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.
Wednesday, 23 September 2009
Monday, 21 September 2009
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.
Friday, 18 September 2009
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.
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.
Thursday, 17 September 2009
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...
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...
Friday, 11 September 2009
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.
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.
Thursday, 10 September 2009
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.
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.
Monday, 7 September 2009
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.
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.
Tuesday, 1 September 2009
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 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.
Monday, 31 August 2009
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?
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?
Saturday, 8 August 2009
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?
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?
Monday, 3 August 2009
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.
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.
Friday, 17 July 2009
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.
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.
Thursday, 16 July 2009
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!
Wednesday, 8 July 2009
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.
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.
Monday, 6 July 2009
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.
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.
Thursday, 2 July 2009
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.
Wednesday, 1 July 2009
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?
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?
Tuesday, 30 June 2009
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
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
Sunday, 28 June 2009
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.
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.
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