#EAPM – Last Tango in Paris (and Madrid, and Budapest, and Amsterdam, and…)

| February 12, 2019

The old line says that it takes two to tango. And indeed it does. But it also takes (at least) two to have a conversation, and transform a potentially good idea into a workable reality, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.  

An exchange of information, an exchange of views, and the ability to express oneself while also having the capacity to listen – all these are key to this. A key part in almost every form of progress is communication.

Yes, it holds true in healthcare as elsewhere. But let’s look at it on the bigger perspective. While personalised medicine puts the patient at the heart of his or her own healthcare and encourages patient/doctor dialogue to empower said patient, it is also the case that communication needs to work on a larger scale.

We have lawmakers, policymakers, those with a research perspective, those with a payer perspective, pharmaceutical manufacturers, bodies in charge of governance and standards, IT experts, journalists, lobbyists and, of course, those patients.

So many words are written about health care in the 21st century and there is a cacophony of voices each with their own slant, their own silo viewpoint, but is anybody actually listening to anybody else to all practical intents and purposes? So many angles, so little consensus…

Good ideas appear all the time, but can only be made practicable if people agree how to make these ‘lightbulb moments’ work. To do this, all stakeholders must communicate, inevitably compromise, and certainly see the whole picture if not before, then at least during or after sitting down together.  Ideas put into words are great, the best starting point to facilitate necessary change, but if they remain simply as words without subsequent action, then it’s surely all little more than hot air.

And even when mountains are being moved in the healthcare realm, as is the wont of mountains, they move slowly. Too slowly at the moment.  Put simply, building consensus is the way forward in healthcare, and this can only be done through clear expression and the ability to listen used in tandem.   Just like that partner you need when doing the tango…

Aside from a silo mentality that still exists in many areas of healthcare, and the need to train doctors to better communicate with their patients, plus the absolute necessity of ongoing training for the former and more-easily available information for the latter, we have at least seen some examples of communication, cooperation and coordination.  Take health technology assessment, or HTA.

While the levels of cooperation (mandatory or not) are still currently being hotly debated, it is undeniable that down the years, individual member states, who guard their health care competency under the Treaties jealously, have been cooperating on HTA for two decades.

As we move forward, ‘consensus building’ is a key aspect. For its part, the EAPM believes that alignment between member states and stakeholders is absolutely required in order to ensure that innovation is getting into Europe’s health-care systems.

This may, of course, be easier said than done. But the chances are better if there is a sensible exchange of views and this presupposes that both sides listen to the other.  Talk, for sure, is some times cheap. But it can also be of high value.  In the aforementioned case of HTA, it is clear that Europe needs more and better clinical evidence, to determine the efficacy and therapeutic advantage of medicines. And it needs to be exchanged.

As alluded to above, EAPM is heavily focused on consensus building generally across the EU and stakeholders.     Innovation, it says, is a major pillar in bringing new, targeted medicines to patients. In the health arena, this means the translation of knowledge into what we can call “value.”   The latter covers the value to patients but must also take into account value to healthcare systems, society and, of course, manufacturers.

And yet we haven’t actually defined ‘value’ in this context, as everybody is singing from a different song sheet. Or dancing the tango on their own.

What is certainly clear is that early dialogue between technology developers, regulators, HTA and, where relevant, pricing bodies will promote innovation and quicker access to medicines at affordable prices, for the benefit of patients.      So in many areas we need agreement, or ‘consensus.’

As mentioned, healthcare remains a member state competence, and despitethe 20-year voluntary co-operation of HTAs, the EU’s direct involvement in overall healthcare is still relatively new.  But this is improving. During recent years the European Union as an umbrella has been actively involved in legislation in the areas of cross-border health care, clinical trials, IVDs and data sharing, as well as HTA.

So the EU has taken a lead, albeit at the behest and with the blessing of member states. (Lest we forget, some 70% of Europe’s citizens want the EU to take a bigger lead in health care.)

Therefore, it follows that the need for better collaboration and consensus building is widely established as a prerequisite to giving innovation a better chance, in Europe, and around the developed world.  Back to HTA and, despite certain objections, most member states do agree that there is room for common ground, although the details ideally need to be agreed before the new Parliament intake and the new Commission.

The mandatory aspect of the Commission’s original proposal is certainly breaking new ground. It’s an idea that many are striving to make work. And at the very least the debate is taking place.

This is to be welcomed and this type of attitude is vital going forward.

In the end, under the European Union’s social pillar,each citizen across all member states should be able to have the same access to the best health care. This is evidently not the case at the moment and a further debate needs to be ongoing about the broader aspects of healthcare.

It’s happening to a degree, but not to a large-enough degree.  In the arena of health care today, with all its challenges, Europe needs a much more cross-border and inter-regional dimension. In the health domain it is often the case that a ‘one-size-fits-all’ solution is no longer feasible and, most certainly, no single country can facilitate necessary changes to modern healthcare all alone.We need to talk, talk, talk but also turn it into action.

That can only be done by acting together. In a nutshell, despite national competences in health care, Europe needs to get together, cooperate, co-ordinate and share best practices for the benefit of all patients (and potential patients) across each and every member state.

If this doesn’t happen it will simply remain that different voices, presenting different ideas, from front, back, left and right of the big healthcare stage, will all be speaking at cross-purposes, across each other, and with no hope of consensus.  To bring ideas to fruition, yes, we have to explain them. But others also have to listen to them. In many cases, it’s happening, which is to be welcomed.

Nobody really wants to tango on their own. That idea wouldn’t work.


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Category: A Frontpage, EU, European Alliance for Personalised Medicine, Health, Personalised medicine

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