Commentary

Hardly a day goes by without reading about press references on the cost, use or improper use, or the lack of availability of medicines. The reason for this attention to medicine use is that the traditional role of health professionals within the healthcare system is changing, and the discipline of pharmacology is at the forefront of these changes.

Rapid growth in the drugs bill, combined with ever-increasing pressure on central healthcare expenditure, inevitably places pharmacoeconomics at the leading edge of thinking on achieving optimal drug use.

In Malta's national health system, with or without applying sound pharmacoeconomic principles, the final decision of playing 'god' and deciding who gets a medicine or who does not falls squarely on the shoulders of the director general of health. This is an unenviable task, especially if he has to do it when he is not such an expert in the field.

Yet a more focused collaboration between health professionals and the politicians who determine how much money is to be spent on medicines and on determining which medicines are essential would certainly help to facilitate the cost-effective use of new drugs.

Such a collaborative environment with the support of academics in the field may prevent the health issue from becoming a political football to the detriment of the patient.

Medicines are too serious a matter to be left in the hands of politicians only and perhaps to a physician who is, as his position implies, a 'general' director and cannot focus solely on this important aspect on medicines.

A collaborative effort would help to achieve the common aim of efficient and effective delivery of healthcare to patients. To add to the complex situation we have recently read how doctors were taken to court to face charges for not prescribing antibiotics in time.

Without going into the merits of the case and the dilemma of how best to use medicines not only in a clinically effective manner but also in a cost effective one, such a case only led to induce doctors to prescribe more and more medicines in what is referred to as the practice of defensive medicine.

Pharmacoeconomics is a science which, when applied in a serious manner, can be very helpful to understand the local dilemma on the cost and supply of medicines. However, as the subject was handled last Wednesday at the Vodafone Economic Forum you get the impression that the subject could be talked about in a heated manner by one and all as if one is discussing a football match.

It was very strange to see that even medical doctors (who would certainly be shocked if one tackled medical matters in such an amateurish manner) participated in a very puerile and emotionally heated way more suitable to a Xarabank-type of show than to an economic forum.

We do not wish to blame the person selected to chair the discussion because the participants were rather difficult to handle. It is a pity that such a serious subject is discussed in such an atmosphere, lowering this economic forum to the level of street debates.

The issues were tackled with little science and expertise in the matter. No wonder that director general of Health Ray Busuttil was reported to state that the health authorities were finding it difficult to identify what was contributing to this state of affairs.

We cannot blame them. If what the director general said is true, and there is no reason to believe that it is not, that is that medicine suppliers told the authorities that the charges imposed by the medicines authority are reasonable, then why did some of largest suppliers withdraw all or a number of their products from the local market?

A knowledge of pharmacoeconomics, even a little knowledge, should have pointed out that the 8,000 medicinal products on the local market compared to 5,000 in another European markets is too large a figure but, then, by the same comparison, the 2,000 products currently on the local market is too small a number.

Another simple question: If the new regulations do not cause an increase in price, then why is the government persisting in dispensing medicinal products of doubtful quality produced outside the EU? Why is the government still carrying out partial manufacturing and dispensing in a manner certainly not conforming to the stringent regulations imposed by the Medicines Authority on the private sector?

And all this happens when the health authorities have stated that there is no great expense involved in following the rules imposed by the Medicines Authority. Is safety and efficacy of medicines not as relevant for those getting the medicines provided by the government for free as it is for those who obtain them from the private sector on payment?

Why are patients forced to buy inferior products from the government services dispensed not strictly in accordance with the requirements of the Medicines Authority because the local agents cannot buy the originator product from their suppliers because of regulations and fees imposed by the same Medicines Authority?

Does the government have the right to risk the safety of its clients? Should the Medicines Authority be imposing expenses to follow the requirements that are irrelevant to Malta simply to abide by the EU regulations, and this solely in the private sector?

All these questions point to the importance that the subject of pharmacoeconomics must be applied in a more scientific manner. The University is in duty bound to provide its expertise to the government on this issue.

The government is on the other hand morally obliged to consult the experts at the University to provide a cost effective pharmaceutical service to our society. The final authority and responsibility remains with the health authority, but a little advice will do no harm.

No one is expected or should pretend to be an expert in all areas. Everyone agrees that registration of medicines is an essential exercise. Expertise is required to apply the registration of medicines in Malta in a rational, cost-effective manner, considering Malta's size, limitations, market and the expanding pharmaceutical industry.

Some intellectual exercise and lateral thinking was and still is required in this field. Although the Minister of Health is renowned in laying down policy and then allowing the civil service to follow up that policy, the time has come for him to take the situation in his hands.