Flawed data, financial interests and big pharma influencing healthcare decision making

The Pandemic Response and Recovery All-Party Parliamentary Group’s latest meeting heard an update on the World Health Organisation’s (WHO) pandemic agenda before hearing about transparency in healthcare with a presentation highlighting the widespread problems of conflicts of interest in healthcare and scientific research and the need for more transparency.

Members were told about the flaws in the evidence currently being put forward for the WHO’s convention on pandemic preparedness, prevention and response from leading public health scientist Dr David Bell, who worked for the supranational body for eight years and presented early findings from the University of Leeds REPPARE project. Glasgow based GP, Dr Margaret McCartney, then spoke about her research into the impact of conflicts of interest in medicine and how they should be managed.

Talking about the basis for the WHO’s pandemic Treaty and proposed amendments to the International Health Regulations, Dr David Bell said: “We are being told by the WHO, with the backing of the World Bank, that their member countries must sign up to far reaching emergency powers, as set out in the International Health Regulations’ amendments and the Treaty. They are the only way to prepare for future pandemics which are going to increase in frequency and become more serious. The G20 2022 Bali Declaration presents us with studies which purport to demonstrate all of that, at a cost of $31 billion a year. I can find no evidence that serious zoonotic pandemics are increasing and neither, in their 2019 pandemic influenza recommendations, could the WHO. We hear a lot about disease outbreaks with very low burdens compared to say Tuberculosis and yet here we are looking at ratifying these one size fits all pandemic preparedness measures that will have great impact on our liberties, welfare and the healthcare we receive no matter which part of the world we live.

“We are finding major flaws in the data used to support the WHO’s proposals. The notion that there will be an exponential increase in epidemics and deaths is based on figures that do not tell the whole story. The invention of PCR testing, for example, has had a massive impact on the detection rate of these outbreaks. Once upon a time we simply did not know they happened, partly because there were very few deaths, but we now go hunting for outbreaks such as Bird-flu, which though often touted as a major problem has actually reduced as a cause of human disease in the last 20 years based on WHO data. The evidence base used for claims of an ‘exponential increase’ and high annual average mortality from zoonotic-derived epidemics takes no account of new and increased use of such detection methods, and relies on a few outlier outbreaks (such as the West African Ebola outbreak of 2014, or the inclusion of HIV as a zoonotic pandemic) that do not justify the type of broad response measures proposed.

“This disease speculation is being used to justify spending vast sums of public money on the basis that it will justify even greater savings, for which again the evidence appears to contain major flaws. Based on the last three years of the Covid pandemic the opposite is true and what you end up with is a small number of already very wealthy people becoming wealthier while societies and economies the world over suffer avoidable harm, increased mortality and worsening pubic health. This is not the good investment the WHO and the World Bank would have us believe it is, nor a justification for the swinging emergency powers that will be imposed.”

Dr Margaret McCartney has been writing and talking about conflicts of interest in healthcare and medicine for twenty years. She said: “When professional judgement is compromised, whether it concerns patient safety or the validity of research, that is a big problem. The impact is far reaching and we have seen the terrible consequences time and time again. Avoidable harm happens because decisions are made or advice is given that is not evidence based, or research findings are influenced that result in outcomes that may be beneficial to the pharmaceutical companies but are not to the patient. The Independent Medicines and Medical Devices Safety Review in 2020 showed only too well the devastating effects on people’s lives. The potential for conflicts of interest can happen at every level of healthcare. It might apply to a GP prescribing in their practice or, when it came to the Covid pandemic, we have the examples of proper procurement processes not being followed and the potential conflicts when SAGE was set up and we did not who was on the group, what their biases might be and how they were going to be mitigated.

“Unfortunately the bottom line is our guidelines are failing and this has been the case before and since the last big Inquiry into the influence of the pharmaceutical industry in 2004, to which I gave evidence. It found that the pharmaceutical industry was driving policy within the NHS and presented evidence that this was doing harm not just to patients but to the NHS budget. By allowing industry to lead many areas of policy, this creates considerable conflicts of interest because they profit from these decisions. Which is why it is crucial that conflicts, both real and perceived, whether financial, career related or otherwise, be managed properly. This is the only way trust in the healthcare system can be maintained and that starts with a good system of disclosure of interest and one that is well managed. Instead what we have ended up with is a health service that is enthralled by the pharmaceutical industry. I think it’s clear we need another inquiry.”

APPG Vice-Chair Lord Strathcarron said: “These presentations have highlighted the enormous problems of transparency and conflicts of interest in public health, medicine and medical and scientific research across the board. There is clearly a need to take a step back and fully understand what is involved with regards to the WHO’s pandemic treaty and health regulation amendments. I fear we are rushing headlong into a dangerous set up based on flawed data and evidence which needs to be reassessed. But, as we heard from Dr McCartney, flawed scientific data due to conflicts of interest are nothing new and there are many examples of where financial or career interest have led to serious and fatal harm to patients and the public over the decades. We need to find an effective way to manage conflicts of interest whether it’s at the level of supranational bodies such as the WHO or at the level of community healthcare.

“A number of investigations have been carried out, the latest being the Independent Medicines and Medical Devices Safety Review and out of that the Health and Care Act 2022 has been proposed, to bring in legislation to ensure better disclosure and increased transparency of industry payments, from the pharmaceutical industry to healthcare professionals. We must also hold the WHO to account and carefully scrutinise what is being proposed in the Pandemic Treaty and by the amendments to the International Health Regulations and ensure that we do not sign ourselves up to something we will later regret.”

Vice chair Rt Hon Sammy WIlson added: “We heard very clearly that conflicts of interest impact healthcare systems everywhere and from top to bottom. It is something we have been aware of for some time but it seems that efforts to address the problem come to very little. I can only conclude that it is due to the power of the pharmaceutical industry, the revolving door between industry and senior government positions and a lack of political will. It does not seem to be something the Covid Inquiry is considering and as we heard, there was the potential for conflicts of interest among SAGE and JCVI members who were making decisions that carried enormous impacts. I sincerely hope the Health and Care Act 2022 goes some way to change the situation for patient care in the UK health system.

“I am also deeply concerned about the WHO’s Pandemic Treaty and amendments to the International Health Regulations. Very little has been discussed or debated openly and there is clearly far more to these proposals than meets the eye or that we are currently led to believe by those conducting the negotiations for the DHSC and FCDO. I would like to know who is responsible for these negotiations and what exactly it is that is being decided. Members of both Houses will, presumably, get a chance to scrutinise any legislation that is introduced as a result of the Treaty being ratified and the IHR amendments being agreed and it is very clear to me that far more transparency is required surrounding both of these pandemic instruments before that time comes.”

Biographies of the speakers:

Dr David Bell is a clinical and public health physician with a PhD in population health and background in internal medicine, modelling and epidemiology of infectious disease. He has worked in global health and biotech for the past 20 years. Previously, he was Director of the Global Health Technologies at Intellectual Ventures Global Good Fund in the USA, Programme Head for Malaria and Acute Febrile Disease at FIND in Geneva, and worked in infectious diseases and coordinated malaria diagnostics strategy at the World Health Organization. He currently consults in biotech and international public health, and is a senior scholar of the Brownstone Institute.

Dr Margaret McCartney is a GP based in Glasgow and a freelance writer and broadcaster. An academic at the University of St Andrews and a fellow of the Royal Society of Edinburgh, she has written for the BMJ, The Guardian, Unherd and has been a regular contributor to BBC Radio 4’s Inside Health. She is an advocate for evidence-based medicine and is the author of The State of Medicine: keeping the promise of the NHS.