Speech by Carlo Capece Minutolo, former president of the Scientific Representatives Association of Pescara.
PESCARA. «Today the dominant and perhaps wrong idea is that all drugs are the same and at the same time it is thought that all patients are the same. This is not true, there are patients in whom the generic or equivalent drug manages to have an excellent response and it is right to administer it, both for therapy and to contain costs, while in other patients a more modern solution must be sought, with drugs of new generation that are more expensive but also more effective». Carlo Capece Minutolo, former president of the Scientific Representatives Association of Pescara, an association which in Abruzzo has 650 members for an audience of 4,000 doctors, explains how pharmaceutical spending and cuts do not always go hand in hand.
First of all the accounts: in Abruzzo, the agreed pharmaceutical assistance cost 289 million euros in 2006, 13.8% of the total health costs. Without the intervention plan of the Region, expenditure in 2007 would rise to 295 million euros, with cost containment the figure for 2007 will have to return to 268 million, 12.4%.
"The imperative is to save money, as the Abruzzo Region also requests with respect to the costs of pharmaceuticals, a right choice", he observes Carlo Capece Minutolo, «but we have to look carefully where we are going to save: for medicines there is a spending ceiling set by law at 13%; however, we completely forget the other component which is the 87% of expenditure, which ranges from laboratory tests to instrumental ones, hospitals and improper admissions of private nursing homes. What's the point of saving on the smallest part of the expense that represents the most delicate link for therapy and patient care?».
The discussion on drugs revolves around the concept of "designer" drugs, ie branded drugs that are more expensive than those defined as "equivalent" or "generic", which have lower costs.
«When talking about "designer" and "generic" medicines, improper terms are used, such as saying, the first is from a boutique and the second from a stall», observes Capece Minutolo, «we should say today's medicines and medicines from the past. The former made with decidedly more modern technology, the latter with what was available 20-30 years ago. If, for example, we compare the antihypertensives, we can say that a drug that has the best effect by intervening on the patient's pressure in an irrefutable way is "clonidine", this drug is so effective that it lowers the pressure in all patients, often even leading to collapse. Instead, let's take a modern drug, for example, the "sartanics", these are certainly less aggressive on the patient but, certainly, with an almost absence of side effects. This causes the pressure to drop without discouraging the patient from carrying on with the therapy, therefore, in the long term we would certainly have better results, because the patient is more adherent to the basic therapy, he is constantly treated. This drug is the result of 30 years of research. Pushing the doctor to always and only prescribe the generic drug for economic reasons means wanting to regress scientific research and make it go back at least 30 years".
The costs to the citizen, however, also in this case remain the central problem. Sometimes the difference can be glaring. For the same indication, an antibiotic of 3 and a half euros can be used against a «grif
PESCARA. «Today the dominant and perhaps wrong idea is that all drugs are the same and at the same time it is thought that all patients are the same. This is not true, there are patients in whom the generic or equivalent drug manages to have an excellent response and it is right to administer it, both for therapy and to contain costs, while in other patients a more modern solution must be sought, with drugs of new generation that are more expensive but also more effective». Carlo Capece Minutolo, former president of the Scientific Representatives Association of Pescara, an association which in Abruzzo has 650 members for an audience of 4,000 doctors, explains how pharmaceutical spending and cuts do not always go hand in hand.
First of all the accounts: in Abruzzo, the agreed pharmaceutical assistance cost 289 million euros in 2006, 13.8% of the total health costs. Without the intervention plan of the Region, expenditure in 2007 would rise to 295 million euros, with cost containment the figure for 2007 will have to return to 268 million, 12.4%.
"The imperative is to save money, as the Abruzzo Region also requests with respect to the costs of pharmaceuticals, a right choice", he observes Carlo Capece Minutolo, «but we have to look carefully where we are going to save: for medicines there is a spending ceiling set by law at 13%; however, we completely forget the other component which is the 87% of expenditure, which ranges from laboratory tests to instrumental ones, hospitals and improper admissions of private nursing homes. What's the point of saving on the smallest part of the expense that represents the most delicate link for therapy and patient care?».
The discussion on drugs revolves around the concept of "designer" drugs, ie branded drugs that are more expensive than those defined as "equivalent" or "generic", which have lower costs.
«When talking about "designer" and "generic" medicines, improper terms are used, such as saying, the first is from a boutique and the second from a stall», observes Capece Minutolo, «we should say today's medicines and medicines from the past. The former made with decidedly more modern technology, the latter with what was available 20-30 years ago. If, for example, we compare the antihypertensives, we can say that a drug that has the best effect by intervening on the patient's pressure in an irrefutable way is "clonidine", this drug is so effective that it lowers the pressure in all patients, often even leading to collapse. Instead, let's take a modern drug, for example, the "sartanics", these are certainly less aggressive on the patient but, certainly, with an almost absence of side effects. This causes the pressure to drop without discouraging the patient from carrying on with the therapy, therefore, in the long term we would certainly have better results, because the patient is more adherent to the basic therapy, he is constantly treated. This drug is the result of 30 years of research. Pushing the doctor to always and only prescribe the generic drug for economic reasons means wanting to regress scientific research and make it go back at least 30 years".
The costs to the citizen, however, also in this case remain the central problem. Sometimes the difference can be glaring. For the same indication, an antibiotic of 3 and a half euros can be used against a «grif
