Federal target program "Cheap and bad pills for everyone"
The state will start saving on patients. The main criterion for the effectiveness of the drug will be its priceLyudmila Rybina, Novaya Gazeta, 11.09.2009
"The Federal Antimonopoly Service (FAS) of Russia will check several large international pharmaceutical companies to identify how they influence our doctors, and through them, consumers," Timofey Nizhegorodtsev, head of the Department for the Protection of Competition in the Social Sphere and Trade of the FAS, told members of the Association of Russian Pharmaceutical Manufacturers (ARFP) on September 8. In his opinion, foreign companies have a separate budget in order to "persuade" doctors to prescribe their drugs, and our manufacturers are being infringed.
The domestic manufacturer, of course, needs to be helped, especially in a crisis, but is it worth looking for an external enemy for this? Especially when you consider that in the war of security forces and officials with "villainous" foreign firms, as always, patients will lose…
When a patient comes to the doctor, he hopes that he will try to do everything to help, will use all his knowledge for this…
But here's what they tell on patient websites:
"I brought the child to the doctor. We were prescribed medicine and an expensive inhalation device – a nebulizer. The prescription contains the name of our doctor and the address of the pharmacy where we have to buy both the medicine and the device. And now I'm thinking, do we really need the device, or does the doctor get a percentage from this pharmacy or from the manufacturer of what we pay, and our needs are not so important to him?"
"I noticed that our district doctor has the name of a well-known drug manufacturing company on the pocket of his robe, and also on the pen she writes with, on the calendar that is on her desk. I asked her: and will you prescribe medicines for us from this company, too? But she pretended that she didn't understand what I was talking about."
"The doctor gave us a brochure about cough. It's interesting, and with pictures, and at the end an advertisement for a cough remedy – lazolvan. Is this a sanitary light or an advertisement? She had a whole pack of such pamphlets."
You can continue, but it's clear: traffic cops can no longer claim exclusivity in their indifference to our wallets, it's sad, but the example turned out to be contagious.
Collusion or sanprosvet?But the problem is worth looking at from the other side.
There is a myriad (obviously excessive) number of medicines on our market. The doctor doesn't know them. He appoints 3-5 known to him from the institute bench, and it's good if he updates this list after each professional development (every five years). Our doctors, for the most part, read very little, they do not prescribe medical periodicals, they do not use the Internet en masse, they do not speak English to such an extent that they can read on the Internet. Who in this situation will introduce them to new products? So the head doctors do not refuse to let specialists from pharmaceutical companies attend medical conferences. If these are representatives of well-known world manufacturers who introduce doctors to tested and certified drugs abroad and in our country, this is only for the benefit. In the case of intrusive advertising, it is not large foreign firms that are more dangerous, but local healers with dubious potions and non-certified (which is within the law) biologically active additives.
The fact that the security forces are going into battle is frightening. How will the FAS be able to identify why the doctor began to prescribe a new medicine more often – because he received information that it is effective and effective, or because he is paid extra for it? And will the doctor shy away from new drugs from Western companies in fear that he will be suspected of collusion? And there is another danger – that the doctor will not have this unsafe choice in the conditions of hunting for "bribed doctors": unspoken instructions will go – to prescribe domestic, and not to think about its effectiveness.
Against imports and patients?The offensive on imported medicines is becoming more active.
At a round table organized by the Association of Russian Pharmaceutical Manufacturers, Deputy Head of Roszdravnadzor Elena Telnova said: "In 2008, it would have been possible to save more than two billion rubles and more than 1.2 billion rubles in the first half of 2009, if domestic drugs had won at auctions." The cynicism of this statement is limitless. For a doctor, medicines, like a patient, do not have a "nationality". The Formulary Committee has repeatedly stated that the country should have a single list of vital medicines for inpatient and outpatient treatment and it can only include medicines with proven effectiveness.
(The Formulary Committee of the Russian Academy of Medical Sciences is a public expert committee in which more than 50 people work on a voluntary basis, about half of them are academicians and corresponding members of the Russian Academy of Medical Sciences. The Committee changes and supplements the list of vital medicines, as well as forms a negative list of medical technologies, prepares proposals for registration or re-registration of medicines.)
It is proven efficiency, not the place of production and not even the price, that should play the main role here. Can it be considered a rational expenditure of funds to spend huge amounts – and this year the volume of public procurement is 64 billion rubles (30% more than in 2008) – on something that will not benefit, will not save people who can really be saved by medicines of new generations. Unfortunately, such medicines are not produced in our country. As stated in the report of the Formulary Committee for 2008: "Drugs developed 15-50 years ago are produced in Russia, there are no new innovative technologies." Why manipulate the figures and consider the billions that went to public procurement last year "wasted"?
The purchase of medicines for beneficiaries under the Supplementary drug provision program (DLP) belongs to the powers of the subjects of the Russian Federation. But Roszdravnadzor continues to advance. As Elena Telnova said, a letter was sent to the regions with a proposal to the governors to figure out why there is a "clear bias towards imported medicines" in the framework of public procurement. Roszdravnadzor is lying: there is no need to understand this, it is known: there are no domestic effective drugs for most diseases, and for many there are not only effective ones - there are none. But the governors are under pressure with crafty figures. "From 2005 to today, unfortunately, the share of domestic medicines has only decreased: from 20 to 4.5–5% in value terms," Telnova said. These figures are crafty: the most modern medicines are the most expensive. Billions have been invested in their development, they simply do not have competitors, but they really save people. And they, these drugs, have been purchased in our country in recent years. For example, the purchase of blood clotting factors that are produced abroad in our country has increased 20 times over the past 10 years. However, almost from scratch. Costs? Yes! But you need to count correctly. As the president of the All-Russian Society of Hemophilia Yuri Zhulev explains, without these drugs, patients with hemophilia become severely disabled, who need constant care, pensions, expensive operations. People who have been given medications live almost a full life: they work, provide for themselves and their loved ones. So leaving them without medicines is a difficult thing, even if you measure everything with money.
Domestic does not mean highly moralProfessor Vasily Vlasov, president of the Russian Branch of the North European Branch of the Cochrane Cooperation, says: "This is a complete lie - about the exclusivity of international companies.
Russian companies use the same means, often even more rudely.
(The Cochrane Collaboration is an international non–profit organization. Named after British epidemiologist Archie Cochran. Its main task is to collect the latest, reliable information about the results of medical interventions.)
Manufacturers of dietary supplements – mostly domestic – behave just viciously. And the FAS absolutely does not fulfill its role as a controller in the domestic pharmaceutical market. Demonizing pharmaceutical companies is fruitless. The state (regulator) and the second party (doctors) bear no less responsibility. Doctors are very fond of selling themselves, giving paid lectures to please the customer, writing articles in magazines, ostensibly scientific, but in reality just supporting the sale of the drug. At the same time, I do not know of a single case that the medical association of Russia, the institute, the Academy opposed this practice. It's easier to just spit in the direction of pharmaceutical companies, and even foreign ones. The FAS claims that Russian manufacturers with drugs similar in content and quality to imported ones cannot win at auctions for formal reasons, for example, due to the inconsistency of the drug packaging and its instructions with the auction conditions. But in fact, the opposite is true: most auctions are defective precisely because the federal and regional authorities support targeted purchases of medicines by domestic companies. "If we are talking about health, about a serious illness, the patient, of course, believes the doctor and cannot even think that he is acting not in his interests, but in the interests of a foreign pharmaceutical company," the representative of the FAS summed up. And if not foreign, but your own, is it better? It is enough to give an example of how our Ministry of Health and Social Development recommended for swine flu in addition to oseltamivir and zanamivir (recommended by WHO) also arbidol, together with other domestic drugs. The manufacturer of arbidol is associated with the family of two ministers of the Russian government. Is this not the basis for the FAS proceedings?". Despite the restrictions on advertising medicines, it is arbidol that is advertised in our country so that it firmly leads in the top ten best-selling. I must say that none of the ten best-selling drugs in Russian pharmacies belongs to the category of vital, almost all of them, according to the estimates of the Formulary Committee of the Russian Academy of Medical Sciences, "have no evidence of the effectiveness of use, in particular, arbidol, actovegin, vitrum, essentiale."
Irresponsibility from impunityYes, marketing methods of stimulating the discharge of medicines, in which the manufacturer or distributor is interested, and not the patient, corrupt the doctor.
But why are our doctors completely irresponsible about this? Yes, because, first of all, the doctor is not responsible for anything. If the patient should not get the medicine for free, but buy it himself at the pharmacy, doctors do not bother with prescribing prescriptions: they name the drugs orally or write on a piece of paper (and not on a prescription form). And why a prescription, if the rules of prescription leave have stopped working, although according to international rules there are prescription and over-the-counter treatments. In our pharmacies, medicines are treated simply as a commodity: the buyer asked, the pharmacist sold. You can buy almost anything, including drugs that can have severe toxic effects and even drugs (if you try).
Information on the effectiveness of medicines prescribed by a doctor is still not collected and analyzed in our country. Although in world practice, patient registers are kept for the most socially significant and costly diseases, as well as for the introduction of new or little-used medicines into practice. The results of the analysis and reports are published and are publicly available when only personal data is classified. While in Russia, information about the prescribed medication is recorded only by the doctor's hand in a paper card, and with some tragic consequences it is easily corrected or lost, it is useless for the FAS to deal with questionable prescriptions. In the USA and EU countries, in addition to patients (who are completely disenfranchised and powerless in our country), they are interested in accurately documenting all appointments insurance companies. In any insured event, all appointments made by a doctor are raised. In our country, courts with the most severe and even lethal consequences of treatment are very rare.
The rescue of drowning people is in their own hands. The patient, if he wants effective treatment, should check for himself what he was prescribed. By the way, it's possible. On the website of the Cochrane Society, you can find information about the effectiveness of drugs and indications for their appointment. However, for this you need to read in English. And the average doctor, as a rule, has neither English nor a computer. So go ahead, FAS.
P.S. Alexander Saversky, chairman of the All-Russian Society for the Protection of Patients' Rights advises patients to visit not one specialist, but several in order to get an objective idea of the drugs needed for treatment...
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Under the text
Herman Galdetsky is prescribed the wrong thing
Herman Galdetsky, the hero of the publications of Novaya Gazeta, and in general, a hero (a 19–year-old student single-handedly initiated several official checks at the Department of Internal Affairs on the Moscow Metro on the facts of the rape of girls by police officers, which ultimately led to the resignation of the head of the Department of Internal Affairs), was stopped five years ago by a shot in the temple. Galdetsky then went to intensive care for a long time and miraculously survived, and then a very difficult rehabilitation began. The perpetrators have not been found so far.
Herman's mother Alyona Arkhipovna is very grateful to everyone who has been helping the family to return speech, movement, and memory to Herman all these five years. But the post-traumatic consequences are very severe, Hera is a disabled person – group I of the 3rd degree of restriction, and he has been prescribed medications that must be taken constantly.
For the first three years, the Galdetskys did not apply for preferential medicines. Actually, Alyona Arkhipovna was told that Herman was entitled to them in Lithuania, where in the first years after the injury, her son visited rehabilitation on average once every three months. The pharmacist of the local pharmacy was surprised: "Your medicine is prescribed for free, why do you pay for it?". But when Alyona Arkhipovna asked to prescribe free medicines at the pharmacy of Fryazin near Moscow, where the Galdetskys live, it turned out to be a problem. And prices are rising every month. If a year and a half ago medicines for a month cost 3 thousand rubles, now it is already 7. Treatment was prescribed to Herman at the Institute of Neurosurgery named after him. Burdenko, and in the statement it is written "without replacement with analogues". This postscript is not accidental. Herman's rehabilitation was clearly progressing on precisely selected drugs.
Nevertheless, in the Fryazin polyclinic, lamictal manufactured in the UK is proposed to be replaced with Indian lamitor. They say they have the same active substance. But the professor observing Herman explained: the active substance is not everything. The drugs have a different rate of absorption of the active substance, which means that the effect is different.
Lamictal, which Herman needs, is on the federal list of vital medicines, but the Moscow Region apparently loves India more than the UK. Or the style of promotion of drugs by distributors? Galdetsky, after they sent a letter to the regional health department, was called and persuaded to take an Indian drug.
Mom is indignant: "We have written: no replacement!". Apparently, in order to get rid of the stubborn mother, the polyclinic began to deceive: they write out a prescription not for lamitor or lamictal, but write in a preferential prescription just the active substance, really the same in both drugs – lamotrigine, but the dosage of the Indian drug is set at the same time: 50 (in a British box of 30 tablets). They say that there is something in the pharmacy, then they will give it to you. And what they will give is clear: what promotes the region.
Portal "Eternal youth" http://vechnayamolodost.ru
24.09.2009