New EU health chief questions plan to let drug industry communicate directly with patients
John Dalli, a former Maltese economy and social affairs minister, will have more influence over public health policy than any of his predecessors when he takes up his post as the European Union’s health commissioner next month.
In a move that underlines the increasing importance of health issues on the European agenda, his five year mandate, which is due to start on 1 February, will include responsibility for drafting all future pharmaceutical legislation. The previous health commissioners, Markos Kyraniou and Androulla Vassiliou, had argued unsuccessfully for this policy area to be transferred from the European Commission’s enterprise and industry directorate general, where primary importance is given to commercial considerations, to their own bailiwick.
Now the commission’s president, José Manuel Barroso, has agreed to the transfer. A deciding factor was the Lisbon Treaty, which came into force at the beginning of December and updates the European Union’s rulebook. It includes pharmaceuticals and medical devices under the health policy heading.
The transfer has been generally welcomed. The European consumer organisation BEUC says that it "will bring more consistency and coherence to European public health policy." Jo Leinen, the German Socialist member of the European parliament (MEP) who chairs the parliament’s environment, public health, and food safety committee, pointed out: "The Lisbon Treaty strengthens health policy, and this is the right time to strengthen the commission’s infrastructure in this area."
The European Federation of Pharmaceutical Industries and Associations has given a measured response to the change while emphasising the importance of the continuing recognition of the industry’s dual role of meeting patients’ needs and contributing to Europe’s economic wellbeing.
Mr Dalli was careful to strike a similar tone when cross examined by MEPs for three hours on 14 January on his suitability for the health post. He confirmed that he would place the interests of patients first but insisted that this did not exclude a strong commitment to the future competitiveness of the drug industry.
"Patient interests rest on a strong profitable pharmaceutical industry," he said. "Support for the industry and patients are not contradictory. You can get synergy between the two. I will push the industry to do more to put patients in the frontline."
Mr Dalli has set out his priorities. He will press ahead with two relatively non-controversial pharmaceutical proposals already on the table: stepping up measures against counterfeit drugs and improving pharmacovigilance.
But he expressed strong concerns about controversial plans to allow drug companies to communicate directly with the public by allowing companies, under certain conditions, to publish information on their products in newspapers and magazines.
"We will reassess the package on information and bring more patient perspective to the proposal," he said, adding that the reassessment would include stronger demarcation between information and advertising. "You do not want a situation where people in a vulnerable position can be coerced to purchase a product that may not be good for them," he said.
Pharmaceutical policy is not the only extension of powers that the commission’s health directorate general for health and consumer affairs, known as DG SANCO, will receive when the changes take effect on 1 February. DG SANCO will also take over responsibility from the enterprise and industry directorate general for the operations of the London based European Medicines Agency.
In reality the change is more administrative than substantive, as both directorates already have a seat on the agency’s board, an arrangement that will continue. However, in future it is DG SANCO that will take the lead in the commission’s relations with the agency. These include budgetary issues, a review of its activities, and, in the near future, the search for a new director.
Mr Dalli confirmed that he would continue to champion legislation allowing patients to receive reimbursable medical treatment in another EU country. The proposal was blocked by Spain and a minority of governments last December. He plans an early meeting with the Spanish health minister to try to break the deadlock, although progress is unlikely before the second half of the year, when Belgium takes over the six month rotating presidency of the EU from Spain.
The incoming commissioner may have disappointed some when he said that, given the limited finances available, he prefers to tackle broad health determinants such as alcohol, tobacco, and obesity through information and educational programmes rather than specific diseases.
"Health determinants cut across diseases. To concentrate on specific diseases would give a short term and narrow outcome. Heath determinants will give us health equality more quickly," he explained.
He sees a strong role for patients’ groups in EU policy making while recognising the financial difficulties they face and the dependence some have on drug companies for funding.
"We need to find new ways of financing them so that we can ensure their independence. Perhaps the money should not come directly from industry but through some kind of system," he suggested.
Mr Dalli, who will also have responsibility for European consumer policy, received a generally warm reception during his parliamentary hearing. But already health organisations are setting the bar high for the next five years. Monika Kosinska, the secretary general of the European Public Health Alliance, has called on him to "show bold leadership and vision" and provide "creative solutions and unwavering commitment to protecting the public interest."
By Rory Watson
Cite this as: BMJ 2010;340:c353
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