Tribune’s guest a member of the Federation Council Committee for Social Policy, the senator of the Orel Region, Vladimir Krugly.
See Part 1 Vladimir Krugly: “The quality of Russian pharmaceuticals is improving; and both citizens and doctors are changing their opinion about them”
- It is a long process from the creation of a medicine to its introduction to the pharmacy network. There should be long-term experiments, clinical tests in order to prove effectiveness of this drug. Is there a problem of the way how to proof the use of medicine?
- This problem exists in the world, and Russia is no exception in this sense. The difficulty is the evaluation of the effectiveness of medicine. There are different levels of proving. The more countries participate in research, the more reliable the results will be.
In the 80s the whole world was overflowing with Western publications about the effectiveness of medicine by manufacturers. And the results weren't quite apparent and entirely accurate. The Kohrenovsky special fund was created then. It was a voluntary association of researchers and doctors, who carried out analysis of studies. Therefore it carried out a test in respect of the level of evidence. They chose the aims of the test, analyzed the way it was organized and so on. Medicine should be based on some sort of evidence.
Our country is developing so fast towards evidence-based medicine, but frankly speaking it still lags behind in comparison with European and American healthcare. The most purchased medicine in the Russian market is Essentiale forte. Kagocel takes second place. The effectiveness of these medicines hasn't been proved by well-organized multicenter tests. For example, if we try to find the "most purchased drug with unproven effectiveness" we will find Aktovegin. Therefore, the problem continues to exist.
- Meldonium, our domestic drug developed in Riga, in the Soviet Union, is widely used. Does it have proven efficiency or proven harm? The fact that it was added to the list of banned drugs is due to extreme jealousy, isn’t it?
- If it was widely used, it seemed there was an effect. There were studies, and it was used for recovery from exercises. However, it doesn’t influence sports results at all.
- Let's talk about such sad problems as pediatric oncology. How available is oncology treatment in Russia right now?
- Pediatric oncology was separated from adult oncology in 1997. Children have completely different prognoses. Results of treatment are quite different as well, and many children become healthy again. Lymphoblastic leukemia is one of the most frequent diseases. Due to early diagnosis and proper treatment, 90% of patients recover. If we take such particular diseases as lymphoma of the kidneys, then recovery happens in 95-97%, there should be 100% recovery with different types of sarcoma in the second stage. There are diseases with more favorable and less favorable prognoses, but still, of course, the majority of children with cancer should recover.
In the 90s, we began to use modern and effective methods of treatment for children – chemotherapy – and the results were simply amazing. The effect of chemotherapy during lymphoma, for example, can be compared with the effect of the use of antibiotics in the 40-50's. Just in 5-7 days you see how from a condition of dying, a seriously ill child improves, they recover, and they have their own children. These are beautiful, intelligent, successful people in life, and it's very nice. Oncology diseases are always very hard, and you have to go through some tough road of treatment, but there is still such goal, which makes it all worthwhile. In no case should you ever give up when diagnosed with some kind of oncology disease. Today, all diseases can be cured, of course, all diseases have different outcomes, but mostly good.
- But another issue is the availability of this treatment.
- It is available. But to say that we have resolved all the problems would be wrong. Currently, there is another level of diagnostics, and now many diseases, especially oncohematological, are treated with bone marrow transplantation. All of this is a part of the high-tech help, but the sum, the quota which is allocated for the treatment, is, unfortunately, insufficient. That is, I can tell you, maybe a little roughly, not precisely, in other words, the quota is 2.3 million, for example, and 6-7 million is necessary in order to cover those expenses that the health facility bears. And we live in conditions of budgetary restriction today, so not everything is possible. This section of the treatment of children with cancer must be maximally supported by the state. Although, of course, it is a philosophical question, to give something to someone you must take something from someone. We certainly understand that the possibilities are somewhat limited today, but nevertheless, those are somewhat exclusive cases. And the vast majority of patients of the standard risk group are treated in regional children hospitals or federal centers, this treatment is absolutely available. It is covered by the compulsory health insurance system.
- Then why is it often said on TV and social networks that a child needs a treatment, and collection of money begins?
- Free medical assistance under the guaranteed state program is declared in our country, which includes almost everything for children. When some famous people, famous actors come out and say "help this child", of course, every person really wants to text an SMS. The majority of these children can be treated for free in Russia. Anyone who becomes ill with any disease in Russia, including the common cold, may want to go to Germany for treatment. Why should the population pay for it? Standard-risk diseases are mainly treated in some regional centers, and the level is very high in our country. We have federal centers, there is Dmitry Rogachev Federal Center of Pediatric Oncology and Hematology. It's just a European level center, in which German professors are working, by the way, on a permanent basis. They come regularly, every two weeks, hold consultations. Why are they collecting money so that a patient goes Germany, if the disease can be cured in Russia? And even worse: they collect money to provide treatment in a private Russian center. I saw the following announcement: “My child, 8 years old, a boy, has a club foot, and he needs treatment on the Ponseti method.” This is the simplest method, it is provided in all public hospitals.
- I remember how people collected money for well-known actors on social networks. And then there was an announcement on behalf of the actors that they are absolutely unknown people, who hide behind well-known names, and try to get rich this way illegally.
- This is obvious fraud.
- Maybe it is some sort of stereotype that the foreign healthcare system is better, isn’t it?
- Maybe it is. But money is often collected by some foundations, organizations. The idea of charity is very compromised by the fund-raising. Of course foundations can be helpful. For example, the 'Give Life' foundation helps Dmitry Rogachev Center. They compensate the compulsory health insurance system's lack of funds. These are some kind of exclusive cases. For example, we had a patient with acute leukemia, who became disabled due to her disease, and the foundation presented her the 300 thousand-ruble electric-powered wheelchair. Of course, not every family can buy it; people do not have an opportunity. Charity is needed regarding such things. But people feel some sort of cognitive dissonance when, the Minister of Healthcare recently says that treatment is free, and then they collect money for treatment of children. There are a lot of cases when the fund-raising is carried out to get money.
