Table 2

Specific examples of influences cited in the text by target and type of influence exerted (the examples are a synthesis of the statements made by the interviewees)

Target of influenceType of influenceExamples
High positions in government (Ministers, Secretaries of State, General and Under Secretaries, General Director, assimilated)Direct pressure
  • Alcohol producers boast of successfully applying pressure at the highest government level, over the head of the Minister of Health, to avoid regulation of low age consumption.

  • The Ministry of Health received pressure—that was effective—to change a regulation in favour of some drug companies, from parliamentarians whose vote was essential to adopt the national budget.

  • The Government has accepted influences from companies that have resulted in appointments of directors general that were welcomed by the interested actors.

  • Presidency’s and vice-presidency’s offices have directed pressure on under-secretary of health or health directors to adopt positions in favour of the health-related industries.

  • A drug company sought to ‘blackmail’—unsuccessfully—the Ministry of Health during the influenza A pandemic (2009) by threatening to interrupt the supply of influenza vaccine unless they received a contract exempting the industry from any responsibility in case of adverse effects.

Economic offers and deferred income through revolving doors
  • Directors generals described that they received offers when in duty to enrol in the future drug or food and drink companies receiving high wages. They were also informed on the pathway to sidestep regulation by entering 2 years in a foundation related to the company. The phenomenon was frequent in people responsible for the pharmaceutical policy but also in other areas, where the bargaining chip was frequently inaction of the decision-maker.

  • Drug industries have tried to bribe top officials at the Ministry of Health including the Minister.

Gifts and other attentions
  • The Minister of Health and her/his close environment were target of capture through attentions to all Cabinet personnel with gifts and other advantages such as invitations to special events (business lounges, club rooms, etc).

Personal threats and attacks
  • The business organisation of medical technologies managed to move several regional Health Ministers towards an unfavourable position against the new State policy for increasing the quality and intensity of evaluation of technologies. At the same time, the specialised press, supported by the same organisation, attacked the people in charge of promoting the evaluation of health technologies.

  • The specialised health press has frequently decried the Director General of Drug Policy if his/her actions did not align with the interest of the drug industry.

Access to strategic information and agenda control
  • The health-related companies had access to inside Ministry of Health information including the position on a particular issue of high-level decision-makers. This fact increases the vulnerability of the Ministry to external influences.

  • A media corporation exerted intense pressure to get the Minister of Health involved in a press event.

  • A drug company offered the Minister of Health a jet to deal with the requirements of his/her official schedule while attending a scientific meeting organised by the industry.

Agencies and their expertsRevolving doors
  • Directors and senior officials at the Spanish Agencies of Medicines and Food Security receive offers to join the industries or their business organisations.

Scientific and professional environment
  • The Spanish Agency of Medicines do not find experts on oncology free of conflicts of interest.

  • Members of the Committee for Medicinal Products for Human Use of the European Medicines Agency relate that there is an organisation culture favourable to put onto the market new products. While security issues are not affected, questions on efficacy are perceived as less relevant.

  • The Spanish Agency of Medicines receives direct pressure from high levels of Government to widen the indications of some new drugs once approved, particularly of antineoplastic agents.

Senior officials of the Ministry of Health
  • Easily influenced targets

  • Direct pressure

  • Deferred income through revolving doors

  • Some officials inside the Ministry of Health have been successful in delaying the approval of generic drugs through diverse procedures.

  • Health officials who participate in European Union groups receive offers or pressure from corporations to modify their position in favour of a company’s interests.

  • Revolving doors in a frequent phenomenon in Deputy Directors increasing the risk of policy capture.