Conflicts of interest (in medicine)

I would like to attend this seminar:

Professor George Lowenstein
Behavioural Economics and Conflicts of Interest

“A conflict of interest is a clash between an individual’s professional responsibilities and their personal, typically financial, interests. Traditional economics has not shed much light on conflicts of interest, perhaps in part because it has not recognized the importance of professionalism as a motive in human behaviour. In this talk I will present results from a variety of studies that examine the behavioural economics of conflict of interest. Focusing mainly on conflicts of interest in medicine, some of the research shows how people who care deeply about behaving in a professional fashion can be corrupted by economic incentives. Other research shows how disclosing conflicts of interest, far from helping the recipient of information, can backfire, helping the advice-giver and hurting the advice recipient.”

Lecture Theatre 3, Cambridge Judge Business School. Tuesday 25th February 5-6.30pm. No need to register but arrive early in order to get a seat.

Unfortunately, I can't attend. Any info will be appreciated.
You may follow events on Behavioral Economics, here.

PS. Our public expenditure on health on 2012 gave ground, and was close to 5 years before: 2007. Such expenditure over GDP is still at 2008 position: 5,3% , while our GDP per capita (27.442€) is  at levels before 2006 (!). Therefore we are spending on health (more than) proportionally to our GDP historical trend, however our GDP has shrinked a lot. And we maintain distance to OECD average health expenditure (6,69%) although our per capita GDP is 2,7% larger. That's all right now, it's an issue of months.

PS. Interesting post by Josep Maria Via.

The market size of stratified medicine

Defining and quantifying the use of personalized medicines

There is a lot of noise around the message that the personalised-stratified medicine era has arrived. If you split the clamour from the message, the result is close to 34 medicines at the end of 2012, and in market volume accounted for 3% of the global market by the end of 2009. You'll find this details at NRD and this is the key comment:

First, in terms of characteristics, oncology agents dominate personalized medicine utilization, and disproportionately address unmet medical needs as revealed by priority, accelerated, and orphan disease FDA designations. Second, older drugs that have become personalized medicines post-launch have had a significant impact on the growth of small-molecule personalized medicines; however, the translation from label to clinical practice remains uncertain. Third, per capita usage of personalized medicines in the EU5 markets is greater than in the United States, with usage rates in Japan and the rest of the world growing rapidly

 Affair in Cascais

Club des Belugas- the Chin Chin Sessions

Everything is connected

Pla Interdepartamental de Salut Pública

We all know that improving population health is a task that exceeds the healthcare system. The political debate is too focused on healthcare rather than other determinants to improve health. However, today is a different day. A new plan to introduce health in all policies has been approved and this means a change in the agenda. We'll see how this will be managed, since it is a new approach.
Have a look at the document. The authors have been working hard for months on it. Such policy follows EU criteria and represents an innovation in the current health policy landscape. Let's see how effective it is.

Capitalism and morality

Market Reasoning as Moral Reasoning: Why Economists Should Re-engage with Political Philosophy

I found this article. Have a look at the abstract:

In my book What Money Can't Buy: The Moral Limits of Markets (2012), I try to show that market values and market reasoning increasingly reach into spheres of life previously governed by nonmarket norms. I argue that this tendency is troubling; putting a price on every human activity erodes certain moral and civic goods worth caring about. We therefore need a public debate about where markets serve the public good and where they don't belong. In this article, I would like to develop a related theme: When it comes to deciding whether these or those goods should be allocated by the market or by nonmarket principles, economics is a poor guide. Deciding which social practices should be governed by market mechanisms requires a form of economic reasoning that is bound up with moral reasoning. But mainstream economic thinking currently asserts its independence from the contested terrain of moral and political philosophy. If economics is to help us decide where markets serve the public good and where they don't belong, it should relinquish the claim to be a value-neutral science and reconnect with its origins in moral and political philosophy.

There are health economics implications, with a little effort you can find them.

Effectiveness, first things first

Homeopathy in Healthcare – Effectiveness, Appropriateness,Safety, CostsAn HTA report on homeopathy as part of the Swiss Complementary Medicine Evaluation Programme

Swiss government requested a report on homeopathy through the Complementary Medicine Evaluation Program, just to understand its cost-effectiveness. You'll find the complete story in this blog.
The key table is here.Such report and this table created controversy due to conflicts of interest of their authors.
Finally the government decided not to include homeopathy in the reimbursed benefit basket.
Is there any reason to regulate when the effectiveness has not been demonstrated?. This is my question today to a regulator that it seems busy on this issue. My answer is clear, it is unnecessary. He has to inform the citizens and incriminate providers in case of false advertising.

PS. I already said this before, here and here .

Competing on biosimilars

One year ago McKinsey released a report on biosimilars. They explained what happened in Europe after 2005 regulation. Now NRD has published an interesting article by Henry Grabowsky et al. that shows wide differences within Europe. In Germany, 42% of the market of Epoetin is biosimilar, while UK remains at 7,9% (!). The article explains the reasons behind such variation. If we have to summarise in one cause, this would be: incentive regulation. And since prices are 25% less than original products, such difference has high opportunity costs for UK citizens (however the price levels in Germany is higher than the UK).
In their words:

One major finding is that the competitive performance of the biosimilars we analysed in Europe is mixed both across countries and products. Although the European Union has a common regulatory system for approving biosimilars, differences in reimbursement practices and incentives as well as variations in medical practices have resulted in  different outcomes across countries.

Does anybody know what's happening here?

PS. IMS presentation.

What is the rule of law?

If we look around us these days we can detect that these conditions have mostly vanished in many public environments:

1. The government and its officials and agents as well as individuals and private entities are accountable under the law.
2. The laws are clear, publicized, stable and just, are applied evenly, and protect fundamental rights, including the security of persons and property.
3. The process by which the laws are enacted, administered and enforced is accessible, fair and efficient.
4. Justice is delivered timely by competent, ethical, and independent representatives and neutrals who are of sufficient number, have adequate resources, and reflect the makeup of the communities they serve.

 How can health policy be implemented in a setting that doesn't conform to such criteria?. Day by day, I'm more convinced that the problem is beyond any policy. Have a look at decree 16/2012, p. 31292, one criteria for public funding of drugs is:

- Social and therapeutic value of the drug and incremental clinical benefit, taking into account its cost-effectiveness relationship

New drugs are being accepted every month, and since June 2012 the Health Ministry hasn't updated the website. Nobody knows its cost-effectiveness. Some weeks ago a transparency law was approved. It's a joke. 
There is one and only option: disconnect asap and forget this nightmare.

PS. I said something similar one year and a half ago. 

PS. Is there any price-cap on publicly funded drugs? In France, the recommendation is to limit any new drug to 50.000€. You'll find it here p.15.  Let's see what really happens here. In UK, confidential discounts apply. Welcome to the transparent world!. Have a look at my previous post on the same topic and the table.

PS. Lewis Mumford dixit:
"For most Americans, progress means accepting what is new because it is new, and discarding what is old because it is old. This may be good for a rapid turnover in business, but it is bad for continuity and stability in life. Progress, in an organic sense, should be cumulative, and though a certain amount of rubbish-clearing is always necessary, we lose part of the gain offered by a new invention if we automatically discard all the still valuable inventions that preceded it.”