What dynamics have changed patient care in recent years? Why are costs growing and healthcare becoming increasingly poor?
In the Western world, widespread frustration with increasingly poor health care is making the medical professions dangerous. In the last 20 years, business has changed the healthcare system. A US research tells how people react by attacking medical personnel. A widespread trend also in the UK and in Italy.
Business, medicines, diseases, cures. How did we get to today?
Cancers and chronic diseases are the mirror of the system. To understand how we got to this point, we discussed it with Professor Umberto Tirelli, oncologist, former Director of the Medical Oncology Department of the National Cancer Institute of Aviano, currently director of the Cancer Center of the Tirelli Medical Group in Pordenone.
Do the market and business actually dominate the needs of patients?
“Certainly there has been progress in the field of treatments, but not such as to consider many oncological diseases under control, which must increasingly be treated with prevention, early diagnosis and various ad hoc treatments. It must be understood that each tumor is different from the other. Two breast or lung cancers, in two different patients, are different diseases. It becomes difficult to find a single treatment that is valid for all cancers of the lung, pancreatic or colon, for example, because everyone is different. Today even very expensive treatments are being done but we should go towards very targeted treatments, evaluating case by case, which is not done now. It is not certain that these very expensive standard drugs are the right way”
Which drugs cost the most?
“Biologicals have driven the steepest cost increases over the last 5-10 years. All cancer drugs have increased disproportionately in the United States and in Western countries. They are the most expensive group of drugs ever, far behind are vaccines and still behind are all the other drugs even for important diseases. This happens because expenses are charged for the development of these drugs and which should give the greatest advantages compared to the traditional ones we have used so far. Instead we still have many patients who die of cancer. There has been an improvement in survival but often because the treatments are done earlier than they used to or at a more initial stage of the disease”
Can you explain the phenomenon of shortage, of which little or nothing is said in Italy….
“In the United States this was already reported in 2006. The shortage is the periodic shortage of drugs, not only oncology but also antibiotics, painkillers, antiepileptics, etc. All this is explained by a low production of the drugs themselves. The same situation is denounced in Canada, in Brazil, in Australia, even in Italy. The primary substances for the basic drugs are never lacking, they are always there. In reality, the market closes drug establishments that are inexpensive, because they are not profitable, in favor of more expensive drugs. If one wants to believe that there are no drugs, they believe it. A lot of people don’t believe it.”
It’s a business issue so…
“The European drug agency or the American one or even the Italian national one… they easily believe it. Maybe because they are implicated in the speech?”
Are you telling us that in some cases there are conflicts of interest?
“Yes, in short, it is very likely that there are conflicts of interest. The numbers tell us about these disproportionate increases. To produce these new biological drugs we have much higher costs. The question is: do they make that much? Certainly in some tumors, but there are also many tumors in which they don’t work and don’t have the same advantages as the traditional ones. You know, the costs of our healthcare also depend on these factors, it’s not just a problem of personnel costs but also the weight of the cost of the drugs that the pharmaceutical industry offers us”
A profound trend in the Western world is for people who have chronic diseases to be assisted with the use of opioids or opioid-containing medicines.i…
“There was a phenomenon that developed in the United States with the company that produced them also going bankrupt: it was a very relevant case. Opioid drugs have been used on a massive scale and there were experts who said they gave psychological benefits, but then you risk becoming addicted and it’s trouble.”
It is estimated that between the end of the 1990s and 2022, this phenomenon caused almost a million lethal overdoses of legal opioids, including analgesic drugs, and illegal ones, such as heroin…
“Yes, it’s called the ‘opioid epidemic.’ There have been 100,000 deaths in the United States in the last year alone. There are certain US cities where people seek out opioids on the street to relieve pain. We also use these opioids in Italy and we need to be very careful that over time the same thing that happened in the USA does not happen. It is a particular phenomenon but one that always falls within the dynamics of the pharmaceutical industry. But it’s not all bad.”
Explain to us
“Thanks to the pharmaceutical industry we have controlled many deadly diseases. Among the many, I mention hepatitis C which is a high risk factor for tumors, from which today we can heal with drugs”
What should governments, institutions do to reverse this trend, where business is so powerful as to determine the nature and history of patient care?
“The key to everything is the prices that need to be regulated. This must be a European process that EMA and the other political regulators do. The pharmaceutical industry must be told that primary resources must be available, as well as drugs and prices that must be regulated especially if we are talking about essential medicines. It’s very important: we need someone to bang their fists on the table. There are many drugs that have an important impact, however, then there are also drugs that are not so active and functional but which have very high costs and we use them anyway. There needs to be someone, but it’s not easy to find, I haven’t found him around yet, who at the political level I am intervening at the root. But anyone understands that it’s not a simple speech. The world is now in the hands of these economic processes which cannot be stopped. Politics should do this job but I haven’t yet found someone who clearly stands out in favor of patients, allowing for a regulation of the process”
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