An EU Referendum on Drug Pricing?

July 20, 2016

Not yet, says Reflector. But to judge from the European Parliament's latest foray into the subject, there could be plenty of support for such an approach to this complicated subject.

Don't be too alarmed. There isn't going to be a referendum on drug pricing. Not yet, anyway. But to judge from the European Parliament's latest foray into the subject, there would be plenty of support for such a "sudden death" approach to this complicated subject – and the results would doubtless be as catastrophic as the UK's recent and lamentable decision-making process on EU membership.

The parliament's health committee has decided to draw up a resolution on access to medicines in the European Union, and the prime mover behind the project, Spanish socialist Soledad Cabezón Ruiz, is already winning widespread support for her suggestions that governments should use compulsory licensing of expensive medicines to compensate for their limited negotiating power with drug firms. In her view, “This is controversial for the industry, but it’s necessary to talk about it."

Eleonora Evi, an Italian MEP from the anti-establishment "Five-Star Movement", was quick into the discussions, offering her health committee colleagues an opinion on the subject that she has piloted through the committee on petitions (yes, there is a European Parliament committee on petitions), and that invokes "European citizens" in its demand for tough action against "the monopolies of large companies in the market."

Her committee's attitude to "the EU options for improving access to medicines" runs the full gamut from A to B. The opinion highlights "issues that citizens feel concerned about, particularly inadequate distribution of medicines, the impact of the economic crisis on medical and pharmaceutical care, and issues regarding marketing procedures and patents for medicinal products." It "deplores the fact that there are 18 million people without access to health care or medicines, whose human rights are being violated on a daily basis."  It says the "key obstacles to access to medicines" include "the lack of affordability and availability of medicines, the budgetary cuts resulting from the financial crisis, the high price of medicines." And it  Identifies patent rights "as a major obstacle to access to medicines, and urges public policy makers to take proactive steps towards making generic and biosimilar medicines available."

The reassuring substantiation for this vigorous approach to problem-solving is the committee's beliefs, "on the basis of petitions received and in the light of the matters arising from them." It says "the opinions of European citizens voiced by petitioning the European Parliament are fundamentally important" – and apparently that is all it needs to know to reach this opinion. Strikingly, however, says in the same brief opinion that it "finds it alarming that there are 25 000 annual deaths in the EU due to lack of effective antibiotics" – without apparently stopping for a moment to wonder why this is the case. It merely issues a lazy call for governments "to support research and development that focuses on the medical needs of all citizens" via "a pooled public platform for R&D financed by all states via a contribution of 0.01 % of their GDP." So that's sorted, then.

Evi's compatriot, and fellow-member of the party founded by popular comedian Beppe Grillo (which is coming closer to power in Italy as the country's political framework looks every day a more likely victim of meltdown), has also won support for an opinion on the subject in the Parliament's development committee. This committee, whose brief is for policy in the poorer countries of the world far beyond Europe, has no hesitation in insisting that, "without transparency of research and development costs to originator companies and information on the actual prices paid for medicines across the EU, any discussion on fair medicine prices remains impossible." It cites UN and WHO figures and targets for the world in general, but fails to take account of any of the wealth of discussion of the issues underlying drug pricing in Europe that have been raging throughout this year. It displays the same innate hostility to intellectual property rules and "monopoly protection", and makes a blanket recommendation for promoting generics and limiting drug companies' scope for action.

Over at the European Parliament's employment and social affairs committee, French MEP Joëlle Mélin – a member of the far-right party led by Marine Le Pen – has been busy winning support for an opinion from her committee. This reflects the strong anti-European mindset of her political family, attacks "interfering EU regulation", and underlines that questions of access to medicines should be dealt with principally at the level of each country acting individually. The unsophisticated nature of the opinion – selecting what Bart Simpson would describe as "some from column A, some from column B" – demonstrates again how ill-informed the discussions frequently are when the European Parliament – the people's representatives in Europe – steps in.

The preparations for the Cabezón Ruiz resolution – due to be debated in late September – have also included a workshop on the subject in Brussels in mid-July. This featured a line-up of the usual suspects among European discussions of health and drugs: a token presence from industry, a strong contingent of health-related non-governmental organisations and patient associations, some inveterate critics of the drug industry and of drug patents, and some regulators, academics and officials.  The tone of much of the debate mirrored the prejudices of the MEPs behind it – to such an extent that one of the voices arguing for a more considered view of the issues felt necessary to warn that his opinions might shock.

Dirk van Erps, head of unit for antitrust in pharma and health services in the European Commission's powerful competition department, prefaced his defence of drug prices with the words "You may not like it." He resisted calls for the Commission to investigate drug firms for abusing their market position simply because their prices are considered to be high. "The price is a signal for investment. If you intervene there, there is the short term gain that you can make, but there is also in the long term, a possible cooling down effect on innovation,” he said. He cited his commissioner's view that innovation has to be rewarded.

Ill-informed debates in the European Parliament are nothing new, and own-initiative resolutions such as the one that Cabezón Ruiz is currently confecting are particularly prone to strong opinions with weak substantiation. Unlike Parliament's work on legislation, where MEPs have to accept some responsibility for the way a law turns out, own-initiative debates can become little more than fact-free zones for crass prejudice among those bearing a grudge.  But the shallow reasoning and personal posturing on display in this debate carries uncomfortable echoes of the travesty of discussion in the UK in the run-up to its June referendum. And the unhappy outcome of the naked mendacity and hardcore ignorance that characterised the "Leave" campaigners as they lied their way to success ought to stand as a warning to any debate on serious issues conducted at the level of a slanging match in a school playground.