Germany Now on Big Pharma Hit List

Earlier this month, Bush administration officials showed up in London to badger the British health authorities into opening its market to the drug industry's predatory pricing policies. (See this earlier post.) Now, the British Medical Journal reports similar goings-on in Germany.

Last week in Cologne a member of an association for people with diabetes and representatives of the drug industry walked out of a hearing of the Institute for Quality and Economic Efficiency in Health Care in Cologne because they were not allowed to record the hearing, which was on the use of short acting insulin analogues. The institute has provoked anger among patients' groups and the drug industry by saying that no evidence has been shown that short acting insulin analogues had any advantage over human insulin.

After the walk-out drug firms accused the institute, which was founded in 2004, of insufficient transparency. The institute's director, Peter Sawicki, said that its rules did not allow participants to record hearings and that this had always been the case.

Tension between the drug industry and the institute has grown since the German government proposed expanding the institute's role, so that it will no longer consider only the clinical effectiveness of new drugs but also their cost effectiveness. The proposal is part of the government's package of reforms currently before parliament.

The institute's evidence based evaluations will become the basis for decisions by the federal joint committee of doctors, health insurance companies, and patients' representatives that decides which treatments will be reimbursed by the state health insurance companies. Under the new reforms this committee will include independent members as well as representatives of doctors and health insurance companies chosen by the health ministry.

"For the analysis of the cost effectiveness of treatments we will use internationally accepted methods, just as we do for looking at the scientific evidence," said Professor Sawicki.

The U.S. has no agency like this one in Germany (or the National Institute for Clinical Effeciveness in Great Britain) that compares drugs for relative efficacy and their relative cost-effectiveness (why take a pricey pill when the generic works just as well?). But calls for creating one are growing. Gail Wilensky, who ran Medicare in the Bush I administration, recently endorsed this reform in the usually conservative journal Health Affairs.

The drug industry is working hard to strangle this baby before it is born. Are efforts to discredit similar efforts abroad part of the campaign?