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Editorial

Nature 454, 667 (7 August 2008) | doi:10.1038/454667b; Published online 6 August 2008

Clean hands, please

The Italian government needs to maintain a careful distance from industry.

Fifteen years ago, at the height of Italy's 'Clean Hands' anticorruption campaign, police broke into the house of Duilio Poggiolini, head of the national committee for drug registration, and discovered gold bullion under his floorboards. For many Italians, the image of that gleaming bullion still resonates — an enduring symbol of a time when government officials, up to and including the health minister, routinely took bribes from the pharmaceutical industry to approve drugs and fix their prices.

Steps were taken to avoid such a situation arising again. So it is worrying that Nello Martini, a pharmacist with no political associations, has been removed by Prime Minister Silvio Berlusconi's new government as head of AIFA, the autonomous agency created in 2004 to register drugs and supervise their use. Martini successfully carried out a mandate to limit spiralling drug expenditure to 13% of the total health budget. But in the process he incurred the wrath of industry. Only a few weeks ago, government prosecutors in Turin charged Martini with disastro colposo, or 'causing unintentional disaster', for bureaucratic delays in updating the packaging information on the side effects of a few drugs — although none required more than minor rewording of existing text.

Martini was replaced in the middle of July by microbiologist Guido Rasi, a member of AIFA's administrative board, who has been described in the Italian press as being close to the far-right party Alleanza Nazionale, which forms part of Berlusconi's coalition government. Even more worryingly, the government, which took office in May, says it plans to reduce AIFA's power by separating the pricing of drugs from technical considerations of their efficacy, bringing pricing back into the health and welfare ministry.

At a time when all countries are struggling to find a way to pay for hugely expensive new-generation drugs within limited budgets, this makes little sense. The autonomous agency needs to be able to integrate all technical and economic information if Italy is to operate a cost-effective health system. Moreover, the health and welfare ministry's connections with industry are uncomfortably close. For example, the wife of the minister Maurizio Sacconi is the director-general of Farmindustria, the association that promotes the interests of the pharmaceutical industry.

In fact, Berlusconi's government has shown unsettling tendencies to allow industrial interests to gain influence over state agencies. A few weeks after Martini's dismissal, the Italian space agency was put into the hands of a commissioner who heads the space division of the aerospace giant Finmeccanica. The government should think twice about whether it really wants to open the door that was deliberately closed after the Poggiolini affair.