Healthy Skepticism Library item: 1664

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: news

RiviÈre P.
Drug deals in Europe
Le Monde diplomatique 2002 Feb
http://MondeDiplo.com/2002/02/05drugs

Full text:

The big pharmaceuticals firms use conferences and dinners to persuade doctors and patient groups of the merits of their latest drugs. Observers in the medical world find it scandalous that there are hardly any information sources independent of their laboratories. Increasingly, clinical trials are conducted not by independent researchers but by research bodies under contract. They are bound by secrecy clauses and cannot reveal their findings without their backer’s approval. In response to this, the editors of 13 of the world’s most important medical research journals have just announced a tightening of their publication criteria in a joint editorial (1). An investigation by the Wall Street Journal showed that some laboratories use the right to information as a pretext to disseminate the results of “post-marketing studies: limited research on already-approved drugs, driven by marketing objectives as well as by science” (2).

Innovation is a loaded term. It figures large in debate and in relations between doctors and patients, but it is seldom clear what the new product brings by way of treatment. In its review of new drugs and treatments approved by health authorities last year, the International Society of Drug Bulletins (ISDB) says that “no more than a few percent offer a worthwhile advantage to patients over previously available options.” The remainder – improved production methods, discoveries of equivalent products making for keener competition between laboratories – have their uses, but the ISDB regrets that they “blur the distinction between genuine therapeutic advance and mere innovation. The pharmaceutical industry increasingly creates the impression that there is an imperative for faster development and approval” (3). It points the finger in particular at the “laissez-faire” attitude of the industry’s regulators, the drugs agencies, who are unable to carry out their own studies. The arrival of the single European currency has given the laboratories the opportunity to launch a fresh offensive against the system for setting drug prices in Europe. Not market prices, they are negotiated country by country and may vary as much as five fold within the European Union. On average, Germany pays 132 euros for products that cost 85 in Spain, while prices are two or three times higher in the United States. Most of the difference is due to the regulatory machinery: in countries where government and manufacturers set prices jointly, they are lower than the European average, but they are higher where prices are free, that is regulated by competition alone. But prices in the EU tend to level out over time. The manufacturers want them to converge at the top of the scale. They point out that the US share of the world market grew from 31% to 43% between 1990 and 2001, while the European share fell from 32% to 22%. What they do not say is that this is because prices in the US and the volumes sold there have risen astronomically, not because European expenditure has fallen in absolute terms. If Europe fails to bring them more profits, new products may not be sold there any more. “We’re waiting longer and longer before bringing new products on to the French market and if the government continues to put pressure on prices there won’t be any more,” Pfizer’s chief executive Hank McKinnel said last June (4). The Centre for the New Europe is a Brussels-based think tank whose motto is “market solutions to policy problems”. One of its members, journalist Stephen Pollard, explains that “if pharma companies do not find the EU ‘hospitable’ – for which read profitable – then there is nothing to force them to stay or, perhaps still more importantly, to offer their latest treatments to European patients.” That is already starting to happen. Tom McKillop, chief executive of AstraZeneca, said recently that “all the major pharmaceutical companies are making decisions not to launch products” on the European market (5). Pollard is looking to patients for the “market solution”. They will not, he says, settle for second-class status: “Once they realise what they are being forced to settle for – and do without – they will surely push for changes which will give them access to new medicines.” Will patients’ groups be drawn into this fight against their own health-care systems, or will they free themselves from the manufacturers’ stranglehold and fight for patients as they should, against both laboratories and governments?