,034 “in a store specializing in bar equipment and bottle openers” was for jugs, glasses and coffee flasks for meetings and events, and $1,034 “on a website for home and garden equipment” was for office storage cupboards. The urbane response from NICE stops short of pointing out the obvious – that $190,000 in such expenses over two years for a body responsible for overseeing a multi-billion healthcare budget is in any case peanuts. But it does pointedly observe in a letter to the paper’s editor: “You have a right, you might say a duty, to examine how public bodies spend their money. But if you’re going to do it, you should do so with due care and attention. You haven’t done so in this case and as a consequence you’ve both misled the public and damaged our reputation.”

Given the high profile of everything related to medicines, to healthcare, and to regulatory decision-making, it is no surprise-and no bad thing-that there is plenty of attention to propriety. The Mail episode is yet another lamentable example of a failure by custodians of virtue to meet the same high standards of accuracy and fidelity that they claim to require of those under scrutiny.