A prescription for transparency: Reforming industry payments in UK healthcare

Dr Piotr Ozieranski and Dr Emily Rickard are researchers at the University of Bath. They have been studying drug company promotional activities and their regulation for over a decade. They have recently worked with Channel 4 Dispatches on an investigation into unethical marketing of a new wave of weight loss medications across the UK. In addition, together with international academic colleagues and civil society advocates, they have published an IPR policy brief calling for enhanced transparency of industry-NHS collaborations in the UK. 

Imagine a healthcare system where doctors, researchers, and patient organisations can receive millions of pounds from pharmaceutical companies without public scrutiny. Where blockbuster weight-loss drugs could be promoted based on financial incentives rather than patient needs. This isn’t hyperbole – it’s the reality of the UK’s current approach to industry payments in healthcare.

At the heart of the issue is Disclosure UK, the pharmaceutical industry’s voluntary transparency initiative. While designed to allow companies to declare payments to healthcare professionals and organisations, it has proved woefully inadequate.

What’s going wrong?

Our research has scrutinised the Disclosure UK system for the last seven years, revealing major failings:

• Unlike government-mandated systems in the US, France, and Denmark, Disclosure UK lacks legal enforcement, allowing companies to selectively report payments. For example, the system fails to capture £3.3bn drug companies paid for research on their products between 2015 and 2022.
• The data disclosed is of low quality – it is incomplete, inconsistent, and difficult to interpret, making it nearly impossible to track financial relationships and identify conflicts of interest.
• Disclosure UK lacks sufficient investigative powers and enforcement mechanisms, leading to inconsistencies and gaps in reporting.

The Novo Nordisk controversy: a wake-up call

These failures are not just theoretical concerns debated by academics interested in pharmaceuticals – they have recently become the subject of headline media stories (see here, here, and here) featuring Novo Nordisk, Europe’s largest listed company.

Building on methodologies developed over time through our academic research, we submitted a complaint to the pharmaceutical industry’s watchdog, the Prescription Medicines Code of Practice Authority (PMCPA), regarding the unethical conduct of Novo Nordisk, the manufacturer of the weight-loss drugs Ozempic and Wegovy. The PMCPA ruled that the company brought the pharmaceutical sector into disrepute by failing to disclose payments totalling £1.2 million to professional bodies, patient organisations, and obesity charities – at the very time it was aggressively marketing its blockbuster products, which were at the centre of a recent investigation by Dispatches. The industry’s self-regulatory approach failed to prevent this.

Why transparency matters

When transparency fails, patients suffer. Recent history has shown us time and again how undisclosed or poorly managed financial relationships between the pharmaceutical industry and healthcare professionals can lead to disastrous consequences, such as:

• The opioid crisis in the US, where financial incentives from manufacturers to doctors fuelled widespread overprescription, addiction, and thousands of preventable deaths.
• The pelvic mesh scandal in the UK, where companies promoted unsafe medical devices, leading to life-altering injuries for countless women.
• Undermined scientific evaluation of drugs and trust in the NHS – treatments may be recommended for use on the NHS by experts with undisclosed industry ties, making them unaccountable to the public.

The solution: meaningful, legally binding reform

Despite these risks, the UK is lagging behind its key international competitors in life sciences. Countries like the US, France and Denmark have already put in place robust transparency legislation that ensures meaningful transparency and accountability to the public.

The government has so far signalled a preference for minor tweaks to Disclosure UK rather than comprehensive reform. This is not good enough. If we truly care about patient safety and responsible healthcare spending at a time when healthcare budgets are increasingly tight, the UK must adopt a robust, government-mandated transparency system that puts patients first.

Here’s what needs to happen:

1. A national transparency database: The government must establish a fully independent, authoritative database of industry payments, with a user-friendly interface allowing patients, journalists, policymakers, and other members of the public to track financial relationships in real time.
2. Mandatory disclosure by law: All payments from drug and medical device companies to healthcare professionals, researchers, and patient groups must be disclosed by law.
3. Strong penalties for non-compliance: Companies failing to disclose payments should face substantial financial penalties – not just symbolic slaps on the wrist. Transparency must become the norm, not an optional exercise.

The time for action is now

The research evidence detailed in our IPR policy brief is clear: without urgent reform to transparency measures, conflicts of interest will continue to jeopardise patient safety, public trust, and waste public resources.

The UK prides itself on having a world-class healthcare system, with strong data transparency in many areas, including prescription patterns and provider performance, that is available to the public. We believe that industry payments and collaborations should be no exception.

The public, policymakers, and healthcare professionals must demand better. Patients deserve to be treated seriously – only genuinely transformative partnerships with industry will stand the test of public scrutiny. The NHS deserves to allocate resources based on evidence, not hidden incentives. And the UK deserves a healthcare system where trust is built on openness and patient empowerment, not secrecy.

The price of inaction is too high. The next scandal could be just around the corner.

All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.