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<P class=MsoNormal
style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; MARGIN: 0cm 0cm 0pt; BORDER-LEFT: medium none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: center; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt"
align=center><SPAN lang=EN-US
style="FONT-SIZE: 14pt; mso-bidi-font-size: 12.0pt; mso-ansi-language: EN-US"><FONT
face="Times New Roman">A rational drug policy is possible!<?xml:namespace prefix
= o ns = "urn:schemas-microsoft-com:office:office"
/><o:p></o:p></FONT></SPAN></P>
<H3 style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US><FONT face="Times New Roman"
size=3>Campaign for rational drug policy and cheap, quality medicines launched
in Belgium</FONT></SPAN></H3></DIV>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt; mso-layout-grid-align: none"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman">‘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. <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt; mso-layout-grid-align: none"><FONT size=3><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US">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.</SPAN><SPAN lang=EN-US
style="mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US"><o:p></o:p></SPAN></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT face="Times New Roman">The
following ten points summarize the basis for the
campaign:<o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><B><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3>1.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></B><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>Medicines are <B>much too expensive</B> 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.
<B><o:p></o:p></B></FONT></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><B><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></B></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>2.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>Because of <B>irrational use and prescription</B> 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.<o:p></o:p></FONT></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>3.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT size=3>The
pharmaceutical market is characterized by <B>chaos, wastage and anarchy</B>.
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.<o:p></o:p></FONT></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt 18pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT face="Times New Roman"><SPAN
style="mso-spacerun: yes"> </SPAN><o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>4.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>Very good and <B>life-saving medicines are sometimes withdrawn from the
market</B> 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.
<o:p></o:p></FONT></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>5.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN><FONT size=3><SPAN lang=EN-US style="mso-ansi-language: EN-US">The
<B>marketing excesses</B> 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!</SPAN><SPAN lang=EN-US
style="mso-bidi-font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: Arial">
</SPAN><SPAN lang=EN-US
style="mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: Arial">(</SPAN><SPAN
lang=EN-US
style="mso-ansi-language: EN-US; mso-fareast-font-family: Arial">Lancet 2003;
361:27-32; 04 January 2003)</SPAN><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><o:p></o:p></SPAN></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><B><SPAN lang=EN-US
style="COLOR: black; mso-ansi-language: EN-US"><FONT size=3>6.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></B><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>There is a blatant <B>imbalance between the marketing of the
pharmaceutical industry and the scientific information provided by independent
agencies</B>. 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). <B><SPAN
style="COLOR: black"><o:p></o:p></SPAN></B></FONT></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><B><SPAN lang=EN-US
style="COLOR: black; mso-ansi-language: EN-US"><FONT size=3>7.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN></B><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>Some measures have led to a perverse paradox in actual practice: instead
of an increase in prescriptions for generic drugs, there is <B>a trend toward
the newest, most expensive medicines in the same class.</B> Within the present
context, a so-called ‘reference reimbursement system’ inevitably leads to such
effects. <B><SPAN
style="COLOR: black"><o:p></o:p></SPAN></B></FONT></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt 18pt"><B><SPAN lang=EN-US
style="COLOR: black; mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></B></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>8.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>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.
<B>Financial thresholds are not the instruments to correct prescribing
behavior.</B> 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.”<SPAN
style="mso-spacerun: yes"> </SPAN>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.<o:p></o:p></FONT></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt 18pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>9.</FONT><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN><FONT size=3><B><SPAN lang=EN-US
style="mso-ansi-language: EN-US">For any public service that is paid for with
taxes, public bidding is required – except for medicines</SPAN></B><SPAN
lang=EN-US style="mso-ansi-language: EN-US">. 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.
<o:p></o:p></SPAN></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoNormal
style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; tab-stops: list 18.0pt; mso-list: l3 level1 lfo1"><FONT
face="Times New Roman"><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>10.</FONT><SPAN style="FONT: 7pt 'Times New Roman'">
</SPAN></SPAN><B><SPAN lang=EN-US style="mso-ansi-language: EN-US"><FONT
size=3>Another drug policy is possible.</FONT></SPAN></B></FONT><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><FONT size=3><FONT face="Times New Roman"> 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.
<B>That means the patients would save 1 billion euro and the health insurance
system would save 1.6 billion euro.</B> These precious resources could be used
to cover other needs in the health care system. <BR>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.
<o:p></o:p></FONT></FONT></SPAN></P>
<P class=MsoBodyText3 style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-ansi-language: EN-US"><U><FONT size=3><FONT
face="Times New Roman"> <o:p></o:p></FONT></FONT></U></SPAN></P>
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<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face="Times New Roman"><SPAN lang=EN-US
style="COLOR: black; mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US">Dirk
Van Duppen</SPAN><SPAN lang=EN-US
style="mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US"><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="COLOR: black; mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US"><FONT
face="Times New Roman">Doctors for the People
<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face="Times New Roman"><SPAN lang=EN-US
style="COLOR: black; mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US">St
Rochusstraat 57-59</SPAN><SPAN lang=EN-US
style="mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US"><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US"><FONT
face="Times New Roman">2100 Deurne<o:p></o:p></FONT></SPAN></P></TD>
<TD
style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; WIDTH: 232.2pt; PADDING-TOP: 0cm; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent"
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style="COLOR: black; mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US"><FONT
face="Times New Roman">Tel: +32-3-3208520 or
+32-3-3229242<o:p></o:p></FONT></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><FONT
face="Times New Roman"><SPAN lang=EN-US
style="COLOR: black; mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US">Cell
phone: +32-3-473.562106</SPAN><SPAN lang=EN-US
style="mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US"><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><SPAN lang=EN-US
style="COLOR: black; mso-bidi-font-size: 10.0pt; mso-ansi-language: EN-US"><FONT
face="Times New Roman">E-mail: </FONT><A
href="mailto:dirk.vanduppen@gvhv.be"><FONT
face="Times New Roman">dirk.vanduppen@gvhv.be</FONT></A><o:p></o:p></SPAN></P>
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