Professor Collier warned that whatever efforts were made to tighten the law or industry codes of conduct, drug companies would find a way to push their boundaries to the limit. "Doctors, governments, and regulators of medicines have got to recognise that the industry may not have the best interests of patients or the NHS at heart. They should . . . try to force the industry to behave in a way that is socially responsible," Professor Collier told the BMJ. "But of course social responsibility does not bring profitability."

members of the British Society of Antimicrobial Chemotherapy oppose the move, the GPs’ magazine Pulse reports (www.pulsetoday.co.uk, 28 Aug, "Fury over decision to make first mainstream antibiotic OTC"). In a letter to health ministers they express concerns that "approvals of this type are determined commercially and not on the basis of medical need."

Bevacizumab is an internationally recognised treatment for age related macular degeneration, and used worldwide, costing around £100 per injection compared with £761 for ranibizumab.5 NICE cannot consider bevacizumab as it can only assess drugs for their licensed purpose. But why is it not licensed for intraocular use? Roche/Genentech manufactures both drugs and is reluctant to get a licence for bevacizumab.

Michael Rawlins, who chairs the National Institute for Health and Clinical Excellence (NICE), has criticised the industry for profiteering.

It has long been suggested that drug companies use clinical trials to get doctors into the habit of prescribing newly approved drugs. A systematic review found only six articles that focused on the topic of such trials—four editorials and two observational studies published between 1994 and 2008. However, none of these publications could unequivocally prove that these trials—known as seeding trials—exist and that they are used by drug companies primarily for marketing purposes.

Seeding trials are not fictional