Preliminary hearing of proposed EU Commissioners

The different proposed Commissioners need to be approved by the Parliament and for that the Parliament Question them a special Hearing. According to the draft timetable for the hearings in the European Parliament will take place from the 11th of January to the 19th of January. More exactly Máire Geoghegan-Quinn (Research) is scheduled to be questioned the 13th at 16.30 to 19-30 and Dalli (Health and Consumer) the 14th of January between 13 and 16. Look forward to hear what Dalli will do about the Patient Information and Patient Rights at Cross Border Care Directives.

If you are interested in times for hearings of other commissioners please contact me directly.

Heads of Commission cabinets selected

The various Commissioners to be have selected their Heads of Cabinet. Interesting is that John Bell from Sanco goes to Research. Maybe we get more healthcare focus in research in the future? Darmanin was previously deputy head of cabinet to Commissionair Borg.

See the full list below:

Health Commissioner John Dalli (Malta)
Head of Cabinet: Joanna Darmanin, Malta

Research Commissioner Máire Geoghegan-Quinn (Ireland)
Head of Cabinet: John Bell, Ireland

Commission President - José Manuel Durao Barroso (Portugal)
Head of Cabinet: Johannes Laitenberger, Germany

High Representative for Foreign Policy and Security - Catherine Ashton (UK)
Head of Cabinet: James Morrison, UK

Trade Commissioner Karel De Gucht (Belgium)
Head of Cabinet: Marc Vanheukelen, Belgium

International Cooperation and Development Commissioner Rumiana Jeleva (Bulgaria)
Head of Cabinet: Jochen Richter, Germany

Climate Commissioner Connie Hedegaard (Denmark)
Head of Cabinet: Peter Vis, UK

Energy Commissioner Günther Oettinger (Germany)
Head of Cabinet: Michael Köhler, Germany

Transport Commissioner Siim Kallas (Estonia)
Head of Cabinet: Henrik Hololei, Estonia

Economic Affairs Commissioner Olli Rehn (Finland)
Head of Cabinet: Timo Pesonen, Finland

Internal Market Commissioner Michel Barnier (France)
Head of Cabinet: Olivier Guersent, France

Fishery Commissioner Maria Damanaki
Head of Cabinet: Markopouliotis Georgios, Greece

Enterprises Commissioner Antonio Tajani (Italy)
Head of Cabinet: Antonio Preto, Italy

Development Commissioner Andris Piebalgs (Latvia)
HoC: Christopher Jones, UK (former director DG TREN)

Fiscal affairs Commissioner Algirdas Semeta (Lithuania)
Head of Cabinet: Stephen Quest, UK

Justice Commissioner Viviane Reding (Luxembourg)
Head of Cabinet: Martin Selmaye, Germany

Digital Agenda Commissioner Neelie Kroes (Netherlands)
Head of Cabinet: Anthony Whelan, Ireland

Regional Policy Commissioner John Hahn (Austria)
Head of Cabinet: Hubert Gambs, Austria

Head of Cabinet: Marc Lemaitre, Luxembourg

Agriculture Commissiener Dacian Ciolos (Romania)
Head of Cabinet: to be appointed

Internal Affairs Commissioner Cecilia Malmström (Sweden)
Head of Cabinet: Mia Asenius, Sweden

Interinstitutional relations Commissioner Maros SEFCOVIC (Slovak Republic)
HoC: Peter Javorcík, Slovak republic

Environment Commissioner Janez Potocnik (Slovenia)
Head of Cabinet : Kurt Vandenberghe, Belgium

Competition Commissioner Joaquin Almunia (Spain)
Head of Cabinet: Carlos Martinez Mongay, Spain

Enlargement Commissioner Füle Stefan (Czech Republic)
Head of Cabinet: Simon Mordue, UK

Employment Commissioner László Andor (Hungary)
Head of Cabinet: Anabela Gago, Portugal

Education Commissioner Vassiliou (Cyprus)
Head of Cabinet: Philippe Brunet, France

According the UK Shadow Minister of Health - what will happen if they win next election?

The UK healthcare system ranking as no 14 in the 2009 European Health Consumer Index as well as the recent reports about the very large difference in cancer survival rates across the country makes it quite obvious for everyone that something have to be done to reform the UK healthcare system. Given that it seems very likely that there will be a change in government after the next election I’m happy to have had the opportunity to discuss with Mr Mike Penning the Shadow Health Minister for the Tories about their plans for reforming the British healthcare system.

Initially he plays it safe by explaining that the starting point for the Tories is that Blair won the argument that NHS needs more money and that they will match the increase in funding already decided by the Labour government. But he continues that this massive increase in funding have up-to now not been matched in outcomes.

Stroke, cardiac, major trauma – all area areas where he sees that they are lagging behind in development. I might here be able to ad Allergy – having listening to Professor Prof.Dr. J.G.R.de Monchy at the Universty Medical Center Groningen and learned that in the UK 68% of patients assumed to have Allergies are not tested at all for Allegies a figure that in Germany is 15%, in Spain 27% and Italy 28%. The country that comes closest is Denmark with 40%...

Now Mr Penning explains that the problems are based in the fact that departments are very silo based – and that there is a need to look at the public health agenda. I.e. he thinks that it’s not possible to only address health at the emergency entrance. Since leadership is important the Tories will change the department of Health to the department of Public Health as a clear signal that this needs to be addressed.

I must admit that when I heard this I thought for myself that I would have looked more at the financial silos and I was quite happy when at the end of our discussion when we were talking Qualies it became clear that they did have a double approach to the silo issue. More about this further down because before we have time to go there he states that it has been a massive increased spent in bureaucracy– because of the increased of targets driven healthcare. The hospitals have had to work to meet these targets – instead of deliver on outcomes. So priorities have been driven by bureaucracy rather than clinical needs. He also promises that this means that the Tories will abolish the targets!

If the problem description probably is quite PC I’m sure that their solutions are more controversial and I had to ask if national guidelines still will be used. And yes the answer is that they will but he underlines there is no point in diagnosing bowl cancer if you then don’t treat the patients. I read this as there will be a slight different focus in the way guidelines are written compared to today but didn’t go into details.

Another area for change is their ambition to extend the choice – in elective care – and to ensure that information enabling choice is available. The rational for this is that the information now being published was available but not transparent – so what needs to be done is to ensure that this information is freed up! This would empower the patients. I ask about the information that Dr Fosters gathers and he explains that this info isn’t available for the general public or even a Shadow Minister of Health like himself, only for the Department of Health etc . Mr Penning wants instead create one single portal into the web where you should be able to check survival rate etc.

He exemplifies the problem with the recent Dr Foster report that looked at particular hospital and found quite remarkable bad management despite that an excellent report have been published one month earlier. This report came after CTC made a decision to send in team due to the suspicious mortality rates they seen in non public material. Question is how this could have been possible. The answer to this is that according to Mr Penning is that:

1. Tories do not want any pre-booked inspections and on this they will go against till management of care if needed!
2. They want the monitoring of the foundation hospitals to be not only on finance but also the clinical side in order to get a better balance in the inspections.

Asking about top-ups he explains that they will accept top-ups in certain situations meaning that if there are drugs that are available in others countries that you receive a prescription on you should have the right to continue with that particular drug.

So then we came back to the Silos. And admittedly one of the things I find most interesting is that he claims that they will change the definition of the Qualy used by NICE. The problem as he sees it is that the Qualies do not take into account enough factors for example if we have a drug that would extend life. He thinks that it should also look at what the alternative cost would be – for example if you would need 24 hours care at home or hospital instead of this drug. I.e. what should be important for a reimbursement decision is the total cost of the state when a patient has a specific disease. If this could in the same way most NICE work do set the standard of how health technology assessments should be done across Europe I would be very happy!

He mentions that he also thinks there is a need to look at the way we are negotiating with the drug companies – for example on how early the NHS would be involved in the clinical trials. A topic that I need to look more into at a later stage – its quite fantastic for me to realise that a big buyer of medicines like the NHS actually do not negotiate on price!

Quite a lot to do so I’m curious about the plan for execution. He explains that there is a 3. 6 and 9 months program as well as one for 2 and 3 years time. They are already discussing with the civil servants .But in many cases we cannot get the info before we are in place. Still civil servants seem to be aware that the current government is out of ideas and changes have to occur.

So he hopes that after 4 years – there will be more people with better outcomes, some living longer some just treated better. Key will be a massive increase in patient outcomes. Well I just hope that his realism about the quality outcomes by the NHS lasts long enough for all of this to take place.

A patient rights vote for a Swine Flu shot?

Last week a blocking minority (Spain, Poland, Portugal, Slovakia, Greece and Rumania) in the Council put an end to the hopes of getting a decision on the directive for patient rights at cross border care.

Despite that the Swedes basically had sold out everything that would for real have empowered patients and put forward a proposal that merely id codify the current case law and gave plentiful of guarantees that governments should still be in power of healthcare. But the hard core of the minority came well prepared after having had their own pre-meetings and where not satisfied and instead they wanted a proposal that restricted case-law – i.e. discriminating private providers - since that was assessed to go against the constitution the Swedes could not accept going further and revising their proposal even more..

One of the things impacting the outcome where that Greece who up to now have been positive have had a change in government and the recently elected health minister didn’t know what to do. According to my sources who attended the meeting the Spanish Health Minister Trinidad knowing this promised her Greek colleague that the issue will be managed during her presidency meaning that the Greeks could without hesitation not make up her mind yet and instead vote no in order to have more time for contemplation and potentially vote yes later. Right.

There is also a guessing game ongoing on what the Romanians got from Trinidad. What is clear is that the Poles didn’t get what they wanted. The Polish Health Minister Kopacz her own problems since she has missed order swine flu vaccines and then tried to claim that 1. There is no Swine Flu in Poland and secondly if they would get it that the ordinary flu vaccine would work. She did before the meeting try to get Sweden to give her vaccines out of the Swedish stock. This happened when Swedish Health Minister Hägglund visited Warszawa to talk about the Directive about Patient Rights at Cross border care. Hägglund answered that it’s not the government but the counties in Sweden that owns the vaccines but Kopacz didn’t rest and send a letter to Hägglund. Unfortunately the Swedes have classified the letter and correspondence around the topic but this decision have been questioned by Swedish Radio and with some good luck the Swedish constitutional transparency regulations will prove useful.

Good to know for the future, given the appointment of Dalli, is that Malta did in the end line up with the majority in favour of the directive. Maybe Dalli when in charge DG Sanco can ensure that they continue to push the issue. Or maybe Trinidad just didn’t want the Swedes to get this through and actually will deliver to the Greeks so that we will have a new proposal this spring. In the meantime patients will suffer.

Dalli EU lead in health and DG Sanco gets responsability for pharma

John Dalli from Malta will be in charge of Health and Consumer Policy in the new Barrosso commission. At the same time the reponsability for pharmaceuticals is being moved to DG Sanco. Mr Dalli who today is Social Policy Minister has a background both in industry as well as in consultancy and should be well equiped to manage the change in responsability. Its going to be very interesting to see what this will mean formost for the patient information proposal - maybe some of the tension around the issue can be eased with this transfer since DG Sanco now has to take responsability for the dossier instead of viewing their role only to safeguarde the safety of the patients and consumers.

Healthcare not the big driver of UK public sector cost

Sometimes those really boring statistical documents shows very interesting figures and I must say that the latest report from the UK Office for National Statistics (ONS) Centre for the Measurement of Government Activity is one of the most interesting documents I seen for a long time.

They have studied how the costs in public sector have grown over a period of 10 years. And they make a productivity measure by looking at cost per unit. Interesting enough the results shows that the healthcare expenditure actually with its average of 3.8 % per year grows exactly on average in the public sectors! The educational, social care, Police, Public order and safety, Children and Adult social care all grew more. Now this type of material is not my speciality but I did miss a comparison with the general inflation in society. I didn’t see anywhere that this material was inflation adjusted and if not its sort of hard to put the yearly 3.8 % increase in cost in perspective.

What was in there was a calculation showing that labour cost grew faster than in the broader economy (5.6% against 4.5% on average). So the reason the lower total spend despite the higher spend on cost of labour is probably that in healthcare the cost of goods and services only increased with 1% compared to the average 2.5%. Generic substitution is pointed out as one of the major reasons behind this low increase in costs for goods and services.

I can only make two conclusions:
1. Its not healthcare that is the problem in public spending.
2. To increase productivity for the future its not the products used in the system that needs to be in focus but the processes and not products to ensure a lower price per unit.

Healthcare is the largest individual spending area (30 % out of the total) in the UK. The study took place from 1997 to 2007 and can be found here.

A bit easier to get EU funding for health projects

Found some good news for researchers, NGOs and others longing for EU funding for their projects. The EU Commission, the will publish a call for proposals in line with the Work Plan for the implementation of the EU Health Programme 2010, for projects, operating grants, conferences and joint actions already in 2009. The deadline for submitting proposals will be around March 2010. This might not seem important but my experience is that especially for those who want to find funding for projects this will make a big change as you must find money also somewhere else than from the EU Commission. This of course takes time and has its special limitations. I.e. other organisations also have budgets and financial steering instruments with deadlines etc for commitments of funds.

So far this have been quite complicated as the publication of tenders have been made in the spring with a deadline early summer the same year.Thus this formally small change in procedure is an important adaptation to other realities such as organisations being able to adopt their budgets before the new budget to the calls they might participate in the following year. Better financial planning will be possible and hopefully more organisations will be able to submit proposals for their projects.

More info on calls for proposals on the Executive Agency for Health and Consumers website.

The shift in the perception of health

I had a meeting a couple of days ago with a representative of Swedish Haemophilia Society association. Chatting about various things he mentioned that he recently had been climbing in Nepal and that the team had been monitoring their oxygen levels. He rightly pointed out that in these times of swine flu of course their oxygen levels while climbing would had caused quite some concerns at an emergency ward. And then he ended in an: But of course we were all healthy people.

A totally natural comment for him but for me who knows that not only has he haemophilia but the treatment given to him in the 80th as a child also as a side effect gave him HIV this was a bit well it wasn’t what I expected to hear.

Haemophilia today at least if you receive treatment in line with the Swedish preventive strategy is just a chronic disease that needs regular treatment. Quite similar is the HIV situation. In Sweden. But if you live in other parts of the world and do not get the medicines you need it is very different. Without treatment each of these 2 diseases is deadly – your life expectancy is substantially shortened.

This might seem trivial but give it some thought what this shirt in perception of health means for our healthcare system. And what it means that the innovation in medicines have given to society. The achievements my friend has managed during in his case very active working life would never have been possible without new modern medication.

It should also makes me to seriously doubt the use of pan European measurement of self-reported health status as for example have been done by for example the Eurofounds European Quality of Life Survey database and the Eurobarometer 2009 on not the childrens but the parents view of their childrens health. It all comes down to subjective individual perceptions and cultural contexts. Not really comparable on a European level.

Pharmacy monopoly in Sweden now sold out

The part of the Swedish Pharmacy monopoly that was devided into clusters to enable the privatisation is now sold at a final price of SEK 5.9 billion.

Apoteket Hjärtat, owned by Altor, acquires 208 pharmacies, with a turnover of SEK 7.1 billion and 1500 employees.

Kronans Droghandel, owned by Oriola-KD and KF, acquires 171 pharmacies, with a turnover of SEK 4.4 billion and 930 employees.

Medstop Holding AB, onwed by Segulah, aquires 62 pharmacies, with a turnover of SEK 3.1 billion and 660 employees.

Its a pity non of the international playeers have entered the market - I hope the reason is that they will establish new pharmacies instead of taking over old stores with old staff.

More information can be found here.

Changes in rutines due to Swine Flu mistakes that will benefit all

It has turned out that 4 out of 6 in Sweden that died from Swine Flu actually visited a clinic or hosital in order to get care at an earlier stage but where sent home again. One region (Skåne) has learned from the mistake and has changed their routines and as from now no-one shall be sent home without having seen a doctor…

Still if the care centres and emergencies would use very simple routines albeit with modern medical technology could help them as pointed out yesterday in Aftonbladet. At Södersjukhuset one of the Stockholm hospitals they use a triage sorting method. There are a several ( see more here) but at this hospital they check pulse, blood pressure, oxygen level in the blood, fever and the patients breathing capability. For measuring the oxygen level in the blood they use a devise that is very simple to use and cost them only 800 Euros to buy.

Let’s hope that those clinics where you don’t get to see a doctor at least ensure they sort patients a bit more careful in the future and make use of the devices available.

Another good thing is the boost the Swine flu discussions have for general hygiene standards. Hand washing seems too been given a real and needed boost. Long term I think this will saving more life’s than the vaccines in many disease areas!

What only the EU can do with regards to HIV/AIDS

In the yesterday launched Citizen's Summary of the EU Comms Communication on combating HIV/AIDS I learn that: “Only the EU can”:

"• collect data and monitor conditions across Europe, giving national authorities more information on which to base their policies "

I thought the HCP HIV index as well delivered on this one and the DG Sanco actually participated at panel of the launch seminar so they should be aware of the work.)

"• provide political support to member countries and stakeholders across Europe to:
o improve access to prevention, treatment, care and support
o reach migrants from countries with a high prevalence of HIV
o improve policies targeting the populations most at risk."

For example patient associations like the EATG do this and also other stakeholders. Took a look at the EATG site and they recently communicated advice on what the Baltics should be doing to improve as well as arranging several networking meetings.

Not to mention that given how political controversial these issues still are I think that maybe there are other more effective organisations than the big consensus machine called the EU Institutions.

Hospital Acquired Infections - 37000 deaths per year in the EU

Hospital Acquired Infections (HAI) is an increasing problem. The European Centre for Disease Prevention and Control (ECDC) estimates that every year 4.1 million patients, equivalent to one in twenty hospitalised patients acquires infections. They EU Commission also estimates that every year 37,000 patients dies directly because of by hospital acquired infections and as that isn’t enough; an additional 110,000 deaths yearly is thought to be due to contributions to such infections.

So its not strange at all that the EU Commission and ECDC works quite intense with the subject and have both released a Communication as well as a proposal for a Council Recommendation on patient safety that deals with HAIs as well as other topics. Same goes for their Patient Safety & Quality Care Working Group with members from NGOs, Member States and the Institutions. More information about their work can be found here. One find if clicking on the meetings some quite interesting presentations.

Now that’s high level for those on the field a good overview of links to various tools, from guidelines by the Royal College of Nursing in the UK for the professionals to patient adapted versions that all can help preventing HAI´s can be found here.

And worth highlighting is this piece that I picked up from an earlier comment on a similar subject made by Andrew Preston from Harm Reduction Works.

2 Swedish sites ranking and discussing healthcare

Om Vård is an excellent independent site enabling Swedish patients’ choice via given the patient information about waiting times and quality outcomes as well as allowing them to both rank their healthcare providers and compare with the 3 closes alternatives.

Also interesting is the new blog initiative from some people with a centre right background working in the Swedish Governmental administration, the Parliament as well as local politics. All of them in one way or the other working with healthcare or social insurance issues. Gives a hint of where the current Swedish majority is heading when it comes to welfare issues.

Both sites are in Swedish.

Rate your GP in the UK

Physicians have a tendancy to claim that its unethical to rate hospitals etc. For me its obvious that all services needs to be rated and that patients have a right to know what doctors that just do not deliver. And in the UK the NHS now realised that this is the way forward and its possible there to rate ones GP practice. All one has to do is type the postcode, select who to rate and click to add ones comments. Interested - click here.

Omnium rerum primordia sunt dura - also for the EU Commission DG Sanco

The European Commission´s DG SANCO launched an on-line discussion on European health and consumer policy to mark its 10th anniversary. This meant that a channel on the Debate Europe forum was open in all EU official languages 14 September to 9 October 2009. The aim was to “provide Europeans with a good opportunity to make their voices heard on health and consumer policy and share their views with others. They will be able to vote in an online opinion poll and learn more about what the EU is doing in this area.”

Not sure about the learning part – I posted a question on the 21st of September and it was never answered. Maybe already the 21st they had given up on the possibility to pull this off?.

Because for discussion; there basically where none. Most well visited seems to have been the English section – almost 300 postings. Most language sections ended on under 10.

But lets hope they do not give up – running an online fora is a good idea but having it online during such a short time spam makes it more or less impossible to get the word out and discussions going. Better luck next time – with some small changes like having a moderator answering questions/trying to have one discussion and not one in each language/ maybe even having their own staff participating.

They could start by using Swedish MEP Gunnar Hökmark´s recepy for success: If everyone recruits one we will double. For a organisation of Sanco´s size this would give around 900 participants.

Now I only wait for the event where the conclusions will be presented ( a special anniversary seminar) – its promised for the 23 October 2009. This one is said to be attended by current and former Commissioners, stakeholders and the media. And 5 of the participants in the discussion – having scanned some of the postings I really look forward to their announcement naming the lucky ones.

Today is the Global Hand Washing Day

It’s a bit sad that campaigns promoting hand washing properly is still needed. Well at least when those needing the info are educated healthcare professionals as with the Clean Your Hands campaign that I written about before. But I join in anyway this day since the London school of Tropical Hygiene have proven that information about hand washing does increase the frequency. And the goal of this year’s campaign for hand washing with soap is to train children. So if you want to join in on the effort some more info on the benefits of hand washing with soap from the site of The global Public-Private Partnership for Handwashing:

”UNICEF estimates that diarrhea kills one child every 30 seconds. Scientific research shows that hand washing with soap prevents disease in a more straightforward and cost-effective way than any single vaccine. Hand washing with soap thus represents a cornerstone of public health. It can be considered an affordable, accessible “do-it-yourself” vaccine.”

If you want to join in on the Global Handwashing Day this is the campaign site.

The Timbro newsletter on Swedish welfare reform

Just received the latest newsletter on welfare reform from Timbro a swedish think tank.

In the newsletter one find interesting links to for example reports showing that staff in privatedly owned healthcare providers are more satisfied compared to those working for the governmentally owned ones, Jacob Arwedssons new book on Health Technology Accounts and a range of articles on the consequences of allowing for private profits in healthcare.

US Health Reform Hub - for reforms with a patient-centred approach

Curious about the discussions in the US about health reforms from a market based point of view? Then you should take a look at the Health Reform Hub (www.HealthReformHub.org) a new site that have been launched by the Galen Institute . The goal is that the site will serve as a central access point for discussions and the latest news and information about ideas for reform with ”a patient-centered approach”.

Links updated

Luxemburg best on HIV care - Sweden and Italy among the worst

A couple of year back when I still worked for the Health Consumer Powerhouse we were in discussions with the World Bank about doing an HIV Index. I think this is one of the more obvious areas for the HCP to do an index over since it’s an area where so many more factors needs to be taken into account beside the pure clinical ones. It really is an area where you need to take a consumer point of view when measuring.

When I then in Gastein a year ago asked Armin Fidler what happen with the World Bank index he explained that one of the member states had blocked the report since they didn’t like the findings. And that is what happens from time to time when national agencies as well as the international ones like the WHO, the World Bank etc produce material. Its a common missunderstanding that their work is objective. Its not - they work in line with the governmental political agendas. This is one of the reasons why it’s so essential that independent private initiatives like the Health Consumer Powerhouse exist.

If nothing else it’s proven when today they do what they World Bank could not by publish their Euro HIV Index ranking the performance of the European healthcare systems with regards to HIV care.

The number of the people living with HIV increases in every member state of the EU. But I do not think that the way to deal with the increase in risky sexual behaviour is to prosecute for unintentionally and unknowingly transmitting the virus as is the practice in for example Denmark and Germany! A special problem is that harm reduction strategies in prisons often is just talk not being implemented. But maybe even worse is that discrimination of people living with HIV is frequent at work and in schools across Europe!

Luxembourg wins the ranking among European 29 countries with 857 points (out of 1,000), followed by Malta (791) and Switzerland (775). Sweden (24th), Italy (27th) and Greece (28th) should be especially embarrassed about the result! You might discuss the relevance of automatic testing the few TB cases you have in Sweden for HIV but its quite clear that the situation with regards to rights is not good. And looking at the score for Italy one gets the impression that HIV is just not on the healthcare agenda. They end up in the bottom by scoring pretty mediocre all over.

The European HIV Index measures 28 indicators, covering 4 sub-disciplines that are key to HIV: Involvement and rights, Access, Prevention, and Outcomes. Each sub-discipline is weighted for importance in contribution to the overall Index score. The full report, the matrix and press material will be available on the http://www.healthpowerhouse.com/ site.

Use bad or good news to raise money for charity?

According to the the FT supplement How to Spend It the UK Prostate Cancer Charity have proven that bad news does not encourage donations to good causes. I am not sure it is that easy. The organization sent out letters to the 33000 supporters. 50 % of recipients got a letter explaining that due to the recession a decline in donation was expected thereby risking important research. The other 50 % got a letter explaining the achievements that had taken place due to their previous donations. Guess what: Those that got the positive news about what impact their money had gave in average 45 % more compared to those that had gotten the bad news mail. I think the others got an excuse not to continue giving. I’m not surprised that a letter stating that ”we know you are having a hard time but please give anyway” result in less money than one playing on the pride of donors ”you are so important and what you do matters”...

The Europa Donna - Breast Health Day

Europa Donna have launched a campaign aiming at increasing awareness of breast health leading up to the October 15 Breast Health Day. Their key message is that physical activity can be a lifesaver since 10-16 % of all breast cancer estimates originate from inactivity. As breast cancer is the most common cancer in women worldwide with an estimated 430.000 new cases, only in Europe every year their campaign if successful could potentially save 40.000 women every year from breast cancer. My favorite from the campaign material is the little checklist available in the leaflet “More active today for your breast health tomorrow”.

I love checklists and hands on fill out guides that encourage immediate action. It engages and involves much more than the usual one-way information. They also give advice on 7 things women can do for their breast health. One of them is sending your friends this card.

Now interesting is that self-examination is not one of these 7 points. In Sweden the organizations active in the area still promote self examination since it engages and involves women but research at Danish Rikshospitalet by Peter C Gøtzsche do show that it is mostly damaging and leading to unnecessary surgery and worry. When doctors start talking about unnecessary worry I usually have a problem with anyone who think we have an over consumption of healthcare or that patients should not worry about their health. They should.

Doctors on the other hand should be able to ensure that there is no unnecessary surgery - also when women worries.

Benchmark against Nintendo in order to enable more health investments and increase choice?

“The opposite to focus on the citizen seems to be failure” Robert Madelin Director General at DG Sanco opened up at the MedTech Forum 2009 Summit. He then continued by explaining that key for the future will be to look at how companies like Nintendo build their business. This since that in the future funding will originate “not necessarily from health budgets but from peoples willingness to pay”.

Spot on. I must admit I think its strange that everyone seems to manage to find money for their own mobile phones but when it comes to even more important things like healthcare products and processes these essential products needs to be funded via governmental budgets. Since governmental budgets per definition are limited this is must be putting a effective cap on citizens health investments.

Dr Miroslav Palat seemed to also take special notice of Mr Madelins Nintendo statement taking the discussion a bit further by pointing out that we all now agree upon patient empowerment but that “the we still need to hear how are we going to open up the healthcare system as a true market for the patient to make informed choices?” And right he is. Choice is a key component in real empowerment and how can choice really be implemented as long as healthcare is a centrally planned service to the citizens by the government? Not all believes in choice since some citizens will fail when making their own choices but as former UK Health Minister and MEP John Bowis stated as a response to Mr Palats questions: “ those that make difficult choices makes a lots of mistakes but those that avoid choices makes the biggest mistake of all”.

Maybe because he´s 5 years mandate that cannot be prolonged have come to its end Mr Madelin he could be quite outspoken and when he responded to Dr Palat he explained that there is clearly people in Brussels that hate the concept of market in healthcare but that for him the Directive on patients rights at cross border care is clearly a step forward in this direction. He continued that the reality is that this part of empowerment is growing.

Lets hope he is right since the only ones that really will focus on the citizens are the citizens themselves.

ECJ decision on GSK vs European Commission on parallel trade of pharmaceuticals

The European Court of Justice yesterday told the Commission, see the full decision here, to review the GSK case on parallel trade. The background is that GSK in Spain have had two tariffs to limit parallel trade. Now the court have clearly stated that efforts to limit parallel trade is illegal but that the Commission should have done a better investigation on GSK application for exemption in this case.

Parallel trade as I see it is when it applies to jeans or wii games a natural development of the market. I would have expected the European Commission to grant an exception in this case since when it comes to the area of pharmaceuticals the situation is slightly different compared to the products paid for by the consumers directly. Pharmaceuticals prices are regulated by the governments and some countries can afford or are prepared from cultural geographical etc reasons to pay more than others. And they should in order to facilitate for poorer countries to get a better price. This means that richer countries healthcare systems should not be allowed to free-ride on these countries lower prices. See my earlier blog on differentiated pricing here.

Some of the legal comments can be found here from Morgan Lewis and from the EU law blog here.

Virtual Museum of Medical Technology

Is a seriously nice new site. Visiting the museum I learn about Nano Technology and what Replacement Organs are as well as what various medical devices there is to support Diabetes care. Still the museum needs more floors covering more disease areas but its a very good foundation to build on.

Eucomed the European Trade association for Medical Device industri pays for it.

Interview with Dr Antonyia Parvanova MEP

Dr Parvanova was appointed member of the European Parliament by the Bulgarian Parliament when Bulgaria first joined the EU; she then failed to be elected but the electorate probably realised their mistake and she did manage this time around. She have been assigned Vice-President of the Alliance of Liberals and Democrats for Europe (ALDE) and is a Member of the Committee on the Environment, Public Health and Food Safety (ENVI) as well as the ALDE group coordinator for the Committee on Women's Rights and Gender Equality (FEMM).

Starting our discussion on the dossier on health inequalities she notices that it might be postponed a bit but it is a very important initiative. The outcome of this initiative will influence several if not all other healthcare related files in the EU. This area in combination with Rare Diseases is certainly the area where she will create the most discussion during the current mandate period. Dr Parvanova wants to ensure a common fund to cover for specific rare diseases in order to reduce the inequalities in the EU. It’s very hard not to agree that if Europe claims solidarity something needs to be done as it’s certainly not the case that all patients with rare diseases gets the appropriate treatment in all member states. No surprise given how expensive treatments of rare diseases can be. Even a wealthy country like Sweden has a burden sharing mechanism to ensure that all regions can afford expensive treatment to all patients in need. But I’m not sure I agree that a EU fund for treatments of rare diseases is the right way forward – for me the best would be to prioritize healthcare within the use of cohesion funds (funds to help poorer parts of Europe to catch up). That way those countries in need of support could get resources without any risk of the EU taking over the responsibility for financing of treatment of rare diseases in the long run. Unfortunatelly Dr Parvanova explains that this is not possible since these funds are for infrastructure investments and that therefore her idea needs to find a mechanism that allows for investment in individual patients for specific period. Well I look forward to see what she comes up with.

She points out that there are several other interesting issues on the agenda that she will get involved in such as Diagnostics, the role of tobacco as primary prevention for example cancer as well as organ donation.

My main curiosity with regards to her future activities beside the inequality dossier though has to deal with the fact that when Dr Parvanova last sat in the European Parliament she was a driving force in the area of Patient Rights – an issue she intends to continue to drive. Not the least because she will be shadow rapporteur for the Directive on cross border care is on the table although that directive also comprises other issues. But she explains that to her patient rights goes beyond this – over quality, access, affordability and safety all the way to information about medical services.

Another area of great concern for her is IVF. She explains that her interest is based on the fact that reproductive health is an area of huge differences in the member states. Invitro fertilisation is for example often not recognized as a speciality because as in Bulgaria it is only offered by private health providers. And reproductive issues are medical problems – to not help is according to Dr Parvanova to discriminate patients.

When our meeting is ending, I get a quick reminder of how down to earth and practical she is. She underlines the importance of a common reasonable approach to the swine flu. She says it is an important issue but the approach has to be consistent with other efforts. For her it is equally important with the normal flu vaccination for elderly. I must say that I understand her hesitation to the costs as she underlines that it’s not only to buy vaccines, the administration of the vaccines needs to be taken into calculation when decisions are made.

In conclusion I realise that she has as high ambitions for her mandate this time as the last time around and will be one of the most interesting MEPs to follow – where she goes things starts to happen. Maybe because she is not only nice and engaged - she knows her stuff as well.

Off Topic - Educating the Eurobrats

New column in L´Anglophone.

New danish site for pharmaceutical information to patients

Today a Danish site for patients about all pharmaceuticals on the danish market as well as discription of 200 diseases including treatment options goes live. Its a project by the Danish Pharmaceutical industry and its really good! Seems like the current European legislation on pharmacuetical information do allow for quite good online info already today… Take a look at it here.

Court of Auditors critical report on DG Sanco's work

Just listened to MEP Christofer Fjellner in the Budget Control Committee in the European Parliament. He introduced the report, previously mentioned here, to his colleagues as Rapporteur on the European Court of Auditors very critical report on DG Sanco's work with the Public Health Programme 2003-2007. The amazing thing was that after his introduction and a short statement from the Court there was not one single question or remark! Well if the budget control guys’ dont realise how important it is to get the public health work in shape I hope Christofer manages, as he intends to try, to get the report discussed in the ENVI committee.

European Commission launch of the European Partnership for Action Against Cancer

I spent the day at the launch of the Partnership. It was quite an impressive show. It should be given that the objective of the effort is to ensure that all Member States have integrated cancer plans and a reduction in cancer by 15 % by 2020. I will just mention some of the highlights.

European Commission President José Manuel Barroso underlined referring to the current financial difficulties that he sees healthcare as a key issue in the coming years and that the partnership really can make a difference and set an example for the world. He seemed rather set on ensuring that the European Commission gets more directly involved in the healthcare sector.

Health Commissioner Androulla Vassiliou was quite interesting. First she explained that she wants to reduce the fragmentation and get focus in the cancer research. I’m not sure though that streamlining is what’s makes research work. Quite a lot of important discoveries have been off springs of other research rather then what original was searched for. Astra Zeneca´s Losec is maybe the textbook example. But she also said that she think believes in added value through demonstrating if the various healthcare systems are meeting high standards or needs to improve. I.e. that she believes in naming and shaming. Still not really PC – but she has my full support on this one. Further she quickly mentioned that it’s not fair that it’s depending on where you live what innovative drugs you get. I think the upcoming report on health inequalities in Europe and the European Commission’s conclusions and proposals based on this report will be very very interesting and controversial.



The panel discussion never really took off but from the civil society there were 2 remarks that made me think a little extra. One was a polish mother of child with cancer who pointed out that when IARC and others specify the various stakeholders and actors in care parents should be specially remembered. This is quite spot on. Key to early detections is to noticing changes in the body – either your own or in this case your child. It’s a different role compared to be a friend or regular citizen. Those close to a patient are often remembered but as a support factor – not as part as best practice in the process of ensuring early detection.

Finally one of the leading ladies in patient advocacy Hildrun Sundseth asked the profession present for common European treatment guidelines. On the surface this seems to make sense but I must confess that I do think it can be damaging in the long run. It cannot be good for further development if everyone is set to do the same – and guidelines agreed upon on a European level would by necessity be a committee product. And as everyone knows who seen the EU in action knows the final agreed result may not necessarily be whats known as best practice.

Today’s meeting did set the tone for the further work. It will be well organized, intense and high level. A good way but I hope those in leading positions can take a step back and let the diversity of all the European countries and various experts work its magic.

Audit claims Public Health Programme 2003-2007 ineffective

Approximate 232 million Euros was spent on 352 projects for the Public Health Programme 2003-2007. Quite a lot of money if used properly. Unfortunately the Court of Audit have found that its not and that the Commission and the Members States ought to reconsider the EU´s funding approach in the field of public health for the period after 2013. The 2008-2013 Programme is already written.

This since the Audit found that the PHP: lacked strategic focus, that the results often where fragmented and that there was no systematic monitoring of actions already taken in the different priority areas leading to duplication of work.

The networking part of the programme seems to be the really big benefit, beside the recurrence of a European dimension. Rather hard words.

But its not so strange. Healthcare policy is the hometown of do-gooders and well meaning actions. Not all to the benefit of a sustainable healthcare system. Healthcare system and public health policy is to important and complex to not be managed more strategic and professional. Its nice to want to do lot of good things but nice ambitions doesn’t necessarily delivers good value. I hope the report give proper eco in European Institutions and that the work done in the future will be based in a more focused measurable strategy.

Next the report is being managed by the European Parliament. One of the rapporteurs is Swedish Member of the European Parliament Christofer Fjellner. Find the report here.

The Netherlands yet again win the 2009 Euro Health Consumer Index (EHCI)

The Netherlands yet again win the 2009 Euro Health Consumer Index (EHCI) and with an increasing margin. Obviously it makes a difference that the Netherlands combines competition for provision AND funding. They actively support patient choice and that is something that now shows results in many areas. The general improvement is also seen in other reform making countries like Ireland and the Czech Republic. But the Spanish, Portuguese and Greek healthcare systems continues to decline. The 2009 index includes 33 national European healthcare systems and measures 38 indicators. The full result is as follows:

The individual category winners are:

• Patient rights and information: Denmark
• e-Health: Denmark, Netherlands
• Waiting time for treatment: Albania, Belgium, Germany,Switzerland
• Outcomes: Sweden
• Range and reach of services provided: Belgium, Luxembourg, Sweden
• Pharmaceuticals: Netherlands, Denmark

More about the index will be possible to find later today on the http://www.healthpowerhouse.com/ site. The report can be found here.

Crying wolf – good or bad for healthcare budgets?

At the seminar on Progress in Respiratory Diseases Professor Trevor Jones from King’s College London presented the estimated future impact by COPD. His claim was that by 2030 it will be the 3rd largest cause of death in Europe. In Sweden already today 3000 every year die from COPD. The cause is smoking, basically its smokers cough, so no real positive change in incidence rate can be expected in the near future. And with no known cure there is no reason to doubt his figures.

At the same time I always hesitate when I hear about the new threat that we all will die from. These type of estimations are quite common in Brussels – and btw the media. Most disease areas have representatives that fully credible manage to claim that specific disease area is the one that really will be the most heavy burden for society in the future. Now they cannot all be right can they? (Swine Flu, SARS etc) And if they are not all right does this mean that they are just crying wolf?

Yes and no. They do cry wolf since its estimations and not known facts and it’s not possible that more than very few of the diseases will actually be the most costly and problematic disease area. Some because other disease areas increase of importance are not part of their calculations. Some because with new innovation and general development they will just not be as burdensome as calculated with current knowledge. But I would also say no they do not cry wolf because the wolf actually do come and we only see a positive development in some are because they got attention and the issue where dealt with in time. There are good examples of when things were taken seriously early enough and we can in retrospective see the benefits for the health budgets.

Also at the seminar where leading expert in Asthma Professor Stephen Holgate at the University of Southampton and Susanna Palkonen who is the Executive Officer of the European Federation of Allergy and Airways Diseases Patients. I come across these two earlier when I attended the Summit for Change in Asthma in 2006 and have with interest followed the work in this field. Especially the Finish experience that Susanna used as a good example in her presentation. Professor Tari Haahtela presented this work in Brussels at an event I attended last year. What Finland did was creating a long-term strategy to ensure better care for the patients at a lower cost for society. It’s a cross sector effort being calculated and evaluated cross sectors beyond the regular healthcare silos. In short I would describe the efforts as that they by increasing the knowledge in the healthcare sector about Asthma and thereby ensuring more regular visits to the GPs and healthcare centres in combination with an increased use of pharmaceuticals (basically double the spend on both these part of the care) the Finns where during a 10 year time able to cut the total cost for asthma management. The cost where saved on less days of sick leave, early retirement and hospital days. Something that beyond the positive effects it had on the state budget also of cause meant quite an improvement in the quality of life for the patients!

Now we will have to see if we could have similar efforts in the area of COPD – there is quite a lot to be done and the postcode lottery is widespread. The Health consumer Powerhouse have looked into the various regions in Sweden and compared the support given and found a lot of differences. I’m know that if similar criteria’s for example with regards to help to smoking cessation would be measured country by country in Europe one would find that it’s not that many countries that actually actively help their citizens stop smoking. But if the right levels listens to Jones we should be able to ensure that we never have to face the a situation where COPD is the 3rd largest cause of death in Europe.

Change in Leadership for the WHO Europe

Mrs Zsuzsanna Jakab have been nominated as the WHO Regional Director for Europe. This means that the ECDC needs a new Director for European Centre for Disease Prevention and Control (ECDC) by February 2010. Even if processess like this is slow the European Commission has already started looking for a new ECDC Director, since Mrs Jakabs had a 5 years manadate due to expire in 2010. In the European Commission that is the rule - all senior officials have to move position every 5 years.

Private insurances do not create two tiered healthcare

A new Danish study done at the Syddansk University by professor Kjeld Møller Pedersen shows that additional private healthcare insurances do not lead to inequalities in care. The study is the largest in its kind in Denmark and has been conducted with 5000 respondents.

The findings are that those with private health insurance do not use more healthcare than those without neither in the private nor the public sector. The reason for this being questioned in Denmark is that there from 2001 the amount of health insurances paid by the employers have gone from 45.000 to 900.000. During this time there have been quite a lot of discussions on whether this undermines the solidaric healthcare system creating a two tiered system. The researchers now states in Danish media as a result of their findings that this do not seem to be the case.

But I also not that given that one of the reason behind the findings is said to be that many simply just do not use their insurances the employers might want to renegotiate the terms with the insurance companies so that they extras enough for the insured to use what they paid for. And it should be able to offer something better given that even if info in Danish healthcare is quite good – outcomes is another issue.

Differentiated pricing of pharmaceuticals

I had the pleasure of listening to Jacques Gorlin make a presentation earlier this week. He pointed out that the issue of healthcare its often said that developing countries should receive medicines at a lower prince something quite easy to agree with at first - well until you start looking at what countries actually define themselves as developing countries.

I would have thought that there is some kind of standards used to define what countries that are developed, developing and the least developed countries. Now usually the WTO classification is used as a reference point but when going to the WTO website I learn that there is no real definition of “developed” and “developing” countries. Instead: “Members announce for themselves whether they are “developed” or “developing” countries. However, other members can challenge the decision of a member to make use of provisions available to developing countries.”

Well as Im a bit sceptic to governments I would assume that as many countries as possible try to define themselves as developing countries. And yes: 2/3rd out of the 150 WTO members classifies themselves as developing. Now there is another category – the least developed countries. That list is more strictly composed but maybe to narrow.

I would say we need help the poorest in for example India and Brazil without the rest, the middle class and upwards, of their population free riding on behalf of for example the citizens in some of the poorer EU member states. So how do we get a clearer definition of who ought to benefit from for example differentiated prices? Maybe the Ministries of Health, the EU Commissions DG Sanco etc needs to ask for help by the Trade Ministers etc.

But for differentiated prices to become a reality rich countries like for example Saudi Arabia first has to be willing to stop aiming at getting a price as low as some of the countries they actually give foreign aid to...

The DG Sanco´s collection of health reporting systems

On DG Sancos website you can find something that is called ”Health reporting systems at national level” Of cause I had hope that this would have been a portal to various sites where I as a citizen could find information on health outcomes etc in the various member states. But no. Some of the links do not work anymore. Some ends up in general governmental health policy sites.

Well please find here some alternative recommendations:

For Sweden the "Quality and Efficiency in Swedish Health Care" measurements.

In Denmark: Sundhedskvalitet a site for Comparison of prices, quality and accessibility
And my personal favorite: the German Quality indicators for patients from BQS.

HIV - ENCAP Manual for Harm Reduction

I have received the Manual for Harm Reduction Service Providers from the ENCAP (Expanding Network for Comprehensive and Coordinated Action on HIV/AIDS prevention among Interactive Drug Users and Bridging Population) project. Well maybe not really a manual it’s quite an extensive introduction to the work on Harm Reduction. The book goes through the pros and cons of harm reduction as well as the various methods and also the problems the people working with harm reduction faces including stress management and how to work with media, municipalities and the police.

It’s quite easy to read but aim at covering too much well at least the focus is in some parts on the wrong areas. I think that chapter 2 could be lost and I would also have liked to see a little less focus and details on the media part especially since better checklist already are quite ready available in various PR guides. Instead maybe a bit of more work on how to work with local municipalities and police could have gone into the material – quite difficult areas but I would assume key factors to reach long time success.

In the methods of harm reduction it always comes down to the basic education, condom distribution, testing and counselling in various phases and of cause the more controversial issue of syringe and needle exchange. So also here. Not very new but it do highlight the issue of female condoms as well – an underused possibility of ensuring that women can be better protected.

All in all I think the book is well worth to read for the professionals in the field. You should be able to get it from the project via www.aidsnetwork.eu.

Off Topic - the Swedish Presidency in L´Anglophone

If you deal with the Swedish Presidency you might be helped by reading my column in the new english magazine L´Anglophone. The magazine is brand new and beside columns from me you will also find Belgian and EU news, legal Q&A, Jaro Vantos columns and all you need if you happens to have time also for a social life in Brussels.

Choice is good - also in healthcare

One often gets to hear that yeah choice is good for those that can afford. Now this is in reality only the establishments snobby way of saying that we don’t believe that those with less money and education of cause cannot be trusted to manage their car them self.

But in reality they are quite good at it – actually much better than the establishment is in securing their healthcare. And they know it - at least if you believe the British Social Attitudes Survey 22nd Report (2005) where one can find that the group who where the most thinks that people should be allowed to choose which hospital to go to is those with semi routine and routine work. 67%. In managerial level the figure is 59%. When in the same study the population is devided on income and educational level instead you still see the same pattern.

And one do understand why it is those with less education and income that wants choice when you take a look at 2 studies published this year – one from the UK and one from Sweden. 2 of the healthcare systems in Europe where healthcare is really an issue of governmental planning limiting patient choice.

Earlier this year a report was published by SKL on how social class determinate the reception and outcome you get from Swedish healthcare. A system where you in most regions still have to go to the doctor practising closest to where you live. The report can hardly be questioned since it actually was produced by the co-operation organisation for the regions responsible for organising the Swedish healthcare. The report points out that white collar workers gets better care with more modern medication and methods compared to blue-collar workers.

And recently a retrospective study of waiting times for elective hip replacement, knee replacement and cataract repair in the UK published in BMJ by Cooper, McGuire, Jones and Le Grand points out the good effects of the changes in NHS system from 1997 to 2007. In the UK there have been quite a lot of concerns raised that the reforms of the NHS with regards to choice would lead to increased inequity but the study shows that rather the opposite have been the results. In equality between various social groups have during this time period have actually decreased. Usually you have to be a subscriber to the BMJ to read their articles but luckily this article have been deemed to be of such importance its accessible in its full text here.

Interview State Secretary Mrs Karin Johansson Swedish Ministry for Health and Social Affairs

Tomorrow in the ENVI committee of the European Parliament Swedish Minister for Health and Social Affairs Mr Göran Hägglund will present his visions for the presidency. I recently interviewed his State Secretary Mrs Karin Johansson. We had a good an open meeting where we talked about co-operation cross borders, swine flu and why the Swedish presidency have not chosen any particular disease area to put a focus on.


The reason for the last Q originates from my interest in how the policy agenda is set. I know both industry and NGO representatives aiming at getting their causes on the Swedish presidency agenda without success. Mrs Johanssons explanation where simply that when planning the agenda it was already quite loaded so they had to really focus on key concerns meaning the structural issues. It still doesn’t really put an end to my curiosity since all others also inherits heavy agendas but still seems to really want to make one or another disease their signum. How these disease areas become so important is still to be investigated. Is it mere personal experience or is it giving in to national interest or just that they are more receptive for clever lobbyist arguments than the Swedes?


Well the Swedes resistance and focus on structural issues can also be seen in their work finding out what incitements are needed to find new antibiotics. Here they even tried hard to get the bilateral discussions between the EU and the US going since they realise that it’s not possible for the EU alone to succeed.


On the other hand admittedly the most concrete issue they are dealing with is the swine flu (not the least because several of the civil servants in the Swedish ministry of health actually have been hit) but it’s not within her responsibilities. Still Mrs Johansson underlines that the ECDC, WHO and EU have different recommendations with regards to the swine flu raising the obvious question how a member state relates to these different recommendations. Her conclusion is therefore that there is from the Member States a clear need of getting the international players to synchronise their work. She explained that this goes also for other areas like rare diseases. I wonder what this will mean for the system and structures if it will include HTA and definition of what equal care for all EU citizens means?


In principle I must say I’m proud of what my current government does in the area of healthcare. They are quite pro patient choice and empowerment also when it means actually lessen the governmental control over the healthcare system. I think it will in the long term pay off with better outcomes and better value for money.


One of the time I noticed this was after Mrs Johansson pointed out that healthcare becomes more and more specialised leading to a smaller and smaller patient base resulting in a need for further co-operation cross border. So far most would agree - in principle. The interesting thing with the current Swedish administration is that this insight also has implications on the application of policy positions and conclusions with regards to how international co-operation needs to be managed practically. Mrs Johansson admits that this is inevitably leading to a more integrated view of healthcare in the EU but the development needs to take its time due to the budget constrains – but she also points out that in the end nothing is more important than the delivery of good healthcare so this issue cannot be impossible to solve!


One of the more surprising statements was probably that she sees competition in itself as a force for development meaning that it’s positive that the different healthcare systems are being put through competition! In Sweden they are working on enabling this on the regional level and of course this is something that also should be achieved on an international level.


This naturally led my thoughts to the current debate on the directive for patient rights across borders. Now it turns out that the Swedish presidency sent out a compromise proposal the last week of July. Negotiations will start in September. As reported earlier on this blog commissioner Vassialou has made it clear that this is a majority decision. So I had to ask if Mrs Johansson thought that Spain really will be overruled. Here she hesitated pondering if given how watered down the proposal in its current version is if it’s not better to just let it be and instead let case law develop. As the Council was not even prepared to take a discussion on the rather compromise friendly decision of the European Parliament one must wonder if she isn’t right.


Of course in this directive the pre-authorisation process is what’s really troublesome beside the issue of how far reaching the co-operation should be. With a smile she adds when I ask that it seems that those with the most problems with the right that the directive gives patients with regards to choice seems to be the same as those that have the least problems with the chapter 4 enabling various ways of co-operation between member states. And of course it’s an issue of who decide of the allocation of recourses etc. Now this means power and not many are willing to give up power.


When it comes to access to medicines as a key - partly as a follow up of the Pharmaceutical forum and the topic for one of their seminars - they try to establish a test case for international co-operation. The structures for co-operation need to be developed in real life situations in order to be robust. She also expects some proposals at the next council meeting on how to move forward with Pharmaceutical Forum 2.0

And by now we was at the end and could just contemplate that even if they are very much pro a more liberal legislation with regards to patient information this is an area where there is no way forward. Strangely enough. But maybe Mr Hägglund while in the European Parliament can convince some of the sceptics – one live on hope. Given the tone and the answers I gotten from Mrs Johansson I actually do have hope for the cross border care directive as well as actually the patient information issue.

The EP to decide what medicines that should be sold?

I might have misunderstood something – at least I hope I have. I thought EMEA approved what medicines that should be allowed to be sold in the EU. Nope its not that simple.

As from the 10th of July all Commission decisions on this issue, comming after the Member States vote, are to be submitted to the European Parliament for scrutiny. So the agreement is that the EP will get the draft decisions from the Commission on for example if a product should be allowed for sale or not and then the EP will have one month to object to this decision.

This is very strange for me – I’m used to a constitution where the political are strictly banned from having any input on individual cases. The political leadership are to be just leadership and then civil servants are ensuring the directions given via budgets and laws are implemented. This ensures a transparent system with predictability in the individual cases. And nepotism etc is avoided.

Is really the European commission performance so bad that the individual cases needs scrutiny by the European Parliament?

Not all is swine flu

It’s one thing that the policy level becomes affected by the media hysteria around the swine flu and invest enormous amount of time and money on planning, buying vaccines and administrating this vaccine. The EU helps by finally finding a role in healthcare and ECDC are driving the development with intense monitoring etc.

Now it seems like the professionals are also affected as there has been 2 cases, one with a deadly turn, of seriously ill patients that been given Swine Flu treatments and told to stay at home when they had meningitis. The scare has gone way too far. Could we instead get some of the focus on the real killers of Europe - we do quite well on cardiovascular care and cancer - but what about diabetes, tuberculosis and HIV?

Who pays your doctor?

As I’m enjoying summer in the Swedish archipelago I don’t spend a lot of time blogging. But as I noticed the WSJ blog last week about the new Eli Lilly ”Faculty registry" I had to take some minutes from the sun for it.

For years I have had a problem understanding why pharma companies should not be allowed to communicate directly to the users of their products. Instead patients are supposed to relay on the info they get from their doctor and pharmacists. At the same time the companies are allowed to market in quite intense ways their products towards these groups. Now I don’t have an issue with this. But the hypocrisy around it all I do find a bit much. It’s getting better: new ethical rules limits doctors trips to luxury resorts with nice social programs paid for by the industry.

Still in Europe lots of thing is still not really transparent healthcare policy and practice and one of these things that is the industry system with”consultants”. Basically doctors (and other academic experts) and are paid to be experts for companies besides the salary they already have – in Europe quite often this goes upon what is supposed to be a full time salary decided upon by civil servants and paid by our tax monies. And if you thought this wasn’t much to discuss its worth noticing that the Brittish GSK recently decided cap upon these fees was placed at 150000 US dollars. Not that the pharmaceutical industry is paying the most - the known figures from 2007 in the US for the medtech industry where even higher with amounts up to one million US dollar per year for 40 physicians.

Now in the US there has been more movement on the ethical issues in this case compared to Europe partly due to the work of Republican Senator Chuck Grasseley. In February Pfizer declared their intent to start disclose the payments to consultants etc for 2009. We can expect the first annual report in early 2010. I think this is a really important initiative and hope that it soon will cover not only US payments as the Lilly Faculty registry seems to do!

But most obvious I think it would be if GSK as a UK company took a lead and also added Europe – not the least because in the Netherlands there are already investigations on GSKs payments to academics who sit on an advisory board that recently recommended a Glaxo vaccine. I would like to see all the payments to experts etc concerning their vaccines including the swine flu vaccine.

New constitution of the EPs ENVI committee

For the real nerd - here you find who is on the new ENVI committee in the European Parliament. New Chairman is Jo Leinen S&D from Germany, Vice Chairman’s are: Corinne Lepage ALDE from France, Carl Schlyter the Greens from Sweden, Boguslaw Sonik EPP from Poland and Dan Jorgensen S&D from Denmark.

Now it seems a presidency that is heavy focused on the environmental issues. Leinen, Lepage, Schlyter and Jorgensen have all a very clear environmental profile. Sonik profile is more diverse with a slight focus on human rights. On the surface a clear change from previous period but on the other hand in the EP strong individuals with passion can achieve a lot of good no matter what their position.

112 a reminder that the EU is good for something

The latest newsletter from the European Emergency Number Association EENA 112 did remind me of the (not so) good old days when you had to called different emergency numbers pending on what country you happened to visit. The 112 was actually legislated on 1991 but Member States didn’t have to implement the change until 1996. And, this surprised me: most Member states (actually all but Denmark, Sweden and the Netherlands) still have kept their national emergency numbers as well. That is not good – how many remembers 2 different emergency numbers? And do anyone think that it help that all countries”must inform their citizens about the existence of the 112 and how to use it”. When in need you must know by heart the emergency number. If you are abroad how likely is it that you will remember the existence of an EU number besides your national number? And if you do remember there is one would you actually know the number? This is an area where the EU should harmonize!

It´s Göran Hägglund vs. Trinidad Jiménez

Swedish Minister of Health Göran Hägglund stated with regards to the outcomes of the discussions on the Directive of Patients Rights at Cross Border Care: we went from if we are going to have this to how to do it. And the gloves seem to be off. Hägglund underlines to media that it’s a majority that decides. EU Commissioner Andrea Vassiliou even asked the Minister of Health from Spain Trinidad Jiménez at the meeting if Spain wanted to end up in the ECJ. Listen to her explaining their position here.

If I understand her right she demands pre-authorisation because it should be the doctor that should decide if there is a need or not... It seems Spain is not really in favour of patients choice. Interesting is that she will in January take over the negotiation of the directive. This will continue to be one of the most interesting healthcare issues to follow.

For background info on the issue.

Healthcare policy lobby seriously suspicious?

Talked shortly to Andrzej Rys Director for Public Health at DG SANCO EU Commission just outside the plane before boarding in Bryssels for Copenhagen today. Wanted to pin him down for a meeting on Health Technology Assessment. That I shouldn't have done. It rendered me and my kids 20 min police investigations since the SAS staff thought this was suspicious! I knew lobbyism in general and health care focused especially was seen with suspicious eyes but I never thought it would mean I would be hold at the Danish boarder, questioned without explanation and then have to wait for 15 min until the cops checked my potential police record?

The police also tried to stop Andrzej but only managed to hold someone looking like him. They where a bit disappointed about this – that they saw this as a failure was obvious. They did look a bit more happy though when I explained that that's maybe just as well given that Andrzej is a high level EU commission official on his way to to meet with all the European Health Ministers. Lets hope he had a better day and managed to convince the Council members about the good of the Directive for Patients Rights at Cross Border Care.

Liz Miller on the NHS new patient rights

The NHS is quite good at communication but often thats all there is. Liz Miller writes about The Emperor's New Clothes - 6 New Rights for Patients commenting on the Health Secretary Andy Burnham disclosure of new NHS "entitlements" for patients.

Barosso wants your DNA

Increasingly the EU maps out the status of its citizens health. It is done in various projects and the various efforts do not seem to be noticed by the regular integrity lobby – it is easier to make your case against this type of invasion of privacy if it is done for police or governmental benefits. In reality, I would say it is more worrying when done in the name of public health since I firmly believe that if we get the knowledge on how to alter our DNA it will be done. And it might start with cures for diabetes but end in adjusting the citizens to better fit into society. Some of the efforts done right now are the BBMRI, the Health-e-Child and various registries here exemplified with the cancer registry.

To start with the BBMRI. Biomedical research needs citizens who participate - or at least they need to get hold of samples of your DNA. One major issue will be how to collect the samples. Over 200 organizations in 24 EU Member States are planning an EU infrastructure, the Biobanking and Biomolecular Resources Research Infrastructure, BBMRI, to deliver as they say:" The samples. The data. The tools." Tools to do what I wonder? On the website they claim that they already today controls 10 million samples but that they aim to increase that number. All is funded by the European Commission with a grant - the agreement has no 212111.


The Health-e-Child is another EU funded project entering into this area. The aim is not to use real DNA sample but they still want to have one single database for all clinicians where they can store all forms of biomedical data. This is not easy to uncover, when you read what they are about it’s not really obvious what they do. To use their own description: "Vertical integration of information across biomedical abstraction, including all layers of biomedical information (i.e., genetic, cell, tissue, organ, individual, and population layer) to provide a unified view of a person's biomedical and clinical condition is the corner stone of the HeC project." Well, they try to put it in a bit more simple language: "common vehicle by which all clinicians will access, analyze, evaluate, enhance, and exchange biomedical information of all forms". Unlike with the BBMRI I cannot find any discussion about data privacy issue on their site.

Eurocourse, is a 3-year project funded under Framework-7 (I.e. also EU money) on best practice among European cancer registries, "and to prepare them for future challenges". Read data privacy issues. One of their aims are "close collaboration with biobanks...~

I listened to a cancer registry expert from the UK having an outburst of anger over the EU Data privacy act and the hassle it had created – continuing that only the individual rights lobby saw any problems with cancer registers since the benefits where so great and obvious to all others. Well if it is so obvious that the registers are good for us all there should be no issue with demanding informed consent, should there?

Still in the European Journal of Cancer issue 7 2009 in an article from Helen Saul their news editor I found this quote from Dr Hans Storm (Danish Cancer Registry, Copenhagen, Denmark) "The interpretation of the European Directive on Privacy (95/46) is very heterogeneous. In some countries, they have almost completely closed down data linkage by insisting on informed consent, which is not always possible. In Estonia, cancer registries have no access to death certificates for cancer patients, which is a very important measure of quality in cancer registration. It makes comparison between some countries virtually impossible."

I assume that since the Cancer Registers actually already faced the problems with data privacy Eurocourse they do take the issue quite seriously. Thus they have established a Working Party on privacy and they also plan to set up a committee including a legal advisor to "help researchers navigate barriers caused by data protection legislation, and improve the systems in place for dealing with requests for research on the data".

Hans Storm continues to defend the collection of data without consent: "no harm has ever come from this data collection, only good. "

Meanwhile in Sweden the so called PUK registry with DNA samples from all Swedes born 1976 or later have taken the opportunity and changed their routines. It is no longer possible to require that you or your child's samples are destroyed. It is now up to PUK to decide whether to anonymize or destroy it. This was sneaked in the regulation as a compromise after among others MEP Christofer Fjellner had objected to the government ideas of using the registry more regularly in police activities.

State driven medical research today supporting police activities tomorrow – and then what – adopting the educational system after our inherited abilities and then maybe also ensure we are not gay, overweight or mean?

Tuberculosis gets some attention

The European Commission, the European Centre for Disease Prevention and Control and the World Health Organisation's Regional Office for Europe meet in Luxembourg today and tomorrow to discuss how to prevent and control tuberculosis.

Good so, as pointed out in an earlier post on the blog, its more urgent to deal with tuberculosis then swine flu and other media hyped diseases. In 2007 there was 85 000 reported cases in the 27 EU and EFTA/EEA countries. DG Sanco has calculated that this represents nearly 55 tuberculosis cases reported every hour and an increase of 55 000 cases in comparison with 2006! And that was 2 years ago. Compare that with the Swine Flu numbers for 2009 – according to the ECDC just over 6000 cases in the EU. And then we have not started on the severness of the 2 different diseases...

At the meeting they will give out an European award to a Non Governmental Organisation to highlight the important work carried out to fight tuberculosis. I think Hans Rosling and his Gapminder should be given the award.

More info from the meeting will be published here

Quality indicators – enabling patients to choose healthcare. US and Hungary

2 different quality comparisons systems have been updated this summer. One from the NHQR enables US citizens to compare healthcare outcomes in the various states.The other enables Hungarians to compare providers. Usually US is quite good at all kind of quality measurements but the Hungarian example shows that they have to make a substantial effort if they are going to keep up. The US data do have the benefit that it’s in English making it easier for me to critique it but I must say that I think it would benefit from some efforts on making the user friendliness.

The Hungarian Quality Indicator System 2009 to be found on www.ebf.hu is a database covering 675 indicators. The total number of data is 120,000. Patients can compare 3 providers at a time.

The indicators are grouped into patient rights, patient safety, waiting list management, supplementary and hotel services, quality management, employee policies, and professional fields like obstetrics, cardiology, emergency health care, breast oncology, in vitro fertilisation and prenatal care.

Given that all individuals have different preferences I really like that individual weighs can be entered into the website!

Some of the findings I find interesting:

A good sign for the future is that patients are provided with information brochures on patient rights in 41% of the hospitals, and the half of the institutions makes the information available on their websites.

Good is that 12% of the consultation time is after the office hours (in 2008: 10%), providing easier access for working population.

But they still have some way to go: For example ultrasound diagnostics are available only in the 90% of the prenatal care providers.

Dr. Zsombor Kovacsy President of the EBF made a presentation on the Hungarian work at a conference on quality measurements that I arranged earlier this year in Prague. His and the other speakers presentation can be found here.