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.”

A disruptive global health policy agenda

The political origins of health inequity: prospects for change

In order to understand the roots of health inequality, political and institutional factors are crucial. However, they are difficult to assess and identify. This is precisely what Lancet does with the new initiative on Global Governance for Health. As you may know, I'm not a fan of certain approaches and research on inequality, however this document is a milestone to understand where we are and where global health policy should go. Just a caveat, somebody may consider that it is naïf to call for global governance for health if we are not able to define a global governance for peace (e.g. Siria). I'm among those.

PS. After reading this article at EP I'm convinced that we need to define governance mechanisms for better public management. The devil is in the details.

PS. A failed state is voting today against universal justice to avoid prosecution of Tibet genocide responsible. What a shame!, those that are voting the proposal should have been in a tibetan skin and they would change their minds.

PS. The Day We Fight Back against mass surveillance

Club des Belugas. Trip to Saint Topez from Chin Chin Sessions album.

Great Music

Time to refocus

Better health, better care, better value for all

Canada Health Council has analysed the impact of health reform one decade later. The report is worth reading, as long as it is full of details of what worked and what didn't. Despite the commitment to primary care, things didn't change as expected. They have to refocus. A key paragraph:

Although the resources to improve our health system and the health of Canadians were made available, the success of the health accords in stimulating health system reform was limited. Overall, the decade saw few notable improvements on measures of patient care and health outcomes, and Canada’s performance compared to other high-income countries is disappointing. Some pressing issues have been addressed including wait times, primary health care reform, drug coverage, and physicians’ use of electronic health records. But none of these changes have transformed Canada’s health system into a high-performing one, and health disparities and inequities continue to persist across the country.

 Governments think only in terms of office, citizens perspective focus on long-term welfare. Fortunately for Canadians, the council cares for a long-term performance assessment of health policies.

PS. Avoiding waste, Value-based medicine at GCVarela

Context and evidence based health policy

Health Care Systems in Low- and Middle-Income Countries

What works?. This is a difficult question. And this is exactly the issue that Anne Mills is addressing in her NEJM article. Her review of health systems in low and middle-income countries achieves and inconvenient but true conclusion:

On the basis of the evidence presented above, few clear-cut conclusions can be drawn with regard to the best strategies for strengthening countries' health care systems. An approach that works well in one country may work less well in another, and not all approaches are equally acceptable to all governments or their multiple constituencies. There is no one blueprint for an ideal health care system, nor are there any magic bullets that will automatically elicit improved performance. This is hardly surprising: health care systems are complex social systems,31 and the success of any one approach will depend on the system into which it is intended to fit as well as on its consistency with local values and ideologies.
A recent historical study of the contribution of the health care system to improved health in five countries identified a number of characteristics of successful health care systems Such systems were able to develop the capacity to select promising strategies and to learn from the efforts of other countries as well as from their own experimentation. The strengthening of a health care system requires a focus not only on specific strategies, such as those considered above, but also on the creation of an environment that supports innovation. Health care strengthening must thus be seen as a long-term process that involves complex systems and requires carefully orchestrated action on a number of fronts. The global community can help by supporting country-led processes of reform and by helping to create a stronger evidence base that contributes to cross-country learning.

I believe that such characteristics hold as well for high-income countries. Evidence for health policy is context based. No universal laws for implementation, only some criteria, some characteristics. Food for thought.

PS. " Our research suggests that the economics of vertical integration makes sense for payors in only a minority of markets.". McKinsey guys at HA blog. I agree.

False advertising

The concern over consumer protection is growing with new health technologies. This is not new, you may think. However the lawsuit by FTC against Genelink for misleading claims is the first case in a genetics testing company. Genelink said that they analyzed your DNA and afterwards send back nutritional supplements customized to your personal genome. The regimen, the company promised, was good for diabetes, heart disease, arthritis, insomnia and other ailments.On request by FTC, they were unable to confirm such promises.
Since you may find a similar test on the corner of the street, once again my question is: where is the regulator?

PS. Some months ago, was the FDA who asked 23and me to stop selling its genetics test kit.

PS. On DTC genetic tests, a good article.