The last couple of posts have discussed the corrupting influence in drug company money in American healthcare. Andre Wenker is a reader from France who sent me this note. “In France, Jardiance is considered as having no ATV (Added Therapeutic Value) and its price at the pharmacy, for 30 PVC-Aluminum blister pack(s) of 1 tablet, is €39.1, (approximately) 15 times lower than in the US, reflecting this low value…”
That is a huge difference. The cash price for Jardiance in the US is about $700. 39.1 euros is $43.51. At today’s exchange rate, Jardiance is just over 16 times more expensive in the US compared to France. There is a good reason for this dramatic difference. The French government has a function called the French National Authority on Health. The mission is simple, coordinated, and explicit. "The Haute Autorité de santé (HAS) - or French National Authority for Health - was set up by the French government in August 2004 in order to bring together under a single roof a number of activities designed to improve the quality of patient care and to guarantee equity within the healthcare system. HAS activities are diverse. They range from assessment of drugs, medical devices, and procedures to publication of guidelines to accreditation of healthcare organizations and certification of doctors. All are based on rigorously acquired scientific expertise. Training in quality issues and information provision are also key components of its work program.
HAS is not a government body. It is an independent public body with financial autonomy. It is mandated by law to carry out specific missions on which it reports to Government and Parliament. It liaises closely with government health agencies, national health insurance funds, research organizations, unions of healthcare professionals, and patients' representatives.
HAS has been built on 3 founding principles: a very broad field of action, which means that it can compare a range of healthcare initiatives; a high degree of scientific rigor; and independence.". In other words, it is like our National Academy of Medicine but it can actually do something rather than simply making recommendations.
Here is their 2020 reassessment of Jardiance. "The initial management of type 2 diabetes is based on non-medicinal interventions and, in particular, the implementation of lifestyle and dietary measures. In the event of failure to meet the blood glucose target, medicinal treatment with metformin or, in the event of contraindications, a sulphonylurea is recommended as first-line therapy, in addition to these measures. Drug combinations are envisaged following the failure of monotherapy."
Plain English. Start with metformin. Give a sulfonylurea if metformin cannot be used. Only after those steps is a more expensive drug justified. The French spend half of what we spend on health care and they cover everyone. This is one of the reasons why. It is really not hard. Are we serious? Do we even want a better system?
Bless the French! I am delighted to see that their emphasis on reason continues. The French Revolution was more dramatic that the American. The American revolutionaries just wanted the same rights as other Englishmen. The French Revolution was different. It found its roots in the Enlightenment and that changed everything. “The Enlightenment – the great ‘Age of Reason’ – is defined as the period of rigorous scientific, political and philosophical discourse that characterized European society during the … 18th century” There was a heavy focus on reason as a guide to the life of human communities. The rigorous scientific basis of medicine persists to this day in the French National Authority on Health. That system benefits all French people, not just the ones with money and power. It is easy to see why the French live longer for half the impact on gross domestic product. It is not socialism. It is just plain good sense.
Money and power have taken over medicine in this country. It is irrational and it does not serve Americans as well as it should. Our National Academy of Medicine has no teeth. Health policy is effectively decided secretly by the executives in big insurance companies, big drug companies, big hospital systems and the politicians they support. They act in their own interests, not yours. We will not have better health at lower cost until that changes. You voice is important if we are to have better health at lower cost.
To have such an agency here in the USA would be only “reasonable”, American healthcare consumers would have true advocacy. Disruptions to upstream and downstream economics is the crux. It’s a despicable predicament.
I believe there is already enough data to support the use of Jardiance at the present time for its preventive benefits. For those you follow this thread, that means I disagree with my friend Bill. If The postprandial sugars are not maintained in the 100-130 range, then the next step is to add Ozempic or Mounjaro. as Bill has pointed out, the cost for these medicines is truly excessive