Cyprus Mail

Our View: Difficult choices have to be made about expensive drugs

PATIENTS were being left to die because the state’s Pharmaceutical Services failed to bring drugs that could have saved lives, said a campaigner for patients with rare diseases at a news conference on Monday. This was picked up by the media which lambasted the inhumanity and incompetence of bureaucrats and politicians that relied on committees following slow procedures to take critical decisions about patients.

While this made for a good story it ignored certain important facts.

First, Cyprus is a tiny country and its Pharmaceutical Services cannot be expected to make available to patients every single drug that is produced in the world. Second, decisions have to be made by these services about which drugs should be in stock, as it is not possible to have drugs for every single known disease. Third, the state cannot order whatever drug a patient demands because he or she saw it being promoted on the internet.

None of the indignant newspaper articles mentioned these points, focusing instead on the €5 million that, although budgeted, had not been spent on the purchase of allegedly life-saving drugs. The thinking was that whatever drug was requested by a patient – sometimes out of desperation – it should be made available by the state, even if there is a similar one already available locally.

In the case of unavailable drugs, the patient request is referred to what is known as a ‘scientific committee’ for a decision. At some point last year, the council of ministers changed the procedure, giving the health minister to take these decisions, even though he had neither the qualifications nor knowledge to do so. Within a few months, Health Minister Giorgos Pamborides correctly surrendered his discretionary power and set up a three-member committee which was given the responsibility for taking decisions.

In short, the case reported by the campaigner was not the result of some scandal, but the inevitable consequence of the state’s procedures for dealing with one-off drug requests. The reality is that criteria and procedures are necessary and preferable to leaving the decision-making to the minister who has neither the time nor the qualifications to issue approvals. Another reality is that not all patients can be satisfied at all times.

Things could slightly improve if and when the national health system is introduced, but we should not forget that Cyprus has a tiny population and will not have the ability to buy innovative drugs in quantities that would ensure reasonable prices. This may sound harsh, but health is also a matter of economics – resources are limited and the state does not have the financial ability to provide whatever drug is available on the world market.

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