The American Spectator

The Public Policy

Drug Underdose

By Doug Bandow on 6.5.07 @ 12:05AM

Michael Moore likes nationalized health-care systems, especially the one in Cuba. It's too bad he can't secretly move to Havana in order to anonymously sample the wonders of Cuban health care.

He probably could move to Great Britain and enjoy the wonders of the National Health System (NHS) like any other resident. One aspect of that experience would be limited access to the newest pharmaceuticals.

Health care is again emerging as an important political issue. And the U.S. system is seriously flawed. A weird hybrid of private and public, American medicine is dominated by third-party payment, with about 80 percent of all health-care dollars paid directly by someone other than the patient. Such a system is neither efficient nor accountable.

However, nationalizing care typically saves money by denying treatment. Political bodies or bureaucracies decide who is entitled to what, and spend accordingly. The well-to-do flee to private clinics or other nations, including America, for better treatment. Everyone else suffers from inadequate or delayed care. The ill consequences are highest for those suffering from diseases requiring immediate, sophisticated, and expensive treatment.

For instance, one bad aspect of a longer life expectancy is a higher incidence of cancer. Thankfully, advances in treatment -- from surgery to pharmaceuticals to radiotherapy -- mean that many more patients survive. In Europe, despite more diagnosed cases of cancer "the mortality rate is stabilizing, however, and in some countries is on the decline," write Nils Wilking of the Karolinska Institutet and Bengt Jonsson of the Stockholm School of Economics.

But survival depends on receiving the best care. Inadequate access to oncological drugs, in particular, means unnecessary suffering and death. Speaking on behalf of the three million Europeans diagnosed with cancer annually, John F. Smyth, President-elect of the Federation of European Cancer Societies, puts the issue squarely:

cancer is a significant cause of morbidity and mortality in Europe, and scientific advances have given us the potential for more treatment approaches than are currently provided. New medicines have no benefits unless they are used by the patients who need them, and the need to balance benefits, costs and available resources should not prevent patients from gaining access to novel drug therapies.

Obviously, cross-national comparisons are complicated.

Nevertheless, the differences in cancer treatment and survival rates are significant. Wilking and Jonsson survey access to cancer drugs in the U.S., a score of European nations, and several others. Their conclusion: "Our report highlights that in many countries new drugs are not reaching patients quickly enough and that this is having an adverse impact on patient survival. Where you live can determine whether you receive the best available treatment or not."

Why? In a globalized world there is no issue of information access or product availability. Rather, the problem is regulatory regime.

Observes Smyth: "There are considerable variations in the time from a license being granted to the actual availability of new medicines in different member states and the speed at which patients are able to gain access to new cancer drugs. Although there is little excuse for lack of knowledge of these new advances amongst the medical profession, the health-economic issues that influence whether or not new medical approaches can actually be delivered to the individual patient are often poorly appreciated."

In fact, one of the most striking features of nationalized systems is their inequality. Although supposedly dedicated to ensuring access to all, that access rarely is equal, varying among nations as well as regions and classes within nations. The differences are most acute in self-proclaimed workers' paradises, like Cuba, where the well-connected -- as well as visiting U.S. journalists like Moore -- receive world-class treatment.

America gets good ratings on drug availability, despite the vagaries of its medical system. Wilking explains: "In the U.S. we have found that the survival of cancer patients is significantly related to the introduction of new oncology drugs." Thus, the researchers add, "it is clearly in the best interests of cancer patients that innovative drug therapies are made available as soon as possible after market authorization. Reduced or delayed access to cancer drugs has a very real impact on patient survival."

Europe is much more a mixed bag. Write Wilking and Jonsson, "Our analysis indicates that there are imbalances and inequities in the ability of cancer patients to access cancer drugs in Europe, with access varying according to the country of residence. There are large differences between countries with regard to the level of uptake and the time period over which cancer drugs become available to patients."

Austria, Spain, and Switzerland were best in adopting new medicines. Wilking and Jonsson also point to Italy in selected drug therapies. At the other end of the spectrum were the Czech Republic, Hungary, Norway, Poland, and United Kingdom, which, the researchers report, "were consistently identified as below-average adopters of new cancer drugs." Indeed, Wilking and Jonsson add, "Four years after the drugs' introductions, several countries still have a large patient population not being treated." Ironically, the UK is number one in cancer research funding yet "lags behind other EU countries in terms of the ability of cancer patients to access new drugs."

Failing to provide the best oncological pharmaceuticals to patients may save governments money -- in the short-term, anyway -- but will cost patients dearly. As Wilking and Jonsson opine, with extraordinary understatement, "This represents a substantial loss to patients."

The problem is simple: citizens of the UK and several other European countries suffering from breast cancer, colorectal cancer, lung cancer, and non-Hodgkin's lymphoma are far less likely to receive the latest, most effective medicines. Columbia University's Frank Lichtenberg figures that access to newer, better drugs has increased both one-year and five-year survival rates. Indeed, pharmaceuticals account for 50 to 60 percent of the recent increase in survival rates. Too bad if you're born in the wrong European country.

Letter to the Editor

topics:
Health Care, Economics, Law