TCS Daily

A Medical Catch-22

By Carlo Stagnaro - April 6, 2005 12:00 AM

Since it was conceived in March 2000, the EU's vaunted Lisbon Strategy has been somewhat downsized. It once sought to create the "most competitive and dynamic knowledge-based economy in the world, capable of sustainable economic growth with more and better jobs and greater social cohesion". Now, at mid-term in that process, the new European Commission has admitted that the EU is having trouble meeting its targets. So it has shifted the focus. A new, more limited goal has been set: "Making growth and jobs the immediate target goes hand in hand with promoting social or environmental objectives."

Commission President José Manuel Barroso is right to narrow the scope of the Lisbon Strategy. Otherwise he only risks widening the gap between rhetoric and reality. Talk is cheap but action is costly -- and resources are scarce. If you spend one euro on environmental protection you cannot cut taxes by one euro, all else being equal; thus you can't make your economy stronger and less dependent upon public intervention.

The gap is epitomized by the regulation of the pharmaceutical sector. Despite the EU's professed emphasis on research & development, information, and competitiveness, Europe's pharmaceutical industry is not free to inform patients about its products. Nor can it engage in science-based campaigns, which might help people to understand how to use drugs in the safest way. The result: Europeans who can speak English and have an internet connection may check out the websites of US companies; all others (who are presumably a majority among the elderly, i.e. the heaviest drugs consumers) rely either on bad information provided by independent and often unreliable websites (that are not regulated in Europe) - or get no information at all.

If an executive of a research-based pharmaceutical company gives direct information to patient, he might even be jailed for it. Informing patients and helping them to recover, even if you have no interest in cheating them (since you are liable for the possible harmful consequences from bad information on your products), is regarded as a crime, such as robbing or killing.

But thanks to the narrower focus of the Lisbon Strategy, something is changing. EU Enterprise and Industry Commissioner Günther Verheugen has mentioned the possibility of launching a pilot "public database" showing information on the safety and efficacy of existing and new medicines. Companies will be involved in the process, together with governments, doctors, and patient groups. It's not yet freedom of information - but it's a move in the right direction.

The question now is whether the Commission will take the next step. Consumers should hope so. The problem lies in the vested interest of two actors in the process, namely governments and doctors, who tend to oppose more freedom of information. They usually argue that patients are not capable of processing medical information. But this is a Catch-22; because people are ignorant we should keep them ignorant. It is the opposite of common sense, that the more information patients receive, the better off they will be.

Doctors defend their strategic monopoly on medical information. It's almost as if they still hold the respected position of primitive societies' shamans. They alone can divine the secrets. It's not just that other people can't understand; it's that other people are not allowed even to try to understand. This despite the evidence that informed people tend to make a wiser, safer, and better use of drugs.

Moreover, European governments must deal with the failure of public healthcare systems. They simply make no economic sense - they cost too much and, as a Stockholm Network survey showed last year, leave citizens largely unsatisfied. Cost containment is the first goal of governments. And the simplest way to cut costs is to save money on drugs - partly because while other subjects are politically strong (doctors and nurses are strongly unionized, pharmacists are protected, etc.), "evil" multinationals are easy targets. Although there is no evidence of a causal relationship between advertising and an increase in drug consumption (quite the opposite is the case), there is a perception that direct-to-consumers information results in a larger demand. There is also some evidence that informed patients may identify and cure illnesses in time, so need less hospitalization. If this is true, more information would also cut medical costs.

(Cost containment is pursued also through other measures, most of which impact pharmaceutical industries: price controls, parallel importation of drugs, incentives to generics, limits to pharmaceutical expenditure, etc. No wonder then that European companies invest less than American and Japanese ones in R&D.)

Companies are not the only victims of European health policies, including anti-information regulation. Patients may not know it but they are victims too. They pay high taxes for poor service. They are not even free to inform themselves about alternatives. If citizens' health does matter, then European governments should trust more in freedom and less in public healthcare systems.



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