PLEASE EXPLAIN...
IPHA CONTRIBUTES TO NATIONAL CANCER STRATEGY
THE PHARMACEUTICAL INDUSTRY UNFOLDED
IPHA was one of a number of organisations invited by the National Forum on Cancer Services to make a submission on the National Cancer Strategy 2003 – 2010. IPHA’s submission argued that the new strategy provided the ideal opportunity to build on the achievements in recent years in the care of Irish cancer patients and to place Ireland to the forefront in the prevention and treatment of cancer. It called for sustained investment in cancer services, greater emphasis on prevention and screening to increase early detection, more emphasis on shared care across the primary/secondary interface and further support for cancer research.
Antimicrobial Resistance The use of anti-microbial medicines (i.e. any substance used to kill or inhibit the growth of micro-organism, including antibiotics and other antibacterials, antiviral, antifungal and antiparasitical agents) has greatly contributed to improvements in health, in treating communicable diseases and preventing infections. However, overuse and misuse of antibiotics (especially in children with respiratory infections) have favoured the growth of resistant organisms. The emergence and spread of antimicrobial resistance has become a major public health problem, within the EU and world-wide.
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PHARMACEUTICAL INDUSTRY GROWS THE IRISH ECONOMY End of year figures from the Central Statistics Office showed that the pharmaceutical industry was responsible for the overall growth in Irish exports in the first nine months of 2002. Total exports of medical and pharmaceutical products, for the first nine months, increased by an extraordinary 67% to €11.3 billion. Total
Irish Pharmaceutical Healthcare Association
Design and production: Slick Fish Design, Dublin
70
71.2
69.6
60 50 40 30 20 11.3 10 0
6.8
2001 Total Exports
YEAR
2002
Pharmaceutical Exports
Source: Central Statistics Office
Publisher: © Irish Pharmaceutical Healthcare Association
80
€ BILLIONS
Content: Anne Nolan, Cathy Curran, Leonie Clarke and Brian Murphy
For more information on this issue please visit the European Union website at www.europa.eu.int
The EU Scientific Steering Committee recommended in May 1999 that take action be taken to reduce the overall use of antimicrobial agents in a balanced way in all areas: human medicine, veterinary medicine, animal production and plant production. European Health Councils also asked the Commission to come forward with an initiative with respect to antibiotics use in human medicine. The Community Strategy outlines a series of ongoing and upcoming actions at different levels.
For more information on the National Forum on Cancer Services please visit the Department of Health website at www.doh.ie. A copy of the IPHA submission is available on request.
Franklin House 140 Pembroke Road Dublin 4 Ireland T: +353 1 660 3350 F: +353 1 668 6672 E-mail: info@ipha.ie Website: www.ipha.ie
In addition, research and development of new antimicrobials and of alternative treatments and vaccines is being encouraged. International cooperation in efforts to combat anti-microbial resistance in international fora a such as the World Health Organisation (WHO) and in particular with candidate countries as well as developing countries is to be re-enforced.
exports for the period rose by just €1.58 billion to €71.2 billion and an overall decline in exports would have been recorded but for the strong performance of the pharmaceutical sector. The IDA Ireland End of Year Statement provided further evidence of the importance of the pharmaceutical sector to the Irish economy. It was noted that despite the turbulent global conditions Ireland continued to attract new pharmaceutical/healthcare investments in 2002. Total employment in IDA supported pharmaceutical companies, such as Abbott Laboratories and Servier, grew by over 1,500 to stand at 19,339. The Agency plans to trade strongly on the reputation and success of biotech investments by Wyeth Medica and Genzyme to win further biotechnology investments in 2003.
medicinesmatter The Irish Phar maceutical Healthcare Association
In This Issue • • • • • • • • • •
IPHA AGM Focus on Heart Disease World AIDS Day Review of EU Pharmaceutical Legislation Healthcare Facts and Figures Advertising Medicines Pharmaceutical Industry grows the Irish Economy The Pharmaceutical Industry Unfolded IPHA Contributes to National Cancer Strategy Pharmaceutical Industry Grows the Irish Econmy
DUMP SAFE DISPOSAL OF HOUSEHOLD MEDICINES
In response to concerns about medicines being unnecessarily hoarded in many Irish homes, the South Western Area Health Board launched a pilot project last October to encourage the safe disposal of unused and out of date medicines. During the pilot project, patients visiting participating pharmacies were provided with a special bag to return unwanted and out-ofdate medicines to the pharmacy for disposal. The project has been supported by a number of groups including the Irish Pharmaceutical Union and IPHA who have donated the Knowledge is the Best Medicine booklets to be put in all the DUMP bags distributed to pharmacists.
DID YOU KNOW? • Over 120 overseas companies have plants in Ireland • These include 9 of the top 10 companies in the world • The pharmaceutical sector now accounts for about 20% of Ireland’s manufactured exports.
SPRING 2003
For more information on the Dump Campaign, please call 1800 520 520
“QUALITY, ACCOUNTABILITY AND VALUE FOR MONEY IN HEALTHCARE” – THE KEY ISSUE AT IPHA AGM The IPHA Annual Meeting took place on Friday 15th November. The theme of the meeting this year was “Challenges in Healthcare: Quality, accountability and value for money” which proved to be particularly topical in light of the current debate about health and the public finances. Speakers who addressed the subject included Vincent Sheridan, Chief Executive of the VHI, David O’Flanagan of Deloitte & Touche, Brian Sweeney, Chairman of the Irish Health Services Accreditation Board and Chris Fitzgerald, Health Promotion Unit, Department of Health & Children. Mr Sheridan described how the VHI was responding to competition in the health insurance sector and the increasing costs of new medicines and procedures, and argued that the company was providing excellent value for money. He warned that an expansion in the number of private hospitals would push up the cost of health insurance and drive some people back onto public waiting lists. According to Brian Sweeney, accreditation had a key role to play in improving quality in healthcare and he described how his Board was working with the Department of Health & Children and members of the health services to introduce appropriate accreditation systems in Irish hospitals. He commented that the accreditation system could be extended in the future to community care, GP services, disability services and other aspects of the health services.
David O’Flanagan presented an overview of Deloitte & Touche’s Value for Money Audit of the Irish Health System. He said that at present there was no broadly based Value for Money framework supported by management processes in place in Ireland. He argued that health was capable of absorbing a more or less unlimited amount of funding, and that if the public wanted a better system, then they had to be prepared to pay for it. He emphasised that with an ageing population, the pressures on the health services could only intensify. Chris Fitzgerald of the Department of Health & Children outlined the Health Promotion Unit’s role in achieving the Health Strategy’s objective of building a healthier nation. He discussed the need for and possible contribution of health promotion. He highlighted health promotion proposals in the Health Strategy and indicated that there were opportunities for constructive partnerships to help deliver these proposals. A lively roundtable discussion ensued which was skilfully facilitated by Olivia O’Leary. To initiate the debate, a variety of panellists were invited to present their perspective on quality, accountability and value for money – Dr Joan Gilvarry, Medical Director, IMB, Dr Joe Barry, Vice-President, IMO, Dr Liam Twomey, TD, Ms Audrey Craven, Migraine Association of Ireland and Fergal Bowers, IrishHealth.com. The discussion was opened up to the floor and there were many excellent contributions from IPHA members and guests such as Finbarr Fitzpatrick of the Irish Hospital Consultants’ Association, Dr Deirdre Murphy, President of the Irish College of General Practitioners and Dr Jim Kiely, Chief Medical Officer, Department of Health & Children. Pictured at the 9th IPHA Annual Meeting in The Radisson Hotel, Dublin are from Left to Right: Dr Joan Gilvarry, Medical Director, IMB, Mr Seamus Feely, Secretary General, IPU, Ms Audrey Craven, Chairperson, Migraine Association of Ireland, Dr Liam Twomey T.D. and Ms Mai Hanlon, outgoing President, IPHA.
PATIENT AREA
ADVERTISING MEDICINES The pharmaceutical industry is an important source of information for medicines and recognises its responsibility for ensuring that this information is accurate and does not mislead. Advertising and promotional activities are essential as a means of informing doctors and other healthcare professionals about the availability of new medicines and to alert them to new uses for existing products. Pharmaceutical companies’ marketing activities are highly regulated by the Medical Preparations (Advertising) Regulations, 1993 which enact in Irish law, a 1992 EU Directive on the advertising of medicinal products. IPHA plays an important part in promoting the responsible advertising and promotion of medicinal products. The Association has published Codes of Practice setting out detailed guidance to assist pharmaceutical companies in complying with the regulations. The IPHA Code of Marketing Practice provides guidance on the advertising and promotion of prescription and nonprescription medicines to doctors and pharmacists. The IPHA Code of Advertising Standards covers advertisements for nonprescription medicines or over the counter medicines aimed at the general public i.e. press, TV, radio, outdoor poster advertising and promotional activities in pharmacies for specific medicines. These Codes have been approved by the Minister for Health & Children in recognition of his support for the self-regulation of advertising and promotional activities by the pharmaceutical industry. All members of IPHA are obliged to comply with these Codes of Practice as a condition of membership. In addition, several non-member companies have voluntarily signed up to the IPHA Codes. Anyone who believes that a particular advertisement is in breach of either Code may submit a complaint to IPHA. Committees chaired by an independent legally qualified chairman adjudicate on complaints. If an advertisement is found to be in breach of either Code, sanctions that may be applied include: • The withdrawal of the advertisement and/or the publication of a corrective statement • Amendments to the advertisement • In difficult cases and/or persistent breaches of the Code, referral to the Minister for Health & Children IPHA’s Codes of Practice may be downloaded from the website at www.ipha.ie.
REVIEW OF EU PHARMACEUTICAL LEGISLATION Discussions continue on proposals for the revision of the EU’s pharmaceutical legislation which are currently working their way through the EU’s co-decision procedure which gives a say to the Commission, the Council of Health Ministers (representing all the Member States) and the European Parliament. The table below provides an overview of the co-decision procedure and identifies what stage the pharmaceutical proposals are currently at: Stages of the adoption process for EU legislation in the co-decision procedure
Progress of proposals for revision of the EU’s pharmaceutical legislation
Consultation stage Proposal adopted by the European Commission
26.11.2001
First reading in the European Parliament
23.10.2002
Amended Proposal adopted by the European Commission
10.12.2002
Political agreement /Common position in the Council of Ministers
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Common position amended by the European Parliament in second reading
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Possible conciliation Parliament/Council
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Final adoption by the Council of Ministers
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Implementation by the Member States
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The Commission has recently released revised proposals for the revision of the EU’s pharmaceutical legislation taking into account amendments made to the original proposals during the European Parliament’s first reading. Details of the new proposals are available on the Commission’s website at http://pharmacos.eudra.org/F2/review/index.htm.
Healthcare Facts and Figures 2002/2003 Did you know that the life expectancy of a 65year-old Irish person is the lowest in the European Union? Or that public expenditure on health has more than doubled in Ireland since 1997 or that Irish people spend more on sweets and chocolate than on medicines? Many more facts like these can be found in the new edition of IPHA’s “Healthcare Facts and Figures 2002/2003”. Commenting on the publication, the IPHA President Michael Dempsey said that he hoped that it would facilitate a rational debate on healthcare, based on the facts.
Other interesting facts from the booklet... • Medicines account for just over 10% of the total non-capital health expenditure in Ireland. • The percentage of elderly people in the population is set to increase by nearly 40% by 2020. • The elderly in Ireland constitute only 11.3% of the total population yet receive 47% of all medicines prescribed on the medical card scheme. • The numbers employed in the health services in Ireland increased by over a third during the 1990s • Over one fifth of all deaths are of people under the age of 65. Nearly two thirds of these deaths are due to cancer and circulatory diseases. • Whilst State expenditure on medicines has more than doubled since 1997, Irish use of medicines remains amongst the lowest in Western Europe. Hot off the press, it’s your vital passport to information on the pharmaceutical and healthcare sectors in Ireland and Europe.
To order your copy please contact the IPHA offices.
PATIENT AREA
PATIENT AREA
PATIENT AREA
FOCUS on HEART DISEASE Cardiovascular disease will eventually kill half the Irish population. For Irish men over 65, it is the main cause of death; in women it is the second cause after cancer. Hardening of the arteries, which is the usual cause of heart attacks, develops over decades yet an artery can block off suddenly causing death within minutes. Recent research suggests that heart attack risk may even start in the womb. Low birth rate may indicate increased risk. The three principal risk factors for cardiovascular disease are smoking, cholesterol and high blood pressure. People who take an occasional drink are at lower risk than teetotallers; the risk in heavy drinkers is much higher. Nearly one in five Irish men drink more than the recommended 21 units of alcohol a week. Countries like Ireland which eat a high fat diet (especially saturated fat) have a much higher heart attack rate than countries, which eat less fat. In Ireland we are lucky to have a number of excellent patient support groups focusing on heart disease:
Irish Family Heart Association C/o Irish Heart Foundation as above Aims to make doctors and the public more aware of heart disease, inform and support those affected and to encourage further research into heart disease and its treatment. Mended Hearts 52 Bettyglen Dublin 5 Tel: 831 4576 Cardiac support group. People who have had heart surgery who support others who are facing surgery. Visits patients in hospital. Home visits on request. Telephone communication and letters. Other useful sites British Heart Foundation www.bhf.org.uk www.cardiaccare.org.uk American Heart Association www.americanheart.com
The Irish Heart Foundation 4 Clyde Road Ballsbridge Dublin 4 Tel: 01 668 5001 Fax: 01 668 5896 Website: www.irishheart.ie The Irish Heart Foundation is a voluntary organisation which aims to prevent heart and circulatory diseases. It conducts community, schools and workplace health promotion programmes and co-ordinates national CPR, ACLS and Nurse’s courses. It also publishes booklets and leaflets on heart health, risk factors and cardiac surgery.
WORLD AIDS DAY December 1st was World AIDS Day. By the end of 2001 an estimated 40 million people were living with HIV and by the end of 2002 it was predicted that there will have been a further 5 million new infections. The following facts are frightening:
Did you know that … 8,000 people die of AIDS every day There are currently 13.2 million AIDS orphans around the world 14,000 new cases of HIV occur every single day 95% of all AIDS cases occur in the world’s poorest countries
Mr Brian Lenihan TD, Minister of State at the Department of Health and Children recently launched the revised “Immunisation Guidelines for Ireland.” The Minister noted that in a little over a generation we had seen the eradication of smallpox and the almost total elimination of several other potentially serious diseases. He cited the example of measles where, prior to the introduction of the measles vaccine in 1983, there were almost 10,000 cases per year in Ireland; the number of such cases had declined very substantially since. Echoing the concern of healthcare professionals at the current low level of uptake, especially in relation to the MMR vaccine, he urged parents to have their children vaccinated “in order to ensure that both their children and the population generally have the maximum protection against the diseases concerned.” Over 100 cases of measles have been reported to the National Disease Surveillance Centre (NDSC) for the period Dec/Jan 2003, which is significantly higher than the average 30 cases usually notified during this period. Most of these cases have occurred in three areas; South West Dublin, the Western Health Board region and the Midlands. The Midlands Health Board has already issued an appeal to parents to have their children vaccinated.
Other useful bodies include …. Heart Children Ireland The Carmichael Centre North Brunswick Street Dublin 7 Tel: 1850 217 017 www.heartchildren.ie A support group for parents of children with congenital heart disorders.
There were 3 million AIDS deaths in 2001
VACCINATION – LOW UPTAKE IS A WORRY
Pharmaceutical companies around the world are testing 98 new medicines against AIDS. The medicines in the pipeline include 38 that attack the AIDS virus, 15 for AIDS related cancers, 6 for the fungal infections which frequently attack the immune systems of AIDS patients, 7 medicines that target opportunistic infections, 8 medicines developed to strengthen the immune system and 14 vaccines. Pharmaceutical companies are working every single day to try and eradicate and prevent the AIDS epidemic around the world. They won’t stop until they find a cure or preventative medicine. For more information on AIDS, you can visit www.unaids.org and www.worldaidsday.org.
The Director of the NDSC, Dr. Darina O’Flanagan has suggested that Ireland consider linking child benefit payments to immunisation status as an incentive to parents to have their children vaccinated. Dr. O’Flanagan has also said that a system needs to be put in place to ensure that children who have not received the MMR vaccination can be identified and treated rapidly in the event of an outbreak of measles in a school or crèche. Dr Marie Laffoy, Director of Public Health with the Eastern Regional Health Authority (ERHA) has estimated that for every 1,000 children who get measles, one will die from the infection. The last major outbreak of measles occurred in the Eastern Region in 2000 and it lead to 1,230 cases. Three children died and over 350 were hospitalised.