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Health warning

We should be looking at prevention rather than cure to help reduce the drugs bill

I know, as soon as I reach for the key-board, the Association of the British Pharmaceutical Industry (ABPI) can sense my presence. It is commodiously located in a palace in Whitehall, next door to a theatre. It is used to drama. Indeed, step out of the office and turn left up Whitehall and you are a hundred paces from Trafalgar Square. The ABPI is used to battles.

What the ABPI is not used to however, is me saying something nice about the pharma industry. But I'm going to. Many of them will reach for the smelling salts. Indeed, some of the more ample executives may need a defibrillator.

Here goes: the NHS does not pay too much for pharma products.

The machinations of the Office of Fair Trading are eruditely dealt with elsewhere in this magazine. It is not territory I intend to stray into. Save only to say this: pharmaceutical products are too expensive, not because anyone is ripping anyone off, not because they are too costly, but thanks to a clapped out, knackered system.

It is an Austin Allegro system in a Ferrari world. It is fish paste sandwiches in a Pret A Manger world. It is NescafÈ in a Starbuck's society.

As pharma products become more sophisticated and the world demands greater diligence and care, the development time for new drugs gets longer. It is not uncommon for it to take 16 years. The patent life is only 20 years: that means companies have four years to recover the squillion-quid spent on trials. Hence drugs cost the earth, the moon and the stars.

What's the answer? Speed up clinical trials? Yes, there are companies that will recruit cohorts of folk with the right age and illness. Machines in laboratories can work around the clock. Researchers in the UK start work in the morning and at tea-time hand their data to colleagues in Singapore, who will press-on `till it is dawn in the US and whizz their stuff over via ethernet for the next team of white-coats to take it on. It is globalised. Yet, it is still not fast enough.

Laboratories full of dogs, mice and monkeys are not a viable solution. The animal rights people have seen to that.

How do you speed up research? The answer is you can't - not without cutting corners and risking safety.

There is another way. It's filed under `bleedin' obvious': how about extending patent life. Why are we stuck with 20 years anyway?

What about a development patent followed by a sales patent calculated as a multiple of the time it takes to find, develop and produce a drug safely?

Fifteen years to make a drug might mean a 10-year period to sell, market and establish a reasonable return. The obvious consequence is prices would come down as pharma recovers its costs and makes a profit over a longer period: same return, longer pay-back period.

The problem with this blindingly obvious commonsense solution is that it would require a change in European law and is beyond the wit of the Eurocrats. There is no one in Brussels bright enough to translate it into 300 languages and get the agreement of half the world to make it happen.

Is there another answer? The ABPI won't like this, but how about using fewer pharmaceutical productsÖ?

Just to set the record straight; I'm not talking about swapping Herceptin for dandelion and burdock leaves, in a mint tea infusion. I'm talking about the only solution that I can see to the predicament we are in.

Try explaining to a Martian why we very bright Earthlings lead lives that make us ill and then spend a fortune, we don't have, fixing ourselves up. A GP friend of mine made me think about this. He says 80 per cent of the people who pitch up in his surgery are there with lifestyle-related conditions.

The Martian might say, why don't you spend the money fixing your lifestyles before you worry about fixing the consequences? This has a compelling logic.

There are companies, such as TNS-Acorn, that can cut, shut and salam-slice data like a sushi chef and tell us where the next generation of high-risk patients are living, what they eat, their dress size and how long they sit on the sofa. We could go and knock on their door and sort them out.

Something else: do you know how much we spend on fixing up people who fall over at home, simply because they can't see what they are doing? It's about ?128m a year.

The National Institute of Health and Clinical Excellence (NICE), which seems to spend a great deal of time annoying pharma, tells us what we can't have and it is now producing guidance telling us what we should be doing. The latest is guidance on falls risk assessment.

Apparently, sight check-ups are one of its nine recommendations. It's not rocket science.

If you can't see what you're doing, you fall over and bust your hip, or burn yourself making a cup of coffee. When you get home, stick a bag on your head, walk around your sitting room and try making a Cup a Soup.

So, for people who can't get to the opticians there is a very neat service, paid for by the Department of Health, and run by a national company, based in Luton, called Healthcall. It provides domiciliary hearing and eyesight checks. It's all free.

I have no idea how much money Healthcall has saved the taxpayer and the blood, sweat and tears of the individuals. I guess it is about the same as it would take to run a small republic.

If we are to get to grips with the pharma bill, we have to move upstream and stop people getting ill and injured in the first place. NICE is moving into the public health arena. It's the only solution. The fact that we need to put an end to sickness and injury is not the news that the pharma industry wants, but it is the only answer that makes any kind of sense.

The author
Roy Lilley is a healthcare author and broadcaster

13th March 2007

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