diverted from their primary use, many drugs are prescribed improperly. A practice which, besides being sometimes dangerous, costly to Medicare.
"Firms tend to encourage doctors to prescribe outside the WMA or recommendations to expand their market," Bruno Toussaint, Prescribing.
Picks
repaid 128 million euros between 2004 and 2009 for the antidiabetic Servier.
20% wastage, associated with prescriptions as an appetite suppressant unjustified.
Among patients treated with the Mediator, at least 20%, according to the General Inspectorate of Social Affairs, should never have swallowed the pills. They were not diabetic, but wanted to lose weight, and their product has been prescribed for its anorectic properties. Yet the sale was not authorized for this indication ... "The prescription of drugs outside the scope of their authorization of placing on the market (AMM) is almost a national sport," complained Jean-Marc Aubert, a consultant at Jalma and former deputy director of the National Health Insurance ( CNAM).
ACOMPLIA
25 million euros between 2007 and 2009 paid for this medication to diabetics slimming reserved manufactured by Sanofi-Aventis.
A third of waste, due to the limitation to non-diabetics.
Sometimes this can be justified for patients with rare diseases or for children: laboratories rarely ask permission for these groups considered too small and unprofitable. But most of these requirements is simply unwarranted. In theory, they should not be supported by Medicare. In practice, the doctors "forget" often noted in their order that the product, in this case is not refundable. A real waste comes dig a little hole in the Safely. Nothing that under these orders abusive, the only Mediator has generated over 25 million euros unnecessary expenditures between 2004 and 2009.
thyroid hormones or diuretics to lose weight ...
CREON
paid 65 million euros between 2005 and 2009 for treatment of pancreatic diseases Abbott.
50% wastage, associated with prescriptions for "aid digestion".
There are no data to assess the extent of these abuses, nor the shortfall for Medicare. But some few studies help identify the magnitude of the phenomenon. Taking antidepressants: "Approximately one third of prescriptions are linked to short or moderate depression. But there is no scientific evidence of the effectiveness of these products in these situations," sighs Jean-Marc Aubert. These molecules have cost 540 million euros to Safely in 2009 - including 178 million probably in vain ...
"The two areas most affected by this diversion is the use of bleaching skin with ointments containing corticosteroid s, and loss of weight," says André Deseure, the order of physicians. Brought to punish unscrupulous doctors, this body considers regular files unnecessary prescribing diuretics or thyroid hormones - from molecules to the slimming effect, although it is often temporary. In the same vein, the High Authority for Health (HAS) investigated the Creon, aimed at treating diseases of the pancreas. Result: This medication is administered more than once on two out of the WMA, to "aid digestion". Wasted: 32 million euros between 2005 and 2009.
STATINS
1 billion paid in 2009 for the cholesterol molecules.
Two-thirds of the treatments were established without following the recommendations (prior regime ...) in 2003. The situation is improving, but progress is still possible.
not enough doctors trained in the pharmacopoeia
"The abuses may also relate to the requirements respecting the WMA but not the scope of reimbursement set by the government" adds Gilles Bouvenot, the HAS. Famous example: Acomplia, the diet pill from Sanofi, withdrawn in 2009. It should be reimbursed for diabetics are overweight. "In fact, one third of patients not taking antidiabetic same time," said Gilles Bouvenot. Most probably do not suffer from diabetes, which accounts for Safely undue expense of EUR 8 million between 2007 and 2009. And there are all the tablets prescribed without complying with the "recommendations for good practices" such as antibiotics for viral infection. Or cholesterol molecules, including statins, which are reimbursed up to more than 1 billion euros per year. In 2003, experts from the social security system have demonstrated that two-thirds of these treatments were introduced without any proven cardiovascular risk and without prior regime, contrary to the recommendations. The situation has reportedly improved since then, even if it remains, according to the CNAM, "room for improvement."
ANTIDEPRESSANTS
540 million paid in 2009 for these products reserved for severe depression.
A third of waste, associated with prescriptions for depressive episodes short and mild.
What's there behind these abuses? Pressure from patients and too little training of physicians in the pharmacopoeia. Lobbying labs, too. "Firms tend to encourage doctors to prescribe outside the WMA or recommendations to expand their market," says Bruno Toussaint, Prescribing, which called for the withdrawal of long Mediator. The review led for fifteen years an observatory of the medical, it was pointing drifts. It has not been reprinted since 2006, but the subject remains topical. For proof In France, advertisements are regularly withdrawn for "unwarranted extension of indication." And the United States, AstraZeneca was ordered to pay over 500 million euros for having promoted a treatment against bipolar disorder and schizophrenia in many other diseases (Alzheimer, anxiety, depression ...). A warning to the French labs
article a bit long but inspiring! The worst is that this situation has been known for ages but it let go. This is not for nothing that I yelled against the marketing practices of the lab Accomplia in my book! On skin whitening creams (steroids), I was a little lax, not refusing to renew the black Plaine Saint Denis, and they all had a good explanation to me asking "chronic eczema doctor" .
And antidepressants! I think they really have no place in general practice.
But pressure from the labs, the visual beauty and let yourself be persuaded.
So we could change the title: "these pills that hurt patients."
