As Poland announces plans to create a British-style NHS, one priority should be to address blurred boundaries between public bureaucracies, politicians and industry providers such as pharmaceutical companies.

Although the EU controls the approval process for new medicines, individual member states decide which to prioritise and subsidise. Research published in the British Journal of Sociology suggests that Poland’s pricing and reimbursement policy still lacks transparency and accountability, including deficiencies in the regulations governing conflict of interest.

The study, by Dr Piotr Ozieranski from the University's Department of Social and Policy Sciences and Professor Lawrence King from the Department of Sociology at the University of Cambridge, highlights Poland’s ongoing struggle to embed a culture of transparency and comprehensive governance of conflicts of interest.

The Polish Paradox

While Poland is an EU leader in embedding the formal principles of scientifically informed Health Technology Assessment (HTA) into pricing and reimbursement, it has struggled to ensure full transparency throughout the policy process.

Explaining the findings, Dr Ozieranski said: "What’s particularly concerning are ‘coincidences of interest’: situations where powerful individuals play mutually reinforcing roles in different sectors, sometimes at the same time. These ‘coincidences’ can be very elaborate and not adequately confined/captured under existing conflict of interest regulations – particularly when said individuals may also be setting or implementing these regulations. A case in point are high-ranking officials whose careers include switching back and forth between advising drug companies and being involved in taking decisions on their products while working for public institutions."

Another pertinent finding is that those involved in ethically dubious dealings typically remain unaccountable. Take, for example, a high-ranking official whose relationship with a pharmaceutical lobbyist was subject to Prosecutor’s investigation but who went on to have a successful career in the parliamentary Committee on Health and then the European Parliament.

Misery likes company

Poland can take some comfort knowing that it is not alone. In her influential book ‘Unaccountable: how elite power brokers corrupt our finances, freedom and security’, political anthropologist and IPR Global Chair Janine Wedel outlines major issues within the US system, including pharmaceutical policy, where accountability has given way to the pursuit of private wealth and power.

Even the UK is not above criticism. In November 2015, the British Medical Journal highlighted former Health Secretary, Andrew Lansley, taking an advisory role at global pharmaceutical giant Roche, as well as having held roles at private equity firm, Blackstone Group, and fitness sector trade body UKACTIV.

Break with the past and create a culture of accountability Professor Wedel, of George Mason University’s School of Policy, Government and International Affairs, said: “My research spanning more than two decades shows that blurred boundaries between the economy, politics and civil society have been a defining feature of the postcommunist transition in Central and Eastern Europe. The most powerful players are those who are able to bridge and pool resources coming from the different arenas. These players – often called ‘institutional nomads’ – are so powerful because, depending on the situation, they can ‘change hats’ and avoid culpability even for ethically questionable actions. It is interesting that we can see similar patterns in the technically advanced pricing and reimbursement field – more than 25 years after the fall of communism.”

Much progress has, of course, been made in recent years in areas such as increasing transparency of reports from key expert advisory bodies and introducing stricter conflicts of interest regulations for top ministerial medical advisors. These regulations must be constantly scrutinised to keep up with the increasingly sophisticated forms of bridging different sectors by powerful stakeholders. It is also important that decision-makers act according to the spirit, not just the letter of regulations.

Dr Ozieranski explained: “This means recognising that even if current regulations don’t recognise something as a conflict of interest it still may raise doubts about an official’s conduct”.

Professor King said: “Our findings from the policy world are consistent with well-documented patterns of informality in the Polish healthcare sector, including cherry-picking of winners in public tenders, nepotism and informal payments to doctors. More recently, Poland’s Supreme Chamber of Control has expressed concerns about conflicts of interests of experts involved in evaluating extremely expensive drugs for small patient populations. The current right-wing governing party won last year’s general election based on its tough anti-corruption rhetoric – it should be held accountable for looking into problems such as those highlighted by our research.”