The drug business has in common some dysfunctions, such as access to information for precriptors and even for decision-makers. But the announced reforms ignore it.
Yesterday the Mediator, today Diane 35, tomorrow, 3 pillse and 4e generations, each scandal on drugs denounces, behind the scenes, the same issues in our health system. Instead of responding usefully, governments of all stripes choose the register of emotion and the scapegoat. The withdrawal of a molecule, reports hastily ordered from health agencies who step on their toes, a vague questioning of this or that link in the chain, and here is the image of a firm and taking minister the measure of the situation.
If this posture temporarily calms the anxiety of public opinion, it in no way solves the problem posed by the said scandal. On the contrary, concerning the suspension of Diane 35, several specialists blame the government for this decision taken under media pressure and which risks embarrassing them in the prescription protocols. The European Medicines Agency has repeatedly questioned France’s requests for the re-evaluation of drugs when no new study justifies it. And Michèle Delaunay, dermato-oncologist, commented a few days ago on the withdrawal of Diane 35 by affirming; “If we banned all the drugs that were the cause in 20 years of five accidents, our pharmacopoeia would not be very broad.” And the Minister for the Elderly added, “you have to know how to keep reason”.
As in the Mediator case, that of oral contraceptives points to the inappropriate prescriptions of doctors. By publishing its list of unnecessary drugs, the Prescrire magazine can accuse the industry or the agencies, it is forgetting the responsibility of professionals. French doctors are no better or worse than their European counterparts, but they often prescribe outside of the recommendations without taking into account the warnings. Vice-chairman of the Amm commission recalled in an interview with why actor that the English have a repository of the correct use of the drug “a small book, pocket size type”, updated every year. and which recalls all the useful information on medicines. The English have just published the 64th edition while Professor Jean-François Bergmann continues to talk about it in conferences.
In the aftermath of the Mediator affair, the public authorities excluded the pharmaceutical industry from continuing education for doctors, but did they replace it with another system? This practical CME and the quick and easy availability of drug information would however be the best guarantees of a correct and appropriate prescription.
Because information seems to be the crux of the matter. Recently, associations, doctors and economists have called for greater transparency and easy access to health insurance databases. For years, its leaders have sat on this information like Harpagon on its pile of gold. These figures would have enabled decision-makers to be alerted to prescriptions other than Amm de Diane 35 or to abuses concerning new generation pills. Yet none of these cases has changed the game. It is true that a sharing of information induces a sharing of power. But it is undoubtedly easier to denounce the abuses of doctors, industry, patients or even the system as a whole than to correct one’s own mistakes.
So as Pr Bernard Begaud, pharmacologist recently predicted, “The next drug crisis is already foreseeable”.
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