The Pharmaceutical Journal
Vol 272 No 7301 p678-679
29 May 2004

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World Health Professions Alliance

Consider the value of medicines, not their cost, world health leaders told

From the pharmacy profession’s point of view, a preferred future for health care is one in which developing countries provide people with basic health care and in which developed countries nurture leadership that has the courage to switch from considerations of medicines’ cost to an appreciation of their value. So said Peter Kielgast, immediate past-president of the International Pharmaceutical Federation.

He added that most of the world’s developed countries currently spend nine times as much on doctors and medical interventions than they do on disease prevention and medicines. But the scientific progress related to the sequencing of the human genome would result in new, more targeted medicines becoming available, and spending on pharmaceuticals would likely increase. A better educated and demanding consumer would require access to these new drugs and they would expect the cost to be shared either through insurance or taxes with other members of society. Politicians need to be prepared for that.

Dr Kielgast described how pharmacists’ focus had changed. Pharmacists used to be the professionals who supplied people with medicines. But now the focus had changed from the medicine itself to the medicine user. The change had caused the profession of pharmacy to prosper; the knowledge of pharmacists was, and increasingly is, in demand. The role shift was a success story.

However, if a different yardstick is used, the success is less evident. “The pharmacist is undoubtedly the professional with the most knowledge about pharmaceuticals, their effects and side effects as well as their use. But this knowledge is not passed to the drug user in a a successful way,” said Dr Kielgast. Pharmacists’ competence had been paid for through the sale of medicines, but this was not an efficient way of driving pharmacists’ motivation to educate medicine users.

The competence of pharmacists remains an under-used resource in all health care systems. The physical distribution of medicines no longer requires pharmacists, so what pharmacists must do is make it safe for consumers to use medicines and make sure that medicines are worth the price consumers pay for them. By this he meant that it is pharmacists’ job to ensure that consumers obtain the maximum benefit from treatment.

Turning to the pharmaceutical industry, Dr Kielgast said that there was a lot of focus on dry pipelines and blockbusters losing patents. “Yet the pharmaceutical industry remains one of the most profitable industries and there is every reason to believe that scientific developments will make it possible to treat still more diseases and conditions for which, so far, there is no cure or relief,” he said.

The age of blockbusters is not over, he declared, because the breakthrough for new gene-related, tailor-made treatments has not yet happened. However, politicians need to be prepared for the day when they will have to underwrite the higher drug costs arising from the use of new gene therapies and accept that the industry must remain profitable in order to advance health care.

Politicians need not be alarmed, said Dr Kielgast. “Society can afford it, particularly if we reduce the waste related to wrong use of medicines and the damage resulting from that. This requires therapeutic leadership.”

He mentioned a US Institute of Medicines report which stated that the costs of repairing damage caused by the wrong use of medicines were the same amount as the total drugs bill. “What a waste of resources,” he exclaimed. “And this is the case in highly educated populations. Little is known for populations with a high level of illiteracy, but here a waste of much scarcer resources is even sadder.”

Health professionals and politicians need to think more creatively about equipping patients with the knowledge to use their medicines in a way that will result in saving the money currently spent on repairing drug-induced damage, he said. “Investment in health care and education is investment in prosperity,” he declared.

Dr Kielgast concluded: “It is my preferred future that health care will have a more prominent position in the political hierarchy and that leadership is actively nurtured and not stifled.” He hoped that the spirit of the World Health Professions Alliance would be a role model in that context.

Partnerships can promulgate health and prosperity

Development of partnerships appears to be in vogue as society responds to 21st century health challenges, Thomas Gorrie, corporate officer, Johnson & Johnson, said.

Such partnerships were anticipated 50 years ago in the preamble to World Health Organization’s constitution, where it is stated: “Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.” Appropriately developed, partnerships can promulgate health and prosperity, Mr Gorrie said. Partnerships ought to be based on a foundation of trust with bona fide partners and well-intentioned visions. The best minds in nursing, medicine and pharmacy, along with academics, government officials and those in business and non-governmental organisations, need to engage together in building a new health-competent society — one where a health system, supportive policy environment, innovation and individual knowledge and behaviour are valued and necessary.

Keep the focus on your preferred vision for health

World Health Professions Alliance member organisations need to focus on their preferred futures — their visions — for their profession and for their health systems as a whole, Clement Bezold, president of the Institute for Alternative Futures, said. However, while striving towards their preferred, or visionary, future, it is critical that they have a sense, too, of the plausible, or likely, future. Only with that awareness will organisations be able simultaneously to monitor trends shaping plausible futures and adjust these accordingly to reach their preferred futures.

He told the meeting that the World Health Organization’s “Health for all” strategy was a leading preferred future and that the future would bring significant potential for advances in treatment and prevention of disease. Yet the leading factors shaping health, and particularly disparities in health, will remain at the margins of, or indeed beyond, conventional health care. Examples of such factors are tobacco use and equity of access to medicines.

The WHO statement identifies certain values that it will be necessary to achieve before all have health, Dr Bezold said, and some of these values relate to human rights, the lack of which in certain communities causes health disparities — differences in health that are avoidable and unfair. Reducing and finally eliminating health disparities will ultimately follow historical patterns like the abolition of slavery and apartheid, and the achievement of women’s right, he suggested.

Dr Bezold outlined his preferred future for global health care. He said that health care would increasingly focus on the pre-disease states, encouraging prevention, and would focus more effectively on the major chronic diseases.

Effective treatment of chronic diseases would shift from interventions towards deliberate and personalised prevention. Rather than focus only on treatment, health care providers would focus on diet, activity levels, stress levels, spiritual condition and social contribution, all of which have an effect on health.

His preferred future also includes patients who take responsibility for their own health and whose self-care would be integrated with provider care. He foresees strong patient groups and other forms of advocacy support which would help to develop and apply advances in health care. Such new advances would be applied in the context of behaviour, genomics and the community in which a patient lives.

Concluding, Dr Bezold said that what WHPA member organisations have to do is enhance their members’ ability to anticipate, imagine and create trends in order to achieve their preferred futures for health.

Patients want to be involved in and informed about their own health and health care

Mary Baker, president of the European Parkinson’s Disease Association, told the meeting that the future required that experts — and she meant health professionals and patients — are brought together. And she added that the concept of a world alliance of health professionals, which could have real power, was “marvellous”.

She said that governments are beginning to realise how critical it is for people to become involved in and informed about their own health and health care. Failure to realise this results in considerably higher health care costs, she said.

Mrs Baker acknowledged that patient advocacy groups have little power on their own, and to effect change they need to make strategic alliances with pharmaceutical and biotechnological industries, with health and social care professionals, with academia and with other voluntary organisations. Through such alliances, political leverage can be gained, she said. For example, the European Parkinson’s Disease Association, which she represents, has joined up with the European Federation of Neurological Associations, and now is involved with the European Brain Council, which incorporates even the insurance industry and the media. Through such alliances, patient associations can develop a strong voice and convey a constant message.

She outlined patients’ five principles of care. These are:

· To be referred to a doctor with a real interest in their illness
· To have a better telling of the diagnosis
· To have an early rather than late referral to the multidisciplinary team
· To have continuity of care
· To participate in the management of their illness

Mrs Baker emphasised that there needs to be investment to help clinicians master skills, knowledge and attitudes that will enable them to be more patient-focused. Equally, there must be investment to help society develop more resourceful patients and enable them to ask the right questions. “One without the other will be wasted effort,” she concluded.

Health professionals must work together

All health professionals must work together to lobby for patients and for sufficient funding for health care around the world, Yoram Blachar, chairman of the World Medical Association, told the meeting. “We must strive to implement basic values such as solidarity, equity and accessibility,” he declared.

On AIDS, in particular, he said that it was health professionals’ duty and obligation to support the development and implementation of a comprehensive, effective, efficient, evidence-based and financially sound prevention and care strategy aimed at reversing the dramatic effects of the epidemic in the most affected countries. He added: “This must also include careful attention to human resources planning as we face the reality in which doctors, nurses and pharmacists are among the infected and affected.”

Dr Blachar said that the buzzword in medicine today is “prevention”. Health care systems and those who run them are realising that prevention and early detection can save lives and health care costs, and the combined efforts of the various health care professionals are key in this area. He said: “We can and should all work together to combat the various public health issues that we are facing, such as tobacco and communicable diseases, as well as depression, hypertension and diabetes. When diseases cross borders much faster than ever before, as is the case with SARS, tuberculosis and HIV, bridges between health professions, organisations and countries are essential.”

Dr Blachar foresaw a future of teamwork, trust, wellness and better communication. He said that for patients to receive optimum care, no link in the health care system chain can be absent and no link can replace the other.