Generic drugs, pharmaceuticals, reform of the health service.

[Speaking on the Health (Alteration of Criteria for Eligibility) Bill 2013] …

I speak from the perspective of having worked in the health service. The issue of drugs is deadly simple. The Government should pass a law to make it mandatory to use generic drugs unless there is a specific doctor-ordered exception to the rule, which will arise in virtually no cases. There is a bit of an argument brewing at the moment, which I understand, in the case of some very specialised drugs where the level of the drug in the blood is important. We have heard this argument being advanced appropriately and eloquently by those who are expert in the field of seizure disorders. In general, we should be using generics. I have been using Lipitor for almost a decade for high cholesterol and it has worked extraordinarily well. I have recently started insisting on getting generic atorvastatin calcium and while I may be leaving myself open to a charge of being unpatriotic, the next time I am outside the jurisdiction of the State, I intend on stocking up with a six months supply of it because it is so unbelievably expensive here compared with other countries.

There are many ways we can save money on the drugs bill and there are some ways we cannot. We get some new, highly innovative drugs for conditions such as cystic fibrosis and cancer where we do not have alternatives. At international level I believe there are other strategies and it is a shame we are not pursuing them during our EU Presidency because I believe we need concerted international action on drug pricing. We are beginning to see what I believe is predatory drug pricing in the rarefied, non-competitive atmosphere when companies have ten, 15 or 20 years of patency on products for conditions surrounding which there is significant emotional cost. Cancer and cystic fibrosis are such examples. I have been involved in the development of some drugs which were expensive but where it cost a lot to develop those drugs. I have recently seen drugs with prices of €80,000 to €100,000 a year, where I know they were not that expensive to develop because the trials used to license them involved not the 15,000 patients who were involved in one set of trials in which I was involved, but 40 or 50 patients, which costs much less. This is something beyond the abilities of a small country’s government to do alone, but it is certainly a debate we need to start internationally.

I believe the pharmaceutical industry was playing silly buggers with the Taoiseach and the Minister, suggesting there is some linkage between the location of its manufacturing facilities here and our decision to use generic drugs. Our country appropriately has an extraordinary dependency on this wonderful sector leading to significant employment in a €40 billion industry, nearly all of the output of which is exported. The decisions about where those factories are located are not influenced by our decision to use generic drugs. Those companies will locate their plants here because of the low corporation tax and the ability of workers. It has nothing to do with what one of the smallest drug markets in the world is doing. Its local affiliates are trying to play a little game here and are trying to use a bit of emotional blackmail. I have used similar arguments with them over the years, trying to extort money for research undertakings. It is a game. The reality is that the person making the decision on locating a factory will look at the profit and loss balance sheet for what that factory will produce if it is in Ireland as opposed to Asia or eastern Europe.

What about the inefficiencies in the system? We have now had expert reports from the IMF, which is not exactly a health economist but a loan shark. The IMF wants a system that gets the IMF’s money back. The IMF is like big Vinnie. When big Vinnie comes around knocking on someone’s door at collection time, he just wants his money back and does not care how he gets it. The reality is we have extraordinary inefficiencies in our health system because we designed it to be that way. I do a slow burn when I hear people alleged to be health care experts and international health care consultants, who had no background in health economics or health care consulting before they became officials of the previous Government, lecturing us about the efficiencies implicit in our health system and using a system that they themselves designed.

Our hospital has one CAT scanner. An equivalently sized American hospital would probably have ten. What does that mean? It means somebody sitting in the bed waiting for a CAT scan not for that afternoon but for Wednesday week because it is cheaper to have that person sitting in a hospital for a week not having a CAT scan than it is to get him or her out very efficiently after one day and get different people on each subsequent day. That is how to deal with waiting lists and increase efficiency. It costs a little more but makes much more sense. However, the people at the top of the bureaucracy who run our health system will never see it that way and will always see it in terms of having a budget and needing to make it last. Hospitals are told that if they are great and more efficient at bringing in more patients, they will not get more money. People will inevitably be decanted onto waiting lists because they are free. That is why we need to reform our system. That is why we have the worst waiting list in the world. That is why the British have the second worst waiting list in the world. It is because we follow this absurd budget-based model.

I am sorry if I sound like the same old broken record every time. The Minister of State, Deputy White, is a new victim to my wrath. It is not wrath and I wish him well. I know he will bring the zeal of a reformer to a Department that at its zenith actually has some reformers right now – reformers who are swimming in a sea of treacle to get to the side of the pool where the reform will be achieved. They just have to keep working on it. Until we fix the fundamental structure of how we finance our health system and run our health service, until we deal with the extraordinary bureaucracy which we have allowed to build up within it and until we basically introduce the German model of universal health care, which is available to everybody based on a freely negotiable insurance instrument where everybody goes to one tier of care, we will not reform it.

Comments
One Response to “Generic drugs, pharmaceuticals, reform of the health service.”
  1. ladyportia27 says:

    You taking meds for cholesterol ???

    Doctors are supposed to be healers, not drug pushers.

    Diet would sort that in 3 months flat.

    I have done it just to prove my GP wrong.”Oh you will die young etc and all that scare mongering.

    Rubbish, Nutrition is the answer and a full check up for every citizen yearly as they have in Russia.

    Also full being taken into consideration- mind , body and soul like Russia. Maybe we make headway this way as we sure failed so far.

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