PHA-Exchange> Campaing on meds in Belgium

[Bert De Belder]

A rational drug policy is possible!

Campaign for rational drug policy and cheap, quality medicines launched in Belgium
 

'Doctors for the People,' a group of progressive physicians in Belgium, recently launched a campaign for another-rational-drug policy. Medicines are much too expensive in Belgium because of the super profits of the pharmaceutical companies. Moreover, the Belgian system is chaotic and huge amounts of money are being wasted. 

In a country like New Zealand, on the other hand, a system of public bidding ensures that the best product is available at the lowest possible price. Moreover, medicines are free for the patients who need them. Such a system would save the patients in Belgium 1 billion euro per year while the health insurance system would save 1.6 billion per year. This money could be put to good use to support the first line of health care, upgrade the hospitals, or provide better care for the elderly. Doctors for the People supports any bill that could help realize this and has launched a signature campaign for an alternative, and rational, drugs policy.

 

The following ten points summarize the basis for the campaign:

 

1.      Medicines are much too expensive in Belgium. Even generic drugs are more expensive than in the neighboring countries. In comparison with the wholesale prices of one Belgian company that sells drugs in bulk to NGOs, market prices are 15 to 60 times more expensive. 

 

2.      Because of irrational use and prescription of drugs, the scarce resources are used inappropriately. The most expensive medicines are not those that provide the best benefit. For example, three of the five most expensive medicines (for the social security system) are cholesterol-lowering drugs. The two medicines that are the most expensive for the Belgian social security system are Lipitor and Amlor, which are not scientifically proven to be the best in their class.

 

3.      The pharmaceutical market is characterized by chaos, wastage and anarchy. Many new, allegedly innovative medicines do not have any added value. Often there are 10 to 15 producers of a drug with exactly the same active component and all these companies are spending on marketing, research and development. New, allegedly innovative drugs, which are outrageously overpriced and are promoted excessively, erode health insurance budgets. After some time, scientific research often reveals that these drugs do not have any benefit at all in comparison with much cheaper, older drugs. What a waste! The chaos is even worse for over-the-counter-drugs that are not reimbursed by the health insurance.

 

4.      Very good and life-saving medicines are sometimes withdrawn from the market by the pharmaceutical companies because they are not profitable enough. For example, in Belgium Furadantine, the first choice treatment for uncomplicated urinary tract infections is hard to come by. 

 

5.      The marketing excesses are worsening. For example, in Belgium pharmaceutical companies send 4 to 5 times as many sales representatives to doctors as in the Netherlands. According to an article in the Lancet, 69% of the claims by advertisements for anti-hypertensive drugs, are not based on any scientific evidence. Plain and simple deception! (Lancet 2003; 361:27-32; 04 January 2003)

 

6.      There is a blatant imbalance between the marketing of the pharmaceutical industry and the scientific information provided by independent agencies. The subsidies for initiatives to promote rational drug use (about 1 million euro per year) pale in comparison with the huge resources the pharmaceutical industry has at its disposal to promote irrational drug prescriptions (at least 1,000 million euro per year). 

 

7.      Some measures have led to a perverse paradox in actual practice: instead of an increase in prescriptions for generic drugs, there is a trend toward the newest, most expensive medicines in the same class. Within the present context, a so-called 'reference reimbursement system' inevitably leads to such effects. 

 

8.      Measures to control the expenses at the 'end of the line' - at the stage of the prescribing physician or the patient - lead to unwanted side-effects. Financial thresholds are not the instruments to correct prescribing behavior. They lead to overconsumption and wastage for some and to underconsumption for those who do not have the capacity to pay. They stimulate two-tiered instead of 'evidence based' medicine. Archie Cochrane, the pioneer of EBM, already said: "effective treatments should be free."  He advocated the complete reimbursement of effective treatments for everybody. It is the physician who has to prescribe medicines in good conscience and according to scientifically and socially sound principles. The government should provide opportunities to educate doctors' 'conscience' with intensive and scientifically sound campaigns while curbing the marketing campaigns of the pharmaceutical companies which are irrational and unscientific anyway.

 

9.      For any public service that is paid for with taxes, public bidding is required - except for medicines. According to the principle of public bidding, the government has to choose the best bid from at least three bidders. This is not the case for medicines although huge amounts of tax money are involved (2.7 billion euro in 2002). Price setting by 'confidential' commissions is not transparent. Besides, the pharmaceutical industry and other lobby groups are overrepresented in these commissions. 

 

10.  Another drug policy is possible. In New Zealand, only the best medicine is allowed in the market at the lowest price and reimbursed in full. Off-patent medicines are 80 to 90% cheaper in New Zealand than in Belgium. Even medicines without generic competition are 50 to 60% cheaper than in Belgium. On the average prices are about 70% cheaper. That means the patients would save 1 billion euro and the health insurance system would save 1.6 billion euro. These precious resources could be used to cover other needs in the health care system. 
In New Zealand, the whole pharmaceutical policy is in the hands of one, well-funded and well-equipped institute, Pharmac. This agency selects the best drug per class and only one product is allowed in the market after public bidding. All aspects are considered in the evaluation of bids: quality, effectiveness and price. This example shows that another policy is possible and it couls serve as a source of inspiration for the Belgian and European policies. 

 

      Dirk Van Duppen

      Doctors for the People 

      St Rochusstraat 57-59

      2100 Deurne
     Tel: +32-3-3208520 or +32-3-3229242

      Cell phone: +32-3-473.562106

      E-mail: dirk.vanduppen at gvhv.be

       
     

 
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