Article 32 of the Italian Constitution: The Republic protect health as a fundamental right of the individual and in the interest of the community, and guarantees free care for the poor.
As a doctor, as a citizen and as a cancer patient, I can’t help but be shocked by the episode of PresaDiretta entitled “Let’s save the National Health System” which was entrusted with the implementation of Article 32 of the Italian Constitution, unique in the world, with the law 833/78, which provides for the Right to health as a constitutional right, objectively the greatest gift of our founding fathers.
When in 2006, pharmaco-economist and cancer researcher, I decided to become environmentalist and today I am the President of Isde Medici Ambiente of the Provincial Section of Naples, the Province with the lowest average life expectancy and highest avoidable mortality in Italy, the reasons were already clear to me that on Monday 27 March evening at PresaDiretta have been disclosed to all. But even in that case not everything has been said, nor has it been said clearly.
In order to survive and realize the utopia of equal healthcare for all, the NHS has the indispensable need to have first of all, on the dictates of the Constitution, as its first objective the protection of health and not of disease. It appears clear to everyone, but it was not even mentioned last night in PresaDiretta, the lack of one primary prevention valid in Italy with protection of the living and working environment, substantially absent in territories such as Campania (incorrect disposal of industrial waste more than doubled as production from 2009 to 2019 with zero final disposal plants, uncontrolled diffusion of pesticides, vehicular traffic out of control, dismantling of the railway network excluding only High Speed, etc.). We have Arpa that don’t work and/or don’t want to work and Local Health Authority Prevention Departments dismantled and zeroed out as autonomous funding (absence, for example, of regularly functioning cancer registers). The absence of a valid Primary Prevention action, especially against cancer, is the first cause of the explosion of all pathologies chronic-degenerative, including cancer, which is becoming increasingly difficult to avoid, then to diagnose early and finally to treat adequately, with ever more expensive drugs paid for by the NHS!
In order to exist, the NHS has an indispensable need to be adequately financed by the State and this happens through the general taxation and no longer through mutual societies (as in Germany), considered a source of inequality. Yet today the Germania demonstrates that the “Bismark-style” mutualistic model, corrected for inequalities, is concretely the best for a simple and banal reason: it is based on regular, decently paid employment contracts that guarantee reliable funding from everyone to the NHS. It is impossible in Germany to be treated if you work illegally, as happens in Campania up to 47% and throughout Italy for no less than 30% of all our manufacturing activities. They are precious economic resources stolen from the NHS, while undeclared work becomes the first cause of illness for all those who suffer it, both in the south (Land of Fires) and in northern Italy.
So long as we are (deliberately!) losing the war against cancer and therefore we fall ill more and more and younger, no one has even dared to point out that if we are scandalized by a doctor paid 1500 euros a day, we should be even more scandalized by a vial of chemotherapy that the NHS pays thousands of euros in maximum silence. We still have the money to give these free vials to all patients, but in many cases these vials are not worth the price we pay as a state. but nobody says it. It is my direct competence and experience in the field to observe that the increase in pharmaceutical expenditure in oncology for innovative drugs it was around 1000% in the last twenty years, but overall survival thanks to these very expensive patent medicines is equal to around 10% overall in the last 5 years considered (2016-2021). A definite cost excessive compared to surrender, never in terms of healing but only of chronicity of the disease!
Today everyone notices the excess of extra profits that Big Pharma is cashing in thanks to the vaccines of the Covid pandemic, but no one even dares to mention the exceptional extra profits that cancer and all autoimmune and chronic-degenerative pathologies in real explosion have ensured for decades to Big Pharma, especially in the polluted territories identified by Iss with the Sentieri Project (only the people from Campania are about a third of the 6.2 million Italians involved in the environmental disaster caused by industrial pollution!). Only those who pay out don’t collect figures with two zeros of profit/year private healthcare, but also and above all those who produce and/or resell medicines. Thanks to’differentiated autonomy where there are factories that produce the most drugs in Europe (two poles in Italy, Lombardy and Lazio) there will also be the possibility of guaranteeing, for example by stipulating as has been said health insurance supplementary costs paid by the companies, the lowest cost of the medicines produced but only to their own citizens residing in the Region (source Gimbe).
One thing is certain: there is no less philanthropic industry in the world than the pharmaceutical industry (Big Pharma) which is cashing in staggering numbers to the detriment of all the Health Systems in the world, without anyone not only being able to fight it effectively, but, as unfortunately we also saw yesterday evening in Presa Diretta, not even daring to talk about it!
Saving the NHS can still be done, but only if we courageously manage to face the problem of what is necessary financing of the public, supportive and universal NHS: we need Environmental Bioethics (Primary Prevention!), nip undeclared work and tax evasion and Pharmacosophy and Pharmacoeconomics (transforming the drug into an economic resource with an advantage and not just a cost for the NHS), for example by entering in competition or in partnership with private companies and producing drugs to finance and not to make the NHS go bankrupt. Today it would be especially useful in oncology.
When at a trade union table I simply mentioned the problem in the oncological Irccs, emphasizing the need that we should finally decide to enter into competition and not just support the research of private pharmaceutical companies with funds from the public NHS, they looked at me like I was a Martian. Environmental Bioethics and Pharmacosophy: the two essential tools to save the NHS that nobody even wants to hear about. And we just cry without any construct over the dramatic stories of patients in our crumbling NHS.