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Generic Products

Volume 131: debated on Wednesday 13 April 1988

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'(1) Where drugs, medicines or listed appliances are ordered by their brand name for a person by a medical practitioner in pursuance of his functions in the health service, the Scottish health service, the Northern Ireland health service or the armed forces of the Crown (excluding forces of a Commonwealth country and forces raised in a colony), it shall be the duty of the person supplying such drugs, medicines or appliances to supply a generic product approved by the Secretary of State instead of the product by its brand name.

(2) Subsection (1) above shall not apply where the person for whom the drugs, medicines or appliances are ordered requests the product to be supplied by its brand name, and in that case he shall pay any additional cost of such product in excess of the cost of the generic product.'.— [Mr. Wareing.]

Brought up, and read the First time.

I beg to move, That the clause be read a Second time.

When the Government talk about savings and value for money in the National Health Service, one aspect is conspicuous by its absence. Some may consider that it may have something to do with the old adage that he who pays the piper calls the tune. As we know, some pharmaceutical companies are adept at providing funds for the Tory party's election expenses. I wonder whether that motivates the Conservative party in relation to generic prescribing and generic substitution.

The essence of generic prescribing is that a doctor uses the approved name of a drug—that is to say, the accepted name of the chemical entity that makes up the drug. The purpose of new clause 5 is to ensure that, even if a general practitioner has prescribed a branded drug, it is possible and nearly always cheaper for a patient to be offered a generic substitute. I should have thought that that would be in accordance with Government policy, as indeed it is in accordance with the Opposition's policy.

The National Health Service drugs bill is about £2 billion a year. That generic prescribing can bring about a reduction in that colossal figure is proven by the fact that, when the limited list that only partially involved generic prescribing was introduced, the Government were able to claim that £75 million was saved in the first year of operation. The Department of Health and Social Security already advises its general practitioners that they should look to generic prescribing, and hospitals generically prescribe for their patients as a matter of course.

We should be looking for real savings in prescribing. Such savings would benefit not only the Government in terms of public expenditure, but those patients who will be even more deprived as a result of many other aspects of the Government's policy, part of which we debated this afternoon. Anything that helps those patients in these days of higher prices in the National Health Service will be warmly received.

I shall not cite journals of the Labour movement, but the "Drug and Therapeutics Bulletin" of 30 November 1987 estimated that there could be an overall saving of £100 million to the National Health Service if generic substitution were introduced. That journal, worthy though it may be, was assuming that it would be non-mandatory generic substitution. Even more substantial benefits to the National Health Service in terms of cost-effectiveness could be achieved if the Government accepted the new clause. Incidentally, I was rather pleased that, although the Government did not accept new clause 2, there were signs that it did not entirely offend them. I hope that we shall fare as well with this new clause.

The savings would be very great. Let us consider the example of the antibiotic sold by Pfizer under the brand name Vibramycin. A bottle of 50 tablets of Vibramycin costs the patient and the National Health Service £23. Roxycycline, a generic substitute sold by Harris Pharmaceuticals, sells at £10 for 50 tablets. That represents a saving of £13 on every 50 tablets prescribed. It is not excessive to estimate that the overall savings to the National Health Service could be about £400 million if mandatory generic substitution was in operation. Let me give another example. A 100-pack of 100 mg Zyloric costs £16·13, but the generic Allopurinol costs £1·49. On that drug alone there is a saving of 90·7 per cent.—more than £10 million.

If the Government are looking for money for the National Health Service, there is no excuse. In the main, the drug companies—many of them foreign multinationals—are waxing very rich in relation to the National Health Service. I am glad to see Conservative Members nodding. I only wish that their nods were nods in the direction of the Aye Lobby. However, Conservative Members are very late learners; some of them had to wait until this afternoon to discover what was happening under other Government legislation.

It is very important that patients should have a clear idea of what is being prescribed for them. Under the present system of branded products, many different names are given to the same medicine. I am sorry that we are not able to debate the new clause about benzodiazepines. The most lethal of these is lorazepam, which comes either as Ativan produced by Wyeth or as Almazine produced by Steinhard. I wonder how many people who have been prescribed Almazine knew that they were taking this potentially lethal drug which is exactly the same as Ativan, now going under the name of lorazepam.

The benzodiazepine called temazepam, which was prescribed last year over 7 million times at a cost to the National Health Service of more than £11 million, has all sorts of side and withdrawal effects that should be well known to many doctors. According to the British National Formulary, that drug can come in three different forms.

The Government were advised long ago in the Greenfield report of 1982 that generic substitution should he in operation in the National Health Service. Of course we know that the Government are deaf to advice, even from their own advisers. The report said:
"We consider that many doctors would be quite content for their patients to receive an alternative version of the drug prescribed, but that they tend to prescribe the proprietory brand with which they are most familiar. We therefore suggest the introduction of a simple scheme which would require doctors to indicate a positive preference for the proprietory version by initialling a box provided for that purpose".
The report quite clearly approved of the whole idea of generic substitution. The then Minister for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), argued against that when he made a statement in the House in December 1983. His argument was not very convincing. Its crux appeared to be where he said:
"The committee"—
that is, the Greenfield committee—
"acknowledged that it had not taken account of the wider implications, for example on the pharmaceutical industry, of its recommendation."—[Official Report, 8 December 1983; Vol. 50, c. 474.]
The pharmaceutical industry does very well out of the National Health Service. I have yet to hear of one of the large pharmaceutical firms complaining that it is on the border of liquidation. As I have said, some of them can find extra funds to help to finance the Conservative party.

Real benefits can flow from generic prescribing, and that is why we should look for a positive means of giving the National Health Service a monetary boost by cutting its costs. Generic names show the chemical class to which drugs belong and that gives information about properties. Names such as Ativan and Valium do not give such information until it is too late and patients suddenly complain about side and withdrawal effects. Generic substitution would mean a single name and that would reduce the present confusion about the naming of drugs. Normal generic names are used in medical teaching and in medical bulletins, and should be well known to the medical profession.

One other economy for the Health Service would result from the economy to pharmacists. Instead of holding the very large stocks that they presently have to hold because of the large number of branded products, they would be able to reduce their stocks and costs. That in itself would be a saving, and costs would be cut all round. There are many arguments about what those costs would be. In answer to my hon. Friend the Member for Peckham (Ms. Harman), the Minister for Health said on 11 February that only 28 per cent. of prescriptions dispensed in Britain are generically dispensed. That was according to the figures for 1986. On the same day, the Minister said that the prescribing of all drugs generically would bring about a saving of about £35 million in England. Obviously it would he more if it included the United Kingdom as a whole.

9.45 pm

The Government all too often tell us that they believe in competition. We should ask ourselves what branded goods imply. Branded goods constitute a monopoly practice. They are a way of dividing the market between different consumers of essentially the same product. We have heard of that happening in many other respects. For example, it has happened with detergents. What the great monopolist cannot get with Omo he gets with Tide. The same principles apply to the pharmaceutical companies.

General practitioners in our urban areas are often overburdened and are pressurised by the ad-men into prescribing this or that branded product. All too often they have little time to consider the reality that lies behind brand X, brand Y or brand Z. If the Government's belief in abandoning restrictive practices is wider than their belief in simply abandoning those practices in the labour market, they should be looking to some of their friends in the pharmaceutical industry who could be providing a real service to the country by placing their goods on the market for what they are, by providing the public with real information about the chemical composition of a product and by ensuring that there is a cost advantage to the NHS.

It seems wrong for a Socialist to be telling Tories what to believe in. However, I strongly suspect that one of the factors behind the Government's thinking is that they dare not offend their monopolistic friends. There is no reason why they should be worried about that. We are not afraid to offend some of our friends when the occasion demands it. I see no reason why a Government as arrogant as this and with such a large majority who say that they fear nowt should not be prepared to take action.

I hope that the House will give its blessing to the new clause. I know that there are some Conservative Members who will at least have some sympathy with the notion. I hope that the Government will for once feel it in their bones tonight to say yes to the advice that has been given not only by the official Opposition but by the Government's own advisers.

I listened to the hon. Member for Liverpool, West Derby (Mr. Wareing) with interest. It is clear from this and the previous debate that some hon. Members feel that they know much more about medicine than doctors do. That will sound a little odd when one considers what they will be saying on clause 13 tomorrow.

Our objective in much of what we are trying to do is to obtain better health and better value for money. Those are the objectives set out in the White Paper. I am sure that the objectives of the hon. Member for West Derby are the same. Therefore, it is a pity that he felt obliged to have a go at the drug companies in the way that he did.

When we discussed some of these issues in Committee it was clear that some hon. Members—I am not sure about the hon. Member for West Derby—would solve the problems that he described by nationalising the pharmaceutical industry. Indeed, the hon. Member for Wakefield (Mr. Hinchliffe) admitted that.

No doubt there are Labour Members who believe that they could run the pharmaceutical industry as well as they ran steel and shipbuilding and every other industry that was taken into public ownership but destroyed. The noble Lord Wilson put such rather silly thinking into context during a discussion about nationalising high street shops that sold clothes. He said that he would have difficulty explaining to his constituents how nationalising Marks and Spencer would make it as efficient as the Co-op. Labour Members who think that they could run the pharmaceutical industry more efficiently should give that example some thought.

I know that you, Mr. Speaker, will bring us to order if we stray too far from the new clause, but will the Minister ask her right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath) about the nationalisation of Rolls-Royce in 1972? Was that a waste of taxpayers' money?

I am delighted that the hon. Gentleman takes such an interest in my constituents. We have handed Rolls-Royce back to the private sector and everybody in Derby is thrilled to bits.

Given the philosophies of Labour Members, it is not surprising that a small number of companies have reacted in political terms in the way that the hon. Gentleman described earlier.

My Department is the sponsoring Department for the pharmaceutical industry. We should be proud of the industry's achievements, which depend on a strong base and on achieving a reasonable rate of return for its investment, particularly in research and development. If we were to force generic drugs on the National Health Service in the way suggested, the effect on the industry would be substantial and adverse. We are talking about 87,000 people directly employed in the United Kingdom in 1988 by Association of the British Pharmaceutical Industry companies. They estimate that indirect employment amounts to 250,000 jobs. Their capital investment in the United Kingdom will be about £400 million this year and their exports amount to £1·7 billion. The net positive United Kingdom trade balance in pharmaceuticals is about £850 million per year.

The pharmaceutical sector, which the new clause would so damage if it were passed, is the most significant contributor to the United Kingdom's balance of trade, after oil and transport. Most significant of all is its research and development spending. The industry estimates that this year it will spend £700 million in the United Kingdom on research and development. Indeed, about 10 per cent. of all British and manufacturing industry research and development spending is contributed by the pharmaceutical sector.

The case is always put to us—we take it very seriously—that research and development are strongly linked to our spend with the industry. If the National Health Service had to carry out the necessary research and development, I am sure that the cost would be greater than the amounts that I have just mentioned.

Does the Minister agree that the new clause would not interfere with the patent rights of pharmaceutical firms? Those patent rights, covering a period of 20 years, give full compensation for research and development costs.

The hon. Gentleman is quite right. The new clause does not interefere with existing legislation. He will be aware that there are active and heated discussions going on elsewhere about the length of time for which a patent should apply. The drug companies have strongly expressed the view to us that they would be most concerned if generic prescribing were to be made compulsory. We should be aware of the vast amount of research and development that the industry does, using the money that we pay it—we are the largest purchaser of its drugs—and which we would have to do if we were to match the amount that it is doing at present.

The Guardian of 15 March 1988 reported that Glaxo had increased its research and development costs from £67 million to £101 million, which was reported recently to the company shareholders. It is expecting to spend £220 million in the full year, and that is an enormous amount of money. I understand that Glaxo is to spend £500 million over the next five years building a brand new medical research centre at Stevenage, employing up to 2,000 people. That includes some 600 new jobs. I wish that it were in Derby. It will develop new treatment for infectious diseases, cancer and immunology. It will rank among the most advanced research facilities in the world.

Companies can do that only if they know that their products will be prescribed in the way that they are now. I was interested to hear that the hon. Member for West Derby is in favour of a selected list. I listened to his eulogies with great interest. I was a Back Bencher at that time and I remember that Opposition Members spoke against the limited list. I also remember that Opposition Members predicted all sorts of dire consequences as a result of what my hon. Friends were going to do at the time. I also seem to remember that Opposition Members voted against it. St. Paul's conversion on the road to Damascus offers a reasonable analogy to what the hon. Gentleman has just said. We will bear his views in mind.

The new clause seeks the complete and compulsory use of generic products. We do not agree. The Opposition have argued that it would save money. Once again, I applaud the Opposition's interest in that objective. This evening for the first time, with the possible exception of the merit awards, they are keen that we should get value for money in the Health Service.

We believe that we can save money without compulsion and that a better overall objective would be better prescribing. That goes wider than generic substitution. As the hon. Gentleman rightly said, there have been sharp improvements in generic prescription, without any compulsion. He mentioned that the number of prescriptions being written and dispensed generically in Great Britain had doubled from 14 to 28 per cent. in the 10 years between 1976 and 1986.

Even more interesting is the fact that the number of prescriptions written generically but not necessarily dispensed generically, as there may not be a suitable generic product and the doctor writes the generic name, has gone up from 20 to 38 per cent. That means, broadly speaking, that some 40 per cent. of prescriptions are being written in a way that would meet with the hon. Gentleman's approval. The percentage is much higher in England than in Wales or Scotland, and perhaps hon. Members might take that on board.

I am a friend of many of the drug companies, yet they deplore what they are doing in relation to pure research. The Minister should consider the concern of the drug companies, which is shared by Sir George Porter and others, that the Government do not put nearly enough into fundamental science. The Minister mentioned Scotland. The understandable and justified squeals from the department of biochemistry—a very distinguished department at Edinburgh—are one example of the shortage of funds for basic sciences. The Minister and her Department should do something to persuade the Government to spend more on pure scientific research at the universities.

The Government will respond in the usual way to the report of the Select Committee in the other place. We will take into account everything that is said.

I recall that one of the criticisms that is often put to British researchers is that we are very good at basic sciences but pretty hopeless at getting those excellent discoveries brought into development and use. That is not an adequate criticism of the pharmaceutical industry. This industry does basic science and funds a lot of research, including that in university departments. It puts a heck of a lot of money into first-class research and development and brings to the market marvellous drugs to which many of us owe our lives and for which many of us are very grateful. I take seriously what the hon. Member for Linlithgow (Mr. Dalyell) said; I merely suggest that some aspects of the pharmaceutical industry are a first-class example to other industries for which I do not have direct ministerial responsibility.

I agree with many of the points made by the hon. Member for West Derby about local initiatives to improve prescribing. Voluntary measures to improve prescribing are achieving considerable savings. For example, in a group general practice in Scotland, the introduction of a formulary saved about 10 per cent. in terms of cost per person and per item. In Hampshire, the local medical and pharmaceutical committees have estimated that it might be possible to achieve a potential saving of up to £3·5 million. They propose to achieve that saving in a number of ways, including standardisation to 28 days' supply, a two-week trial for new medicines instead of a month, and the greater use of five-day courses for antibiotics, rather than seven.

On that basis—

It being Ten o'clock, the debate stood adjourned.

Ordered,

That, at this day's sitting, the Health and Medicines Bill may be proceeded with, though opposed, until any hour.— [Mr. Peter Lloyd.]

Question again proposed, That the clause be read a Second time.

On that basis, there is considerable scope for other local family practitioner committees and local medical committees to copy. In hospitals, the introduction of a formulary and management system has resulted in substantial savings. Guy's hospital, for example, experienced a decrease in actual spending of 16 per cent. over a four-year period, which is a constant price saving of 29 per cent. From a meeting that I had this morning with the chairmen of a number of family practitioner committees I know that a number of them are interested in using the Guy's hospital formulary.

Wandsworth has had a decrease in actual expenditure of 12 per cent. over four years as against a 20 per cent. increase in activity. Ninewells, which is the teaching hospital in Dundee, effected a 15 per cent. reduction in drug costs on the medical wards in the first year of introducing a formulary. Westminster hospital has demonstrated a sustained reduction over seven years and spent 23 per cent. less, in constant price terms, at the end than it spent at the beginning.

We take on board, therefore, much of what the hon. Gentleman has said. In other parts of the country, similar initiatives are being taken. There is a great deal of local interest in more economic prescribing. That is the basis on which to proceed, rather than by compulsion and limiting ourselves to generic prescribing.

The overall drugs bill for the National Health Service is now over £2 billion, of which £1·6 billion is spent by the family practitioner service. We probably have more influence over the price of the drugs that we buy than many purchasers in other countries. Our negotiations with this important industry are designed to strike a balance between maintaining the strong, vigorous, research-based industry which we have in the United Kingdom and which it is in all our patients' interests to have, and obtaining value for money for patients. Our voluntary system does both. Compulsory generic substitution would probably do neither. Therefore, we reject the new clause.

It is all very well for the Minister to say that she is proud of the pharmaceutical industry. The pharmaceutical industry has far too many blotches and blemishes for that kind of uncritical and complacent attitude.

I do not propose to go on about Opren. If I did, you, Mr. Speaker, would say that I was out of order, because Opren is not a generic product. The Minister, with her pathetic and inadequate advice on that subject, ought to know that she cannot say that the pharmaceutical industry is something to be proud of. It is not. The pharmaceutical industry has produced some fine products, it has a fine record and it deserves great praise, but the Minister ought to reconsider her views and look far more carefully and seriously at the pharmaceutical industry's shortcomings.

I support new clause 5. When drugs are supplied, they should be generic products. I want to speak about tranquillisers. If generic products are supplied, the effects will be much the same as the effects of those dreadful products that are not generic, such as Opren and, in particular, Ativan which are tranquillisers and have caused such terrible damage to millions of people.

The campaign by The Observer in articles by Carmel Fitzsimons has done a great deal to alert the public to the grave and tragic effect of tranquillisers. It is a horrifying story which should disturb the House.

On 25 March, in a fairly remarkable answer to a parliamentary question, the Minister for Health said that half a million people were dependent on benzodiazepines in 1986, compared with 28 in 1977. What is the reason for that astounding increase? It is staggering, and demands immediate investigation.

In June 1984, the Minister said that the Department was fully aware of the public and professional concern that some people might be dependent on prescribed minor tranquillisers. Although the Department was "fully aware", very little has been done by the Government to deal with this grave medical problem. It is appalling that, in the four years since that answer, there are still 25 million prescriptions of tranquillisers every year, and half a million people are affected. Many are generic products. Some are not sold.

I find it shocking that research was not conducted originally into whether those tranquillisers caused dependency, and that general practitioners prescribed them so casually, despite warnings from the Committee on Safety of Medicines. The doctors have nothing to be proud of.

I also find it shocking that the British drug industry is not working actively to help and advise those who are addicted on how to reduce their dependency, and that the drug industry of which the Minister says that she is so proud, ignoring all its shortcomings, is not actively seeking research and treatment for addicts. It is also very serious that the Department is not leading, rather than following, the voluntary organisations in tackling this serious drug menace.

The pharmaceutical industry of which the Minister is so proud has a major responsibility to help. It should embark on a major research project to help to overcome the problems of addiction. The industry of which the Minister is so proud is mainly responsible for the problem of addiction. It caused the problem, and it should do something to solve it instead of sitting back and enjoying the profits. It should work with the Government in a co-operative endeavour to help.

I hope that the Minister will listen to these reasoned, moderate criticisms, and will get together with the pharmaceutical industry and say, "Let us try to do something to help the millions of people who are suffering."

Clear warnings should also be visible on all prescriptions, as is done in the United States. Why cannot these innocent people, who are seeking help because their nerves are bad and the stress is so great, see a warning on the bottle? That would be simple, easy and reasonable, and I think that it should be done. It is wrong that people should have to rely on doctors' advice, because far too often doctors do not bother with advice from the Committee on Safety of Medicines. They are too busy, indolent, or sometimes ignorant. There are some fine doctors, but there are some bad doctors. We cannot rely on the bad doctors. Certain notices should be on the bottle.

The Minister should launch a vigorous campaign to prevent the further spread of addiction to tranquillisers, in particular benzodiazepines, and ensure that back-up support is available.

I know that the Minister's Department is short of cash, but I hope that she will do what she can to finance the marvellous work of voluntary organisations such as Tranx-line, and the one in London whose name I have forgotten.

Perhaps the Minister will help them a little more because they are short of money.

If the Minister takes my proposals on board, she will help millions of people. I spoke last week to a man who talked of committing suicide because of his addiction to tranquillisers. He has tried to end his addiction, but he has hallucinations and he is driven round the bend. He needs help, support, advice and comfort.

I am obliged to my right hon. Friend for raising that issue. In many respects, he contradicts what the Minister said. I noticed that the Minister was nodding her head vigorously and saying that the Government are funding those voluntary organisations. However, the Government have only pump-primed them, with no more than £333,000. For example, the Council for Involuntary Tranquilliser Addiction in Merseyside has received no money at all. Much more is being spent on combating the abuse of hard drugs. Very little is going to the voluntary organisations which are so useful to the NHS.

I appreciate that point. The Minister has written me a letter explaining what she does for the voluntary organisations. However, the voluntary organisations in Liverpool have said that they receive very little indeed. In fact, they have said that they receive nothing. Therefore, the Minister must face the challenge of whether to help such organisations. The organisations are complaining of poverty and a lack of Government help in their work in assisting addicts.

I do not want merely to score points; I want the Minister's help and co-operation. If we all work together we can reduce the suffering of the millions of addicts. Let us help them to beat their addiction. Let us help to prevent addiction. That can be done only if the Minister stops saying that she is proud of the pharmaceutical industry, looks at the blemishes and takes on board the criticisms. The pharmaceutical industry has a fine record, but it also has many blemishes and it is the blemishes that should be examined. The Minister should do something to help those addicts.

10.15 pm

My hon. Friend the Minister is right to praise the pharmaceutical industry. I shall explain why. In 1840, or thereabouts, the average life expectancy was 27 years. Now people can expect to live deep into their 70s and beyond. In fact, Her Majesty the Queen sends out more telegrams of congratulation to people who have reached 100 years of age than ever before.

That is a great tribute to the medics of this country and to the pharmaceutical industry. It is a great credit to all of them, but people must remember that, when pharmaceutical companies put money into research and development for new drugs to sustain life and make people more comfortable, they also put thousands of pounds into unsuccessful research. When they develop a drug that is useful to mankind, they do a tremendous service. They then have to develop a plant, so they have to make capital expenditure on a processing plant to produce and market that research product.

The companies also have to think in terms of recovery in two or three years' time to recover that money. It is right, therefore, that they should have the right sort of profit margin for research and development and to recover the capital costs of their plant. They talk in terms of two or three years because, by that time, someone often develops a new drug and puts it on the market. Therefore, the great profit that people say pharmaceutical companies enjoy goes to another company. However, at the same time, it is healthy competition. It is developing drugs for the good of mankind. It is totally unfair to criticise the Minister for saying that we owe—

No, I shall not.

It is unfair to criticise the Minister for saying that we owe a great debt to the pharmaceutical industry. I venture to suggest that there is scarcely an hon. Member in the Chamber this evening who has not been thankful to the pharmaceutical industry. We have wonderful medics in this country, some of the best in the world. We have wonderful pharmaceutical industries, some of the best in the world. It is right that they should be developing and researching new drugs to sustain mankind up to and beyond the age of 70, instead of the age of 27, as it was in 1840. That speaks for itself.

I had not intended to intervene so quickly in the debate, but I could not resist the temptation, having listened to the absolute drivel that has been promulgated for the last five minutes.

Yes, I am, particularly when it comes from the Conservative Benches on my own subject, which is the role of medicine in the health of the community and particularly the role of the medical profession. I cannot understand how anyone with a basic education could imagine that a major percentage of the increase in life expectancy of the human race is due to the medical profession. Even the medical profession would not have claimed that. I have never heard such rubbish in all my life.

The hon. Member for Littleborough and Saddleworth (Mr. Dickens) disgressed a little from the subject. The increase in life expectancy is due not to the benefits of drugs, but to the way in which life expectancy from birth is calculated. Almost 90 per cent. of the improvement is due to the change in infant and perinatal mortality, which means that the nine out of 10 babies that used to die early in life no longer do so. That is why life expectancy has increased. In the 1840s, if one was fortunate enough to survive beyond the first or second year, one's life expectancy was little shorter than it is now.

The other factors that have played a part are the development of decent wages and conditions, good housing and an adequate diet. Those factors, not the medical profession, have led to an increase in life expectancy.

Let us consider the wonderful pharmaceutical industry. Unlike most hon. Members present tonight, I have worked in the industry and in the development of new drugs—the wonderful new products about which everyone talks. I can think of possibly three over the past 10 years that could be dignified with the description of a major advance in treatment.

Some 95 per cent. of those drugs are what we call "Me, too." someone develops a new product and someone else comes along, takes the formula, makes minor changes, gets a patent and puts it into animals and man. Lo and behold, the new drug has the same effect as the drug that came before it. Small wonder, because it is effectively the same drug. It is not claimed that the new drug is better. However, largely spurious statistical studies are carried out which conclude that the drugs are equally effective. In fact, the conclusion shows that both drugs have the same effects and the effects are indistinguishable. That means that both drugs might be ineffective, and frequently they are.

The drugs used in the vast majority of cases are not terribly effective. They may help us to bear some of the chronic conditions that we suffer nowadays, but they do not cure them. They do not cure any of the modern illnesses like diabetes or arthritis, from which so many people suffer. They cannot cure heart disease, hypertension, arteriosclerosis, or senile dementia.

I realise that the hon. Gentleman is a self-confessed doctor, and I am surprised at his comments. With regard to diabetes, why is the doctor saying that drugs just make people comfortable when he knows jolly well as a medical man that, unless a patient's blood count is right, with the right dose of insulin or sugar, that patient can go into coma and possibly die? How can the hon. Gentleman stand up and give false information when he knows differently from his training?

The trouble is that once one has experience of the subject, one learns that things are not always as they seem. Diabetics certainly do not die as young as they used to, but they are not cured. They receive help to manage their affliction. However, although advances are being made which may change this, at the moment they die in later life from different but related conditions and suffer a great deal in the process. This is a serious matter and we should be careful before we give unrestricted praise to the medical profession or the pharmaceutical industry.

My hon. Friend is making a valuable contribution, which is more than can be said for some of the other contributions this evening. My hon. Friend obviously has experience of the drugs industry from his work as a doctor. Does he have any comment to make on the wastefulness of competition and the wastefulness of very high profit margins enjoyed by the privately owned drug companies at the moment?

The profit margins on successful drugs are extremely high, as I am sure this Government and their predecessors are only too well aware. Hence the restricted list, which was rightly brought in several years ago to restrict prescribing costs. It is legitimate in a society in which drugs are manufactured by private companies to ensure that those companies receive a return on their investment; otherwise we would not have their investment and we might have to look elsewhere for it.

We are perhaps over-generous in the amount of compensation that we give private companies. For example, over the past 20 years Hoffman La Roche has produced drugs that are of virtually no benefit to mankind. For many years it has charged the Health Service inordinate prices for those drugs, and it now leads the struggle against the provision of generic substitutes for those very products. It knows full well that the drugs can be made for pence, yet they can be sold by the company under brand name protection for pounds.

Generic drugs are sound, safe and subjected to the same, if not more, stringent testing for solubility and type of action—I will not go into that, as it is a highly technical point—and they are as effective, or ineffective, as the products with which they are competing. However, generic drugs have the singular advantage that they are much cheaper. Therefore, they can help our over-burdened Health Service to meet a greater proportion of its increased costs through saving money on its drug bills. For that reason alone, the new clause is worthy of support.

I have listened intently to what the Minister has had to say. While I do not accept many of her arguments, particularly about the worth of the pharmaceutical industry, I would not want to detract from the useful research done by the industry. My hon. Friends have pointed out that more quality control may be desirable, particularly with regard to benzodiazepines. I am not won over by the argument about trade, because we have had the experience of transfer pricing by Hoffman La Roche and other monopoly practices by pharmaceutical companies. I am not at all happy that retail price maintenance, which was abolished over 20 years ago for most commodities, still applies to pharmaceutical products.

Having said that, however, I note that the hon. Lady has agreed to some extent with what Opposition Members have said. I am sure that we will return to this matter again and again, until generic substitution becomes the vogue in the National Health Service. Therefore, I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.