Tuesday, August 23, 2005

Drug Stabbing Time

This article in the FT appeared about a week ago. Healthcare spending should be viewed as an investment in people rather than an expensive burden on the state, according to a Pfizer executive...

Europe ’s health investment fails its people
By Ian Read

As European leaders consider the proposal by Tony Blair, UK prime minister, to re-examine Europe’s social model, they might do well to consider a related challenge: rethinking the best path to quality healthcare. Without urgent attention, troubling policy trends will cause further declines in the quality of healthcare—and health.

Europeans first need to challenge an entrenched point of view on healthcare—as a cost to government instead of an investment in people. For more than a decade, political debate has framed healthcare as an expense. A more far-sighted view would consider health spending as an investment in an economic engine.

The reality of an ageing population requires Europe to think anew. In the next quarter-century, the number of Europeans older than 80 will nearly double, from more than 18m to nearly 35m. Will economies crumble under the weight? Or will investments in health allow seniors to contribute economically by remaining healthy and productive? Diet, exercise and appropriate medical intervention can help maintain health, forestall disease and manage chronic conditions. Why, then, do policymakers view spending on health, including medicines—which can prevent serious (and expensive) conditions, and manage chronic conditions—not as tools for keeping people productively healthy, but as costs to be contained?

Of course, I’m hardly neutral. But our stake in believing that medicines can add years to life and life to years does not change the fact that healthcare systems across Europe are reluctant to pay for health, including innovative medicines that could not only extend life, but also improve a person’s health throughout their life.

Perhaps the best example of this benefit/cost tension is found in the treatment for cardiovascular disease—the largest killer in Europe. A rational healthcare system would promote cardiovascular health through a comprehensive programme of diet, exercise and proper use of the best medicines to prevent illness from progressing.

Today, these best medicines include cholesterol-lowering “statins”. Solid clinical evidence shows that using the best of these statins appropriately can help people live longer, healthier lives.

Yet many governments across Europe search for ways to limit spending on statins, enticed by immediate savings and without full regard for the far-reaching economic and health consequences. In refusing to pay for newer and more effective statins, governments are in effect rationing these medicines by putting them beyond the reach of most people who need them.

This scenario is not exclusive to statins. New medicines to treat such conditions as Alzheimer’s disease are kept from Europeans. Why? Because the blunt cost-algorithms of budgeters cannot quantify the intangible human and social values associated with taking care of one’s grandmother.

Not only is this bad for Europeans. It is bad for Europe. Cost-cutting hurts competitiveness as much as it hurts human health. Dr Fabio Pammoli’s EU Commission report on biomedical innovation found that 70 per cent of world biomedical research now originates in the US, with only 25 per cent coming from Europe. Yet, it was not too long ago that Germany was known as “The Medicine Chest of the World”. Obsession with price has driven out profit and innovation.

Some leaders are awakening to the economic consequences. “We will not succeed in tackling [healthcare] if we constantly view this as a burden,” G√ľnter Verheugen, European Commission vice-president, said recently. He rightly argues that Europe must once again view healthcare as a sector deserving robust research and development investment. The pharmaceutical profession would submit that these investments should come not just in the form of academic or public grants, but also in making today’s best medicines available to patients—which would bolster productivity and boost revenue to finance tomorrow’s medicines.

Treating healthcare as an engine of growth is not only good economics; it is also good politics. Half of Europeans are dissatisfied with their healthcare; a full third believe their care has deteriorated in the last decade; and 68 per cent want more involvement in decisions about their own care.

Let us hope that leaders are willing to improve public and economic health by reinvigorating commitment to their greatest resource—productive Europeans—thus grasping the fact that spending on health is an investment that fuels growth and innovation.

It is worth noting that Pfizer's Statin drug Lipitor is the biggest selling pharmaceutical drug (in dollar terms) in the world today. I suppose another point that could be raised is with regard to the value of life. Just how many people die as a result of limits of healthcare spending? An uncomfortably large number no doubt...
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