TCS Daily

Savoir Fair

By Cécile Philippe - May 4, 2004 12:00 AM

If there is one area in which healthcare reform could be successful in France, it is in promoting the availability of medical information to consumers. Indeed, Bernard Fragonard, the president of la Cour des Comptes (the French State Auditors) and head of the Haut Conseil (the high council) for the future of social insurance, argues that it is perfectly legitimate for people to want clear and detailed information when it comes to their health.

The report produced by the Fragonard commission reiterates that it is perfectly legitimate to prohibit commercial competition between general practitioners. And it acknowledges that it is difficult to translate into comprehensible indicators the complexity of the "art of curing." But it does point out that as a consequence, measurement of healthcare performance and quality in France remains very obscure -- unlike many other countries. That is why evolution on this issue is necessary because the simple wish to avoid competition, according to the report, should not justify the fact that the insured patient does not receive clear and detailed information about his healthcare options. The report recognizes that people want and deserve to make free and informed choices and calls for reforms of the existing imperfect channels of communication and unequal sharing of information.

This could be a great step forward, especially after the failure of the European Union to move in the right direction when it had the chance. Indeed, in 2002, the European Commission submitted a draft Directive proposing less strict regulations on prescription-medicine-related data. Unfortunately this draft was rejected in October 2002 by the European Parliament, whose rapporteur on the legislation, Françoise Grossetête, reasoned that "it is vital to ensure that the information communicated to the patient is verified beforehand by neutral and publicly-financed scientific bodies". Which means that in many European countries, legislation relating to medical data must be very strict so as to cover potential medical risks to the public. Indication of any side effects of medicine is compulsory on leaflets, but legislation forbids almost mention of any benefits.

The value attached to a product stems from the ease of choice provided by the medical information available about it. Patients can draw comparisons between products to find the most suited to their needs. Medical information plays a part in the quality of the product sold.

Indeed, the regulation of information to the consumer can lead to high costs in human terms. According to Paul Rubin, a professor at Emory University, 10,000 deaths per year could be avoided if it the ban on revealing that aspirin can reduce heart attacks were lifted. Another ban covers the benefits of folic acid, a form of vitamin B which helps cell development and which could reduce risks of birth defects. The decision to withhold this fact has made more children (and families) suffer than the thalidomide scandal in the 1950s and 60s. Every year 2,500 children are born with spina bifida and many more are aborted. In other words, the tragedies caused by medicine (e.g. thalidomide) are only the tip of the iceberg, while numerous illnesses and deaths caused by restrictions and bans on information to the patient, remain hidden from the public eye.

In Canada, where information to the consumer is forbidden, one man out of nine is at risk of contracting prostate cancer and one out of 20 of dying from it. The progress of this illness could be curbed if information on dyserection -- a symptom of prostate problems -- medicine were authorized at last.

Even though the reforms in the Fragonard report propose nothing new and in particular nothing to really solve the structural crisis of the French healthcare system, one can however hope that by the autumn of 2004 the reform on information to consumers will proceed.

Dr Cécile Philippe is the Director of the Institut Economique Molinari


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