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The latest official review of European health strategy has been released at the request of the European Commission in an attempt to address Europe’s healthcare challenges. Peter O’Donnell reports that the clinical trials community is likely to be disappointed at the report’s findings.
Anyone in the clinical trials community looking for comfort – or even recognition – in the latest official review of European health strategy is likely to be disappointed. This 200-page status OECD report (Health at a Glance: Europe 2016) has been prepared at the request of the European Commission as part of an attempt to get a grip on Europe's ballooning healthcare challenges. The report hardly mentions research at all, and even the broader issues of pharmaceuticals get scant attention – and often with more of a focus on containment than on innovation.
Socioeconomic determinants of health, equality of access and resilience of healthcare systems receive extensive coverage – as befits their undoubted importance. But there is little appreciation of any contribution that drug research might play in maintaining and improving the health status of Europeans. Top officials from OECD and the EU make a glancing reference to "new technologies" in their foreword to the publication, but only as "more pressures on health systems". And any promise that they acknowledge of "better and earlier diagnoses and a greater range of treatment options" also "comes at a cost."
It is the cost of pharmaceuticals, rather than their benefits, that predominates throughout. In 2014 – the reference year for the report - "19% of overall EU health spending was allocated to medical goods (mainly pharmaceuticals)," it notes, pinpointing the high proportion of such spending in Bulgaria and Romania (43% and 37% respectively), and in the Slovak Republic, Hungary, Croatia, Lithuania, Greece and Latvia (all more than 30%). Budgets for prevention have fallen more than budgets for drug spending, it says – blaming in part the costs of vaccination after the H1N1 epidemic.
The report itself offers a brief and routine recognition that pharmaceuticals "play a vital role in the health system", and lip-service is paid to the concept that policy makers must "provide the right incentives to manufacturers to go on developing new generations of drugs." But the compliment is undercut by the insistence that "health care budgets are limited", and that "pharmaceuticals represent the third largest expenditure item of health care spending."
The emphasis on costs is at its peak in a lengthy section on generic medicines. "All EU countries see the development of generic markets as a good opportunity to increase efficiency in pharmaceutical spending," it says. But governments are not doing it enough, the report goes on. "Many do not fully exploit the potential of generics," it says, in an attempt to encourage more aggressive pro-generic policies. "In 2014, generics accounted for more than 70% of the volume of pharmaceuticals sold in the United Kingdom, Germany, the Netherlands and the Slovak Republic," it comments approvingly. At the same time, it adds, with evident disapproval, "they represented less than 20% of the market in Luxembourg, Italy and Greece."
The European Commission does nothing to alleviate the overall impression that pharmaceuticals are officially perceived in a negative light - as a drug on the market, almost. A statement it issued to coincide with the launch of the OECD report urges "spending more wisely on pharmaceuticals, including by making full use of opportunities for generic substitutions."
Even for the obvious health care challenges of tackling identifiable disease, medicines receive little recognition – and research still less. Discussion of the burden of non-communicable diseases is limited largely to reflections on life-style changes. And the "renewed international focus on tackling dementia" is described principally in terms of actions to improve long-term care and support for families, with "finding a cure" relegated to "a long-term goal." As far as Europe's official approach to health care is concerned, it would appear that clinical trials are ignored – maybe even completely forgotten.