Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 280

 

EVENT: The humanitarian #MeToo moment – where do we go from here? 

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Aid and Migration: externalisation of Europe’s responsibilities – New Report

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TB, LAW, HUMAN RIGHTS AND GENDER EQUALITY 

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James Griffin, Dana-Farber Cancer Institute and Novartis failure to disclose NIH funding for patents on leukemia drug midostaurin (Trade name Rydapt)

Strengthening systems to prevent antimicrobial resistance: Results from the West Bank, Uganda, and Georgia Wednesday, March 28th, 9:00-10:00 am EST (Washington, D.C.) 

The fight against antibiotic resistance must not be confined to the rich world

USAID ASSIST Legacy Webinar Series 

Call for papers for new series in Harm Reduction Journal: The state of harm reduction in Eastern Europe and Central Asia 

PROGRAMME TO ELIMINATE HEPATITIS C IN GEORGIA NEEDS TO INCLUDE AN HIV TEST 

Scientists warn 90% of hepatitis B sufferers remain unaware of silent killer 

UNAIDS: All-staff update on 25th CROI (2018) 21 March 2018 

India’s neglected tropical diseases 

Are the London Declaration’s 2020 goals sufficient to control Chagas disease?: Modeling scenarios for the Yucatan Peninsula 

WHO:  “Wanted: Leaders for a TB-free world” 

Governments still not doing enough to scale up access to newer TB drugs 

Time for high-burden countries to lead the tuberculosis research agenda 

A Mighty Grant: With Modest Support, This Environmental Group Achieved Big Changes 

Does Deforestation Increase Malaria Prevalence? Evidence from Satellite Data and Health Surveys – Working Paper 480 

Foresters too silent on tech advances 

The Future of Public Development Banks: questions and answers from the webinar 

Ethiopia’s HRH Strategy: Will the ‘flooding’ strategy go down the drain? 

African Leaders Launch Continental Free Trade Area 

Africa free-trade treaty now set for Parliament approval 

Food insecurity on the rise 

Conflicts Force Up Global Hunger Levels 

 

 

 

 

 

 

 

 

 

 

 

 

 

Concerning the effect of out-of-pocket expenditures on poverty, PEAH had the pleasure to interview Mr. Saliou Diallo as a PhD candidate in Development Economics at the Centre for Studies and Research on International Development (CERDI),University of Clermont-Auvergne, Clermont-Ferrand,France

By Daniele Dionisio

PEAH – Policies for Equitable Access to Health

INTERVIEW

Saliou Diallo

PHD(c) in Development Economics, CERDI, France

 PEAH had the pleasure to interview Mr. Saliou Diallo as a PhD candidate in Development Economics, Centre for Studies and Research on International Development (CERDI). Mr. Diallo is  currently working on the results of fiscal capacity on the progress towards universal health coverage in low- and middle income countries, with a special focus on the effect of out-of -pocket expenditures on poverty.

 

– PEAH: Mr. Diallo, as per your data, what about the figures currently available on public fund health expenditures per capita worldwide and in middle- and low income countries, respectively?

–Saliou Diallo:  In 2014, as sample year, public health expenditures per capita represented $762 worldwide. In middle income and low-income countries, public health expenditures per capita represented respectively $300 and $38. In contrast, public health expenditures per capita represented $3242, 85 times higher than low-income countries.

–PEAH: What ‘out-of-pocket payment’ term does refer to?

–Saliou Diallo:  Out-of-pocket payments (OOPs) are defined as direct payments made by individuals to health care providers at the time of service use whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. It is a part of private health expenditure.

– PEAH: As for out-of-pocket payments for health, please detail about their percentages in low- and middle income countries and the relevant disparities among some equivalent level countries?

–Saliou Diallo:  In 2014, the percentage of health expenditures covered by out-of-pocket payments represented 36.2% in low and middle-income countries. There are many disparities among countries. While in Cuba and Rwanda, out-of-pocket expenditures on total health expenditures represented respectively 4.4% and 28.1% in 2014. In Nigeria, out-of-pocket spending covered 71.7% of total health expenditures during the same year.

– PEAH: Tell us now, please, the effects of health-related out-of-pocket payments on the household impoverishment in Asian and African resource-limited settings.

–Saliou Diallo:  Out-of-pocket payments could have many consequences for households, particularly for the Poor. One of them is to jeopardize access to and the use of healthcare. Van Doorslaer et al., (2006) explored the effect of out-of-pocket payments on poverty in eleven Asian countries. They found that in some countries such as Vietnam and Bangladesh, in which health system is majorly financed by out-of-pocket expenditures, the estimated poverty is higher than the other countries, ranging from an additional 1.2% of the population in Vietnam and 3.8% in Bangladesh. In South-Eastern Nigeria, Onah and Govender, (2014) showed that on average, households spent $33 monthly on health care. That represents 12.1% of household monthly expenditures.

– PEAH: What time dimension and how many low- and middle-income countries does your research engagement cover?

 –Saliou Diallo:  Our research covers 66 low- and middle-income countries over the period 1996- 2012.

– PEAH: Which poverty thresholds are to be considered?

 –Saliou Diallo:  We consider two thresholds of poverty: $1.90 and $3.10 a day (Purchasing power parity).

– PEAH: Owing to the fact that the major part of population in low- and middle-income countries works in the agricultural sector, to what extent out-of-pocket payments do worsen the current neo-liberal policies harmful effects on food access in the same countries?

–Saliou Diallo:  Agricultural sector still employs over two thirds of the labor force in low and middle income countries. Although neoliberalism and globalization offer opportunities for access to major markets, agricultural sector in low and middle income countries does not fully benefit from it because of structural problems. The resultant increased competition and the less competitive agricultural sector particularly in low income countries has the effect of reducing the income of farmers who have to bear the burden of heavy health expenditures. That’s leading them to poverty.

– PEAH: Evidences from literature and your own research suggest that out-of-pocket payments for health should be reduced, mostly for the poorest. What does this imply for decision makers policies and governments directions?

–Saliou Diallo:  Firstly, government should increase public health expenditures. The threshold of 15% of total health government expenditures (Abuja declaration: engagement to set a target of allocating at least 15% of their annual budget to improve the health sector) is a first step. Secondly, low- and middle income countries should implement reforms to progress towards universal health coverage; wich is the main powerful way to reduce consequently the effect of out-of pocket expenditures on poverty. Finally, we found that government should develop initiatives that can improve employment of very poor people.

– PEAH: Thank you Mr. Diallo for your insightful answers.

………………………………………

Quoted in Interview:

VAN DOORSLAER, E., O. O’DONNELL, R. P. RANNAN-ELIYA, A. SOMANATHAN, R. ADHIKARI, C. C. GARG, D. HARBIANTO, A. N. HERRIN, M. N. HUQ, IBRAGIMOVA, ET AL. (2006): “Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data,” The lancet, 368(9544), 1357–1364.

ONAH, M. N., AND V. GOVENDER (2014): “Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective,” PLoS One, 9(4), e93887.

 

 

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 279

 

BMJ: Call for papers—the Alma Ata Declaration at 40: reflections on primary healthcare in a new era 

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FNOMCeO: Dottore, ma è vero che….? Cerca le risposte alle domande più frequenti sulla salute 

MEPs call to raise awareness on benefits of vaccines 

‘Bridging the Gaps in Clinical Guideline to Care in Pregnancy for Women Using Psychoactive Substances’ by Grana Ziia 

This Health Funder Has Joined the Fight Against Opioids. Where Is Everyone Else? 

‘Opium and its Association with Cardio-Vascular Disease’ by Junior Bazile 

Antibiotics Are Often Used At The End Of Life, But At What Cost? 

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Taking a space-age approach to food security 

 

 

 

 

 

 

 

 

The role of the Ministries of Health or Departments of Health in countries where opiates use is prevalent is crucial to establish health campaigns that can address adequately the issue of opiate use and its effects on the heart

By Junior Bazile MD, MPH

Program Director at New York Harm Reduction Educators

Research Consultant and Online Community Moderator at Global Health Delivery Project, Harvard University

Opium and its Association with Cardio-Vascular Disease

 

The opioid epidemic that is established in the United States and part of Europe has already claimed hundreds of thousands of lives. According to the CDC, opioids -prescription and illicit- are the main drivers of drug overdose death. In the United States, opioids were involved in 42, 249 deaths in 2016 and opioid overdose were 5 times higher in 2016 than in 1999[1].

Opium is a powerful drug, also called opioid that is used as medicine and also for recreational purpose. Morphine for instance is a type of opioid that is used in medical settings. Heroin is another type of opioids that is mostly used recreationally and most of the times heroin is used intravenously by intravenous (IV) drug users.

For thousands of years, opium has been called balm. The analgesic effect of morphine, the main ingredient of opium, explains this traditional belief to some extent but only justifies limited use of opium. On the other hand, patients have attained a gradual awareness of pharmaceutical products that contain morphine and are widely used in cardiac settings. Seemingly, these have led to a misunderstanding in the public that the analgesic effect can be generalized to other situations such as ischemic heart diseases (IHD) and their risk factors, even in the absence of pain[2].  Added to that is the previously mentioned recreational use which makes opium dependency a high possibility.

The opioids have the capacity to suppress the respiratory system by acting on receptors located in the brain and block the respiratory center that is located in the medulla oblongata at the base of the brain. That process causes death very quickly in an individual using opioids. Until recent years primary investigation of opioids such as morphine and its derivatives has been focused on their effects on the central nervous system (CNS) thoroughly. However it has been determined that opioids have effects on various physiological systems.

Besides the effects of opium or opioids on the brain leading to their deleterious impact on the respiratory system, there are numerous research studies showing their effects on the cardiovascular system as well. Those studies show that opioids have the capacity to cause coronary artery disease (CAD) and ischemic heart disease (IHD)[3-5].

Opium or opiates are a variable mixture of substances that extensively impact the cardiovascular system. Opium addiction is by far more prevalent in patients with ischemic heart disease (IHD)[2]. They impact the heart in such a way that can lead to blatant myocardial infarction, a condition in which the heart muscle doesn’t receive enough blood to supply it with enough oxygen so that it can continue with its contraction capacity.

Smoking and opiates abuse are very often associated and drug users hardly quit smoking. That put them at risk for more cardiovascular events related to opiates use. In the general public there is a belief that opium has beneficial effect particularly on the heart. That will tend to bring more people to use opium. Some studies have shown that long-term opium use has protective effect on the heart and opium is particularly effective on post-acute myocardial infarction (AMI)[6-8]. However, those studies had serious limitations that should not be ignored. Their sample sizes (the number of people enrolled in the studies) were very small and the mechanism of the protective effect of opium that was offered was controversial. Besides that, some of them only utilize animal data from pathologic laboratory.

Opiates have been shown to cause decreases in plasma testosterone levels by inhibiting the secretion of gonadotropin releasing hormone (GnRH). Plasma testosterone level has a significant inverse correlation with the extent of CAD. Increases in plasma levels of adrenalin, noradrenalin, corticosterone, and glucagon are among the other endocrine effects of this family of drugs. These substances have a depressing effect on the autonomic nervous system, resulting in decreased enkephalin production in cardiomyocytes.

Based on several studies it is clear that the prolonged use of opium has deleterious effect on the heart, having the potential to cause CAD or IHD. It is therefore important for Policy Makers, Program Director and Managers in hospitals, and all health professionals to keep that in mind in designing programs so that the education component can be strong enough to convince drug users and any other individual abusing of opium to change their behaviors. The role of the Ministries of Health or Departments of Health in countries where opiates use is prevalent is  crucial to establish health campaigns that can address adequately the issue of opiate use and its effects on the heart.

 

References

1) Center for Disease Control and Prevention. Drug overdose death data.  (March 9, 2018). Retrieved from https://www.cdc.gov/drugoverdose/data/statedeaths.html

2) Roohafza HR, Talaei M, Sadeghi M, Haghani P, Shokouh P, Sarrafzadegan N. Opium decreases the age at myocardial infarction and sudden cardiac death: A long- and short-term outcome evaluation. Arch Iran Med. 2013; 16(3): 154 – 160.

3) Masoudkabir F, Sarrafzadegan N, Eisenberg MJ. Effects of opium consumption on cardiometabolic diseases. Nat Rev Cardiol 2013; 10(2):733-40

4) Khademi H, Malekzadeh R, Pourshams A, et al. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50,000 adults in Iran. BMJ 2012; 17(344).

5) Sadeghian S, Graili P, Salarifar M, et al. Opium consumption in men and diabetes mellitus in women are the most important risk factors of premature coronary artery disease in Iran. Int J Cardiol 2010;141(1):116-8

6) Marmor M, Penn A, Widmer K, Levin RI, Maslansky R. Coronary artery disease and opioid use. Am J Cardiol. 2004; 93(10): 1295 – 1297

7) Peart JN, Gross GJ. Chronic exposure to morphine produces a marked cardioprotective phenotype in aged mouse hearts. Exp Gerontol. 2004; 39(7): 1021 – 1026

8) Rajabizade G, Ramazani MA, Shakibi M. Prevalence of opium addiction in Iranian drivers 2001-2003. Journal of Medical Sciences. 2004; 4(3): 210 – 213.

 

 

A report on non-discriminatory, good results achieved by AFEW-Kyrgyzstan, and PF Asteria partner organization, following Ministry of Health approval in January 2017, with mandatory use for doctors, of the clinical guideline “Care in pregnancy, childbirth and the puerperium for women who use psychoactive substances” 

By Grana Ziia

AFEW-Kyrgyzstan

Bridging the Gaps in Clinical Guideline to Care in Pregnancy for Women Using Psychoactive Substances

Republished from AFEW International March 1, 2018 http://www.afew.org/headlines/btg-guideline-kz-eng/

 

The estimate number of people who use injected drugs (PWID) in Kyrgyzstan is about 25,000 people. Many of these people are women. Such is the data from the research that was conducted within the framework of the Global Fund’s grant in 2013.

Applying  Recommendations in Practice

In 2016, Public Fund (PF) Asteria, a community based organisation that protects rights of women who use drugs in Kyrgyzstan, applied to AFEW-Kyrgyzstan seeking for a help in developing a clinical guideline to care in pregnancy for women who use drugs. Within the framework of the project Bridging the Gaps: health and rights for key populations, AFEW-Kyrgyzstan decided to support this initiative as there were no modern standards for working with women who use drugs in the country before. A working group that included an expert in narcology, an obstetrician-gynecologist, an expert in evidence-based medicine, and a representative of the community of women who use drugs was created. In January 2017, the clinical guideline “Care in pregnancy, childbirth and the puerperium for women who use psychoactive substances” was approved by the order of the Ministry of Health and became mandatory for doctors’ use.

All the regions of Kyrgyzstan already received the developed clinical guideline

“When the guideline was approved, we realized that it is not enough to simply distribute it among the doctors. It was necessary to organize a comprehensive training for the family doctors, obstetrician-gynecologists and other specialists so that they could not only apply the developed recommendations in practice, but also share their experience with their colleagues,” said Chinara Imankulova, project manager of the Bridging the Gaps: health and rights of key populations at AFEW-Kyrgyzstan.

In April 2017, trainings were organized for the teachers of Kyrgyz State Medical Institute for postgraduate students. The manuals for teachers with presentations have been developed so that in the future trained teachers could deliver reliable information to the course participants. This approach gives an opportunity to train all healthcare professionals in the country and provides them with an access to the protocol.

In August 2017, trainings were offered to obstetrician-gynecologists of the centers of family medicine and obstetrical institutions. During the trainings, specialists got acquainted with the latest research in this field, studied the peculiarities of pregnancy, prenatal and postnatal period of women, who use drugs, as well as ways to avoid or minimize the risks of drug exposure to women and children.

“Two or three years ago, when our pregnant women who use drugs visited doctors, they were afraid that doctors would force them to have an abortion. In September 2017, our client Victoria, who at that time was on methadone therapy, visited the obstetrician-gynecologist. Victoria gave birth to a healthy girl, and doctors treated Victoria and her child very well. Moreover, the doctor even helped Victoria to get methadone so she could spend enough time in the hospital for rehabilitation after the childbirth,” said Tatiana Musagalieva, a representative of PF Asteria.

Women Should Not Be Discriminated

During the trainings, 100 specialists who are working in the republic of Kyrgyzstan were trained. Doctors from the regional centers were also invited for the training. It is very important to provide access to quality medical services for women who use drugs in the rural areas. Doctors also learned to get rid of their stigma towards women who use drugs and always treat them with respect. A class on stigma and discrimination was taught by women from the community of drug users. They told the participants of the training their stories, talked about how difficult it was when doctors refused to treat them or insulted them. This part was useful in reducing stigma and discrimination among doctors, in showing them that women who use drugs are just like the others.

“Before the training I met several pregnant women who use drugs. To be honest, I was not sure that they could give birth to healthy children. Having received the clinical protocol, and with the knowledge I have got in the training, I realized that these women should not be discriminated. I learned about scientific recommendations for conducting pregnancy in the situations that cannot do harm to either mother or child. This helped me a lot,” said the participant of the training, obstetrician-gynecologist Kaliyeva Burul.

All the regions of the republic already received the developed clinical guideline. Doctors who have been trained, share their experiences with their colleagues and help women who use drugs to safely plan their pregnancies and give births to healthy children. AFEW-Kyrgyzstan continues to monitor the work of specialists who have been trained, and monitors if all health specialists have access to the guideline. In the future, AFEW-Kyrgyzstan will continue to work on improving the quality of life of people who use drugs, and will monitor the usage of this protocol by doctors.

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 278

 

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Corruption is 'the abuse of entrusted power for private gain'[i]. Transparency International estimates a loss of 15 billion € per year due to corruption practices[ii] bound up with medical corruption in Germany alone. This definition includes many different kinds of corruption in health care and medicine. It is understood as a global phenomenon and exists all over the world including Germany[iii]

By Christiane Fisher MD MPH PhD

Medical Director, No Free Lunch, Germany MEZIS

Member of the German Ethics Council

fischer@mezis.de

Corrupt Medical Practices in Germany

 

In the developing world corruption is felt at every moment in life.  Often, a prerequisite to good, or even any care is a bribe.  In industrialized countries such as Germany such open forms of corruption are not often seen. As insurance coverage is compulsory and therefore close to 100% (87.5% are publicly, 12.5% privately insured), out of pocket payment for healthcare is rare. This may be why corruption practices here are rather subtle and hidden.  Nevertheless, corruption creates major problems for the healthcare system, for patients and for society.  This article will highlight some corruption practices in Germany.

Illegal or illegitim

Doctors work in Germany either in hospitals or in medical practices. Outpatients are commonly treated in a medical practice, which is often the first place patients go to for care. A medical practice usually has a single or a few doctors of the same post-graduation specialization: such as primary care physicians, pediatricians, surgeons or radiologists.

Corruption practices may involve a direct and explicit money flow or bribes. Since 2015 this is banned in Germany for all types of doctors, pharmacists and physiotherapists under the criminal code (§299 and b StGB).  As in 87.5% of the cases public insurances (and in 12.5 % private insurances) pay, how do corruption practices still take place? Examples of these corruption practices are allocations given by fellow doctors to specific hospitals or medical supply stores or other care for referring patients to them. Bussmann analyses this corruptive practice as very common. He found out that even though most doctors know that these allocations are illegal, 40% see the rule only as voluntary to follow.[iv]

In addition to these illegal corruption practices there are also illegitim aspects of corruption, such as the acceptance of benefits or the granting of undue advantages which penetrate medical practice. As they won’t be made illegal they will continue to exist. These illegitim faces of corruption involve implicit undue advantages aiming to influence physicians’ prescribing behavior, such as gifts, inappropriate remuneration for speakers or food invitations.

How to increase the market share of “me-too” drugs?

The most effective (and corruptible) instruments to change prescribing patterns are pharmaceutical representatives who promote pseudo-innovative medicines which are more expensive but offer no therapeutic progress compared to the old therapeutic standard. Boundaries between information and promotion are intentionally blurred, and pseudo-innovative drugs are promoted with pseudo-information. Through this misleading health information prescribing patterns are changed and so important health resources are wasted. According to estimates 15,000 pharmaceutical representatives visit 20 million practices and hospitals in Germany every year, advertise their products, bring their gifts and remunerate doctors for post marketing surveillance studies (PMSS). They treat doctors to lunch or dinner and pay participation and travel fees for Continuing Medical Education programmes (CMEs).[v]

One example of such a pseudo-innovative drug is Inegy® (ezetimib&simvastatin fixed dose combination), a medicine to treat familiar hypercholesterolemia. However, Kastelein et al found out that the fixed dose combination of ezetimib & simvastatin does not result in a therapeutic progress, as compared with simvastatin alone.[vi] The price difference by contrast is remarkable, the pseudo-innovative Inegy® is 14 times costlier. While the price for 100 tablets of Inegy® in Germany is 224.65 €, 100 tablets of the generic version of the at least equally effective simvastatin (20 mg) are available for 18.03 €.

Drug promotion

In Germany direct to consumer advertisement (DTCA) of prescription drugs is illegal and pharmacies dispense prescription drugs only with a doctor’s prescription. As frequent use of pseudo-innovative information / promotion from pharmaceutical representatives is associated with increased prescribing costs[vii], the role of pharmaceutical representatives in drug promotion is most relevant for the marketing strategy of the pharmaceutical industry.  Logically they see it as a major problem that nearly half of prescribers restrict pharmaceutical representatives’ access.[viii].  In Germany alone 77% (n=160) of doctors are seen weekly, 19% (n=39) even daily  by  pharmaceutical representatives.[ix]

Post-marketing surveys as a marketing instrument

In theory, post-marketing surveys are observational studies meant to systematically collect knowledge about safety, effectiveness, benefits and adverse side-effects of newly registered drugs. However the reality is different. One corruptive strategy in Germany to change prescription behavior with post marketing studies are ‘Anwendungsbeobachtungen’. They are company run post marketing surveys. However in reality they are more an alternate drug pricing mechanism designed to increase the market share by creating awareness for new and expensive drugs and therefore to substitute the newer, more expensive drug for a cheaper,  equally effective treatment. Beatrice et al found out that only 58 % of 330, 000 Anwendungsbeobachtungen were performed with medicines that had been authorized within the past 5 years; 68 % of the drugs in the  Anwendungsbeobachtungen were older than 5 years, and 19 % even older than 19 years[x]. As Transparency International examined, between 2008-2010 half a million patients and 126,764 doctors participated, costs were assessed half a million € per ‘Anwendungsbeobachtung’, each doctor was paid in average 19.000 €.[xi]

Drug samples influence prescribing patterns

The same is the case for drug samples. Doctors with access to drug samples chose unadvertised drugs significantly fewer times than physicians without access to samples, as Adair and Holmgren have shown. Therefore the influence of drug samples on prescribing patterns needs to be interpreted as part of this biased information and therefore as a corruptible instrument too.[xii]

How continuing medical education programmes are misused

As for the continuing medical education (CME) programmes for doctors that are run or sponsored by pharmaceutical companies, MEZIS estimates that in the majority of cases companies ensure that the “right” topics are covered aiming also to use CMEs to change prescribing patterns. Medical speakers often receive inappropriate remuneration. Some even have their slides provided by sponsors.

Why do doctors attend these biased CME programmes?  Participating doctors usually pay a fee for producer-independent CMEs, and pay for their own travel and food. However, in company-oriented CMEs doctors are treated to lunch or dinner and their participation and travel fees are paid for by the company. Unsurprisingly, advertising for costlier, pseudoinnovative drugs replaces objective information.  To fund attending doctors more than travel costs and conference fees is not in concordance with §32 of the German Medical Association’s Professional Code of Conduct [xiii];  nevertheless, it is done rather regularly.

An ethical medicine is possible

Changes in practice and policy include an increase of transparency, such as the US Physicians Payment Sunshine Act [xiv], and access to independent information and independent doctors’ initiatives, such as No Free Lunch Germany (MEZIS).

The aim of MEZIS is to tackle corruption practices in Germany:

• MEZIS fights the ubiquitous influence and unwarranted power of the pharmaceutical industry in healthcare. MEZIS aims not to welcome pharmaceutical representatives nor gifts in their hospitals and practices, and does not use samples.
• MEZIS raises awareness among fellow doctors and medical students that accepting pens, food, trial sponsorship, travel expenses and remuneration for post marketing surveillance studies (PMSS) makes one’s prescribing habits vulnerable to influence.
• MEZIS demands a clear prohibition of influencing and corruption in the regulations of medical professionals.
• MEZIS promotes producer-independent information and Continuing Medical Education programmes (CMEs) as well as medical software that is free from advertising. The medical chamber of Berlin has withdrawn CME points for an industry sponsored training programme.
• MEZIS advocates to ban corruption practices through the criminal code. Our advisory opinion is merged into the draft law.
• MEZIS is part of the worldwide “No free lunch”- network. This shows that an ethical medicine is possible, which builds on a trustful, equitable and healthy relationship between doctors and patients.

 

References

[i]             Transparency International. FAQs on corruption [Internet]. 2013 [cited 2018 March 8].

[ii]           Transparency International. Transparenzmängel, Korruption und Betrug im deutschen Gesundheitswesen – Kontrolle und Prävention als gesellschaftliche Aufgabe. 2008, S. 5.  [cited 2018 March 8].

[iii]          Fischer C. Corruption in healthcare – a problem in Germany, too. Indian Journal of Medical Ethics. 2014;11(2).  [cited 2018 March 8].

[iv]          Bussman KD.  Improper collaboration in health care by “assignment for consideration”. Martin-Luther-University-Halle-Wittenberg: Economy Crime and Research Centre; Berlin. 2012. German.

[v]     [cited 2018 March]. Available from:www.mezis.de

[vi]          Kastelein JJ, Akdim F, Stroes ES, Zwinderman AH, Bots ML, Stalenhoef AF et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008 Apr 3;358(14):1431-43. [cited 2018 March 8].

[vii]          Caudill TS, Johnson MS, Rich EC, McKinney WP. Physicians, pharmaceutical sales representatives, and the cost of prescribing. Arch of Fam Med. 1996;5:201-6.

[viii]         Staton T. How can pharma reps score face time with doctors? [Internet]. Fierce Pharma. 2013 Aug 13 [cited 2018 March 8].

[ix]    Lieb K, Brandtönies S. A Survey of German Physicians in Private Practice About Contacts with Pharmaceutical Sales Representatives, Dtsch Arztebl Int 2010; 107(22): 392-8. [cited 2018 March 8].

[x]        Beatrice K, von Jeinsen G, Sudhop T. A 1-year cross-sectional analysis of non-interventional post-marketing study protocols submitted to the German Federal Institute for Drugs and Medical Devices (BfArM). Eur J Clin Pharmacol. 2013 Jul; 69(7): 1453–66.

[xi]          Transparency International. Forschung oder Korruption? Ludwig Boltzmann Institut. Newsletter Feb 2015 Cr. 134 Forschung oder Korruption? [cited 2018 March 8]

[xii]               Adair RF,A-t. Holmgren LR. Do drug samples influence resident prescribing behavior? A randomized trial. Am J Med. 2005 Aug;118(8):881-4.

[xiii]   Medical law: (Muster-) Berufsordnung für die in Deutschland tätigen Ärztinnen und Ärzte (Stand 2011). – MBO-Ä 1997 in der Fassung der Beschlüsse des 114. Deutschen Ärztetages 2011 in Kiel [(Model) Code of Conduct for doctors working in Germany (as of 2011)-MBO-A 1997- as amended by resolutions of 114 German Doctors’ Day 2011 in Kiel] [Internet]. 2013 Jan 29; [cited 2015 Feb 1]. [cited 2018 March 8].

[xiv]   Library of Congress (Thomas.gov).   Physician Payments Sunshine Act of 2009.  111th Congress (2009-2010) Senate bill.301.  [cited 2018 March 8].

A forward-looking,  balanced analysis, with insightful suggestions for solution, over the impending threats and gaps still jeopardizing non-discriminatory access to global health in Italy

By  Daniele Dionisio

PEAH – Policies for Equitable Access to Health

Review

LA SALUTE SOSTENIBILE

Authored by Marco Geddes da Filicaia*

 Il Pensiero Scientifico Editore, 2018

Brochure

 

This book represents a convincing attempt to put clarity on the current debate whether health sector universal and equitable access in Italy should be guaranteed by (and mostly depend on) public financing only or, rather, a combined approach based on public funding and private assurance systems.

The debate entails some inherent questions: Is the growing trend of public health spending in Italy unavoidable in the long run? Is a combined public/private system expected (and proved) to work better in terms of effectiveness, efficacy and equity?

The introduction and the eleven chapters of the book are like-minded and uniformly structured in their will to provide a basis for reflection and key take-home messages. To this aim, tables, boxes and figures are included as instrumental in enhancing clarity while adding building block information for the sake of readers – be they citizens, students, stakeholders, politicians or advocates.

The first section of the book analyses the Italian expenditure for health (in comparison with other countries) and its future projections, and reports around the reasons and size of national health cuts in funding. Without forgetting the underlying realities (meaning the interests of involved parties) pushing towards private assurance solutions.

The second section turns the spotlight on how to keep up national health service sustainability in the future, where some recipes are suggested for the accountable leaderships. These encompass health spending containment strategies based on avoiding waste, putting a transparent drug price control in motion, reallocating investments from poorly effective to valuable ones, and improving population health through reinforcing all-kind prevention measures. Recipes also include pushing for a coordinated response to fight corruption (while refraining from being caught with corporate holdings in a circle of mutually reinforcing political and commercial interests over public health concerns).

So compounded, the book allows the readers to understand (while offering itself explanation of) the reasons behind a host of issues accounting for the drift towards private health financing options as part of unbridled neo-liberal policies deceptively meant as the driver for economic prosperity.

No wonder that ingrained neoliberal globalization underpinning unfettered trade liberalization (meaning collusion between national-transnational corporations and their political counterparts) is currently responsible for the social inequities and health worsening worldwide.

Italy is no exception to the rule if we have to accept, as maintained by AE Byrn, Y Pillay and TH Holtz in their Textbook of Global Health (2017 edition, Oxford University press), that ‘..the exigencies of market competition and enormous corporate power mean that governments privilege economic priorities and corporate interests over social and environmental needs, even in settings where democratic institutions and decision-making processes are marked by integrity and representativeness…’

Under these circumstances, and consistent with the overall book insights, the Author infers that Italian government should tackle neoliberal drives in an efficient manner to ensure that citizens enjoy equal health benefits on an equitable basis, while advancing global health through public financing over political and commercial interests.

He staunchly messages that interests for the many, not the few, are to be prioritized in Italy to secure non-discriminatory access to health. As such, he calls on decision makers to keep up an effective public health system for nationwide universal coverage, whereby selective interventions can be put in motion for the sake of disadvantaged people, including immigrants and the new poor.

In this connection, the book aligns with a statement made by the Karolinska Institutet Vice-Chancellor Ole Petter Ottersen ‘Achieving health equity is not just a matter of coming up with technical solutions and providing the means to finance them.  We have to consider the political landscape and rectify the dysfunctions that undermine health.’

In a nutshell, this book provides a forward-looking, balanced analysis, with insightful suggestions for solution, over the impending threats and gaps still jeopardizing non-discriminatory access to global health in Italy.

Written in easily readable, brilliant Italian language, the book is a very commendable piece of work. It would definitely deserve to be translated into English and let interested readers worldwide enjoy up-to-date, in-depth information on the debate about public health situation and trends currently in Italy.

Find links to Table of contents, Introduction and 11^th (final) Chapter sections enclosed below to allow readers to enjoy first-hand the leading themes and fascinating style of this book:

• Table of contents
• Introduction
• Chapter 11

 

……………………………………………………….

*About the Author

 

Marco Geddes da Filicaia

Formerly, Chief Medical Officer National Tumor Institute of Genoa; Chief Medical Officer Firenze Centro Hospital Center; Vice-President Italian Health Council; Councilor Department of Health and Human Services Firenze Municipality.

Some of the many books by Marco Geddes: Trattato di Sanità Pubblica (Editore NIS); Guida all’Audit clinico (Il Pensiero Scientifico Editore, 2008); Le Tavole del Regolamento dei Regi Spedali di Santa Maria Nuova e di Bonifazio (Polistampa, 2008); Cliente, paziente, persona (Pensiero Scientifico Editore, 2013); Peste. Il ‘flagello di Dio’ fra letteratura e scienza (co-authored with Costanza Geddes da Filicaia: Polistampa, 2015).

Together with Giovanni Berlinguer, Geddes has edited the annual report La Salute in Italia (Ediesse).

He is a scientific committee member of the quarterly review Prospettive sociali e sanitarie.

 

 

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 277

 

EPWG Statement on US Pharma Industry Request to put EU on IPR Enforcement Watch List 

MSF welcomes Members of the European Parliament response to the US pharmaceutical pressure to stop EU action on high drug prices 

EU to Get Rid of Big Pharma-Friendly SPCs 

Proposed Reforms To The 340B Drug Discount Program 

International Women’s Day: Reminder women must keep fighting — everywhere 

International Women’s Day 2018 – Celebrating women in STEM 

How empowering women leads to innovative agricultural practices 

Bringing health care on foot to women in Haiti 

‘Finally in the (Global Health) Spotlight, Nurses Now!’ by Clara Affun Adegbulu 

Targeted STI testing detects more infection in young women than men in rural South Africa 

Big Problem, Limited Funds: Can Philanthropy Make Headway on Housing? 

Human Rights Reader 440 

Cambodia: Going the extra mile for people who inject drugs 

UNPO Newsletter February 2018 edition 

Aid, poverty and gender inequality in the Indo-Pacific 

‘Global Health and Occupied Palestine’ by Angelo Stefanini 

Towards new Guiding Principles: United Nations discusses the human rights impact of economic reforms 

‘Overcoming Public Health’s Perception Challenges’ by Lawrence C. Loh 

The Surgical Unit-based Safety Programme in African hospitals 

TDR strategy 2018-2023 Building the science of solutions  

Moxidectin: new data support a vital role in the endgame on river blindness 

WHO pre-qualifies the first artesunate suppositories for malaria 

Test spots malaria in two minutes, without blood 

WHO Joint Tropical Disease Program Issues Report On Research Fairness 

One year, 1,198 patients in Uttar Pradesh, MSF’s hepatitis project 

Pharma, Nonprofits Collaborate On Affordable Hepatitis C Treatment In Latin America 

Integrating HIV and hypertension management in low-resource settings: Lessons from Malawi 

Study: TRIPS Flexibilities Widely Used By Countries, Contrary To Reports 

Improving Health And Equity While Addressing Climate Change 

U.N. Chief Picks a Very Rich New Yorker (Not Named Trump) for Climate Job 

Greenpeace: Cut out meat to meet Paris Agreement goals 

U.N. collates global disaster data to help reduce risk 

 

With nurses being at the vanguard of health service delivery in many countries, it is obvious that their voices must be heard loudly, if good, effective policies and interventions are to be implemented. They must be empowered to participate in a meaningful way, in the planning, implementation and evaluation stages

By Clara Affun-Adegbulu*

Intern and Researcher, Health Policy Unit, Institute of Tropical Medicine in Antwerp, Belgium; Masters (MPH) student, University of Vienna, Austria

Finally in the (Global Health) Spotlight, Nurses Now!

 

Last week, on the 27^th of February, Burdett Trust for Nursing, in collaboration with the World Health Organization (WHO) and International Council of Nurses, launched Nursing Now with a series of events worldwide. Nursing Now is a global campaign that aims “to improve health globally by raising the profile and status of nurses worldwide – influencing policymakers and supporting nurses themselves to lead, learn and build a global movement.”

As a nurse, and someone who is passionate about improving health, healthcare and access to healthcare, I am happy about this development. This is because even though globally, nurses account for almost 50% of the health workforce, they have, for far too long, been left out of global health discussions. In fact a quick scan through the CVs of many of the actors within the global health community, would show that doctors, economists, anthropologists, and other social scientists dominate the arena of health systems research and policy, with  nurses being highly underrepresented. Yet they play an important role in health systems all over the world, and will be critical to the achievement of the Universal Health Coverage (UHC) goal that was set during the 58th World Health Assembly in 2005.

According to the WHO, universal health coverage “means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.” Clearly, a key factor to the achievement of this goal, is the quality of health services which should be “good enough to improve the health of those receiving services.”

With nurses being at the vanguard of health service delivery in many countries, it is obvious that their voices must be heard loudly, if good, effective policies and interventions are to be implemented. They must be empowered to participate in a meaningful way, in the planning, implementation and evaluation stages.

How can this be done?

Firstly, the nursing cadre must be recognised as a fundamental part of the health system. This recognition should go beyond just empty words, and should be accompanied by fair pay for the people at the frontlines who are often the face of the health system. This will have the double effect of promoting gender equality, and sustainable development particularly in developing countries. Most crucially, fair pay for their work will show nurses all over the world, that they are as valued as any other member of the health profession, and their contributions are just useful and important. This is vital, because many nurses, as a result of constant belittling, do not think they have anything to contribute the health systems and policy discussions and debates.

Secondly, nurses should be trained properly and supported in their desire for professional development. They should also be encouraged to seek out further education opportunities particularly in research and academia. This would automatically give more of them, access to leadership positions, as well as the “rarefied” arenas where global health discussions take place.

There are many different solutions to this complex issue, but in my opinion, these are the two most urgent ones. They will of course not solve the problem of the lack of nurses’ participation in policy-making for health, but it is a good start.

 

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* Nurse and Public Health Masters student at the Medical University and University of Vienna. She is currently interning as a research assistant at the International Health Policy unit of the Institute of Tropical Medicine, Antwerp, working on a literature review project on health systems strengthening. Clara is particularly interested in global health and development policy