The British pharmaceutical industry, which has become hugely wealthy, in part thanks to government incentives, is failing to develop the drugs the NHS needs, according to a thinktank report.
The King's Fund says that successive governments have been content to buy what the industry offers, rather than negotiate for what patients need, especially women, children and older people.
The pharmaceutical companies spend less on researching ways to protect and promote health than on seeking profitable new blockbuster drugs.
"We want to see a relationship develop between government and the pharmaceutical industry that is geared towards the promotion of health, not just the promotion of wealth," says the report's author, Anthony Harrison, a senior fellow at the fund. "For too long the industry has been in the driving seat of this relationship, with government acting as a passive purchaser of drugs.
"Whilst this partnership has undoubtedly been an economic success, the interests of patients and the public clearly do not always coincide with what will be most profitable for the pharmaceutical industry."
The research agenda is set by the companies, which invest millions in the hope of discovering a drug which will be in demand all over the world, such as Viagra. On the back of such blockbusters, the industry makes some of the highest profits in the world.
But this means that less potentially profitable areas which would benefit patients are neglected, Mr Harrison says.
The problem is compounded by the lack of involvement of patients or other people who use NHS services in setting drug research priorities. The pharmaceutical companies and scientific researchers decide what they want to investigate and which medicines to take to clinical trials.
The report says that the relationship between the government and the pharmaceutical industry, which Mr Harrison describes as "an implicit public-private partnership", needs to be better defined. The government needs to be clear about what health research it would like pursued.
Although most of the money that goes into the research and development of drugs comes from the private companies, the industry gets subsidies or tax breaks from the government, and benefits from access to NHS doctors and patients, who carry out and take part in clinical trials.
The industry's profits from the NHS are capped by the pharmaceutical price regulation scheme, but the report says this allows "an adequate profit margin to finance a high level cost of research".
Patients and the public should become more involved in discussions about the direction of medicines research, the report suggests. It proposes the setting up of a health research and development taskforce to identify the patient groups and health areas currently poorly served, and to suggest to the government and NHS how they should negotiate with the industry to correct that.
The report accepts that this body might clash with the Pharmaceutical Industry Competitiveness Task Force set up by Tony Blair, which comprises ministers and drug company heads, and exists to promote the industry as an employer and a source of income to the UK economy.
An industry statement said: "Dozens of new medicines designed for diseases specifically affecting women, children and people in the developed and developing world have been produced over the past five years, and hundreds more are in the pipeline."
The director general of the Association for the British Pharmaceutical Industry, Trevor Jones, added: "The pharmaceutical industry in the UK is one of the most innovative in the world."
· Getting the Right Medicines? Putting public interests at the heart of health-related research, by Anthony Harrison, published by the King's Fund.
