NOTICE: Penny Tucker worries that there are “miracle drugs and biologics that have turned many conditions from a death sentence into a surmountable challenge” and blames Pharmac for the lack of supply of these. She is disappointed that Pharmac’s budget is not part of the review and criticizes its bureaucracy.
I admit that she has not declared any involvement in the pharmaceutical industry, but her arguments are much the same as those of Graeme Jarvis of Medicines New Zealand. It makes no mention of the role that the pharmaceutical industry plays in the difficulty of financing them.
The title “Pharmac works well. Unless you are sick ”is seriously misleading. The opposite is true for the vast majority of New Zealanders, who received pharmaceuticals worth $ 1.04 billion last year.
Of course, some people have missed new treatments. This is true for all aspects of the health system; people miss GP care, emergency care, outpatient appointments and elective surgery because we can’t provide everything everyone wants. We must prioritize our spending to get the best result for the greatest number. This is Pharmac’s job with the pharmaceutical budget.
* Pharmac does a great job, but loses the PR battle hands down
* Pharmac works well. Unless you are sick
* Pharmac magazine misses a political elephant in the room
It is wrong to blame Pharmac for its budget. It does not set its own budget; which is set by the government. The government faces many competing interests in how to spend our money to improve health. Personally, I would be in favor of increasing nurses’ salaries, ensuring a reliable supply of clean water and sewage disposal, and allowing the poorest in our community to have stable housing. We know that spending on public health priorities has a much bigger effect on health than most therapeutic products (the obvious exception being the Covid-19 vaccine).
I would be horrified if we got rid of the Pharmac bureaucracy. The United States has a much lighter drug bureaucracy. The most striking example is that of the more than 400,000 people who have died as a result of the fraudulent marketing of Oxycontin by Purdue Pharma. They demanded evidence that did not exist to say that it was not addicting. They spent eight times as much as the gun lobby to influence politicians (US $ 880 million in nine years); they have manipulated all levels of the system.
American doctors still prescribe 100 times more opioid drugs than New Zealand doctors because of this influence. New Zealand fortunately had a “bureaucracy” that demanded adequate evidence for any claims, noted that it was little different from other (cheaper) opiates, and provided information to doctors to resist prescribing pressures.
The other extreme example is Tamiflu, which was purchased in large quantities by governments around the world during the H1N1 flu epidemic. Roche has been warned against false advertising. He claimed the drug was able to prevent hospitalizations and the side effects of the flu, but had no supporting evidence and was warned by the US Federal Drug Administration. Strange that a drug that brought in billions of dollars at the time is no longer used in a meaningful way. It was not the magic cure that was being touted.
There is a long list of legal settlements amounting to billions of dollars as a result of fraudulent behavior by pharmaceutical companies. The industry has proven to be untrustworthy and interested primarily in the bottom line. Pharmac has been successful in controlling some of the worst behaviors in New Zealand and limiting price increases.
It’s a difficult job to assess the evidence for a drug’s effectiveness and harm, especially when studies funded by industry have significantly more positive results than studies by independent researchers. There are well-documented issues of publication bias (where only positive studies are published and negative studies are hidden).
Evaluating the cost / benefit of a drug is even more difficult, and yet it must be done because it is the only way to make reasonable choices about what we will fund and what we will not. If we could trust the information that companies provide, it might be an easier job, but their past behavior means we can’t.
Tucker’s spending analysis is simplistic. Pharmac’s annual report details expenses; it is not hidden. International comparisons are problematic. What is important is not the total budget, but the value of the treatment purchased. In most markets, there is a much higher proportion of brand-name drugs purchased than generics, which dramatically increases the bill without changing the level of care.
Pharmac is realizing significant savings through its benchmarking and negotiation pricing processes, totaling $ 74 million last year. Spending in other countries does not cover the entire population with large user fees (for example, in the United States for people without insurance). The fact that we spend less than other countries does not give any information on the efficiency with which this money is spent.
There is no doubt that there are many new drugs out there, and some of them are very effective for particular conditions. We cannot all afford this, and we may wish to spend our money on other priorities. Pharmac is only one player in this field. The government sets the budget and the pharmaceutical industry benefits from it. All three actors must be taken into account in discussions on access to pharmaceuticals.
* Ben Gray, former general practitioner, is associate professor at Department of Primary Health Care and General Medicine at the University of Otago, Wellington.