Healthcare

What the NHS can learn from Germany’s Hospital System

Post-Coronavirus, the UK should not shy away from debate over the NHS, and how to achieve better patient outcomes, argues Fred Roeder

When contrasting how countries around the world are coping with COVID-19, over the past few weeks one country has stood out. Germany’s health system has received regular praise for its resilience in facing the COVID-19 pandemic, but what are they doing right?

Germany is one of the most affected countries in Europe but the mortality rates are significantly lower than in most other European countries dealing with the coronavirus. Germany’s capacity to test widely and early has definitely contributed to this but an often underappreciated factor is its very competitive, modern, and often private hospital system.

While the UK currently has fewer confirmed COVID-19 cases, this is probably due to the lack of testing capacities of the NHS, the more interesting and shocking number is that the death rate per 1 million people is four times higher in the United Kingdom compared to Germany. Germany’s mainly private and decentralized testing infrastructure happens mostly outside of hospitals, in private laboratories, and has enabled Germany to conduct as many as 150,000 tests per week. To put that in comparison, the UK has managed less than 10,000 a day so far.

Being the relative of an NHS patient, I had to assist her to go through its byzantine and centralized testing regime, even for simple blood samples. GPs send patients to hospitals just to get their blood taken and analysed. Scaling up such a centralized testing system allows no mistakes to be made. A decentralized and independent system however allows for some parts in the chain to fail and the other still to perform, and crucially allows room for innovation.

Merely 28% of the roughly 1,950 hospitals that participate in Germany’s universal health system are owned by the government. 37% are private for profit hospitals that treat patients covered by the public health insurances and receive the same amount of reimbursement per case as the public ones or the 34% that are operated by churches and other charities. Despite charging the same as government hospitals private for-profit hospitals have the highest investment per case (about 64% higher than public hospitals), which leads to more state-of-the-art treatment and newer medical equipment.

It is also very interesting to look at how private hospitals perform better compared to government hospitals in Germany. Within the first four years one can observe an increase in efficiency of between 3.2% and 5.4% above those hospitals that had not been privatised. Despite its mainly private character Germany has nearly three times as many beds per 100,000 people compared to the UK. It gets even worse when looking at intensive care beds per 100,000. Germany has over 4 times the intensive care capacity compared to the NHS. In recent weeks Germany added another 40% additional capacity to its already high intensive care beds. This number is not reflected in the comparison.

Given that we are currently facing a massive pandemic it is shocking to see how poorly prepared the centralized NHS was, from a lack of protective equipment for clinicians, to its failure to prepare for mass testing. While the hard work of individuals within the health service has done what seemed impossible only weeks ago, and has prepared the NHS to cope with coronavirus, structural issues remain.

A pluralistic hospital system that endorses competition and patient choice such as the German one seems to be in a much better position to cope with potentially tens of thousands of severe COVID-19 cases.

Yes, also in this comparatively better German hospital system patients die and doctors contract COVID-19. Healthcare workers in Germany are also overwhelmed with the amount of cases and patients. But overall it looks like Germany can endure and face this wave in a much more prepared and resilient fashion compared to the NHS which is still facing huge problems mastering this mammoth task.

After we are all through with this we should not shy away from a debate if it’s not time to open up bigger parts of the NHS hospital systems, allow competition and make the health of British patients a priority.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Testing – not lockdowns – may explain why some countries handle Covid-19 better

This is a post by a Guest Author
Disclaimer: The author’s views are entirely his or her own, and don’t necessarily reflect the opinions of the Consumer Choice Center.


There are ongoing debates about who has been better handling the Covid-19 pandemic: testing or lockdown?

Covid-19

With so many people confined to their homes, passions are running high, and there are ongoing debates about who has been better handling the Covid-19 pandemic. So much so that it feels like comparing and contrasting countries and their trajectories has become sort of a global pastime.

Nearly all developed countries (and others) have put their populations under severe lockdowns and emphasized social distancing as the silver bullet against the spread of the virus. Sweden, however, has recently been castigated for failing to put its population under a lockdown like every other country, especially other Nordic countries which it is compared and contrasted against. 

The problem is that it is quite hard to compare the performance of two randomly selected countries. For instance, on every level Norway seems to be doing much better than Sweden. That said, one can always find a bunch of other countries that are doing much worse despite having been under lockdown for some time.

It should be noted that Sweden has made some questionable decisions, regardless of social distancing. It failed to ramp up testing with increasing cases around March 20, and it only closed its nursing homes for visits in early April.

But aren’t lockdowns clearly working? 

Many people have still argued that lockdowns are clearly working because the epidemic has slowed shortly after their imposition. However, it is important that we are careful when inferring that lockdowns were responsible for the decline. There may be a correlation between the two, but as everyone should know, correlation does not necessarily mean causation, and there may be other intervening variables. It is vital that we not jump to conclusions too fast. While many people believe, and many epidemiological models assume, that unchecked epidemics just grow exponentially until more than half of the population gets infected, the evidence for Covid-19 increasingly suggests otherwise. 

Several research papers (e.g. here and here) argued that the dynamics of the Covid-19 pandemic are well-described by exponential functions only at the early stage, after which so-called power-law functions are a much better fit. A detailed study of the outbreak in the initially hit communes in Lombardy also suggests that in each commune, it started slowly, then briefly became exponential and then slowed, all that before any significant intervention.

To help you better understand what the mathematical jargon above means and why it is so important, consider two simple functions, y=2x and y=x2. The first function is exponential and the second function is a power-law one. You will better see the crucial difference between them if they are plotted together.

If these functions were describing an epidemic, then the x-axis would mean rounds of transmission. In the beginning there is one infected person in both cases. Then, until the fifth round the functions seem to grow in at an almost similar speed but afterwards, they diverge dramatically.

When researchers talk about an epidemic growing first exponentially and then in accordance with a power law, they mean that the growth of the epidemic looks like the hybrid function (first, y=2x and y=x2 after round 5) below. Its growth clearly slows a lot after the fifth round.

Why could an epidemic grow exponentially, first, and then slow down on its own? Here, it is important to remember that real societies are complex. Instead of interacting with random people every now and then, people tend to form groups (or clusters, in scientific terminology) and live in local areas within which interactions are much more intense than outside of them. With obvious implications for infection transmission.

What probably changes at the early stage of the epidemic is that so-called superspreader events are much likelier. Such events, where single infected people spread the virus to scores, hundreds or even thousands of people, have clearly played an enormous role in Covid-19. It is enough to mention the Shincheonji Church of Jesus in South Korea, the tragic gathering of French catholics in Mulhouse and the first coronavirus-hit hospitals in Lombardy. At these events, infected people have an opportunity to spread the virus way beyond their clusters of interactions.

After the initial stage, when everyone becomes aware that the epidemic is in the community and significant events are cancelled, the infection may get increasingly isolated within clusters, first, grow slower and then start falling off. The available data is increasingly hinting at this process in play. In Italy, cases appear to have peaked on the day the national lockdown was announced. In the US, they appear to have peaked on March 20.  

Lockdowns could even be counterproductive

A more speculative but still plausible idea is that lockdowns could, in fact, not merely coincide with the slowing-down of Covid-19 without causing it but actually create more damage than they prevent.

Many people believe that if some social distancing (like closing bars or canceling events) is desirable than extreme social distancing like lockdowns that keeps most people at home most of the time must be even more beneficial. However, this potentially ignores two important facts about Covid-19 and viral diseases in general.

First, it is abundantly clear that Covid-19 overwhelmingly spreads in closed, often poorly ventilated spaces and through close contacts. Secondly, as Robin Hanson convincingly argued, there is a wealth of evidence that the severity of viral disease depends on the viral dose received. This means that if families are forced to stay at home together all the time, this may create perfect conditions for the virus to spread and especially cause severe disease.

The data from Google about actual social distancing patterns in several countries hit by Covid-19 shows that Italy, Spain and France have had by far the most extreme social distancing, and the UK was starting to catch up with them after its lockdown. Yet, these four countries have some of the highest fatality rates in the world per population and detected cases.    

Could testing explain things better?

A better way to try to make sense of the causation is to try to identify a bunch of countries that have something important in common. The most important thing in any epidemic is to minimize deaths, and there is a group of countries that seem to have far fewer deaths by population size, and per identified infections, than others. These countries include Iceland, Germany, South Korea, Taiwan, Austria, and Norway. You can see how low their case fatality rates are compared to other countries with a lot of cases here (see the “death rates” column).

What makes those countries succeed in driving down deaths? One would actually be surprised to learn that none of these countries is, or was, under total lockdown. South Korea hasn’t even closed bars and restaurants. This shows that extreme social distancing measures are not necessarily the best explanation.

The real answer may largely lie in how many tests those countries have been doing compared to others. Testing may reduce fatality rates by giving public health responders valuable information and helping to isolate and quarantine those that carry the virus before they spread it to vulnerable groups like the elderly.

Iceland is the absolute champion at testing. It has already conducted 28,992 tests, which is more than 8% of its entire population. It also has the world’s lowest case fatality rate from Covid-19 at 0.38%. Iceland isn’t an anomaly, and using Iceland as an example isn’t cherry picking. Researchers Sinha, Sengupta and Ghosal showed that country death rates from Covid-19 are significantly correlated with the intensity of testing. They did not, however, control for the potential impact of lockdowns and other stringent social distancing measures.

Testing and outcomes by region

In addition to national data, one can also look at regional data where it is available and see if the testing/fatality relationship still holds. Italy has been publishing detailed regional statistics on Covid-19 starting from February 24. If we plot tests per confirmed cases in each region with reported fatalities per million inhabitants, we get the following picture:

The chart surprisingly shows us that Italy’s worst hit region isn’t Lombardy, and that it is actually the little-known Aosta Valley. We also see that there is a clear negative relationship between the intensity of testing and fatality rates. In fact, the former seems to explain more than half of the variation in the latter, and the regression coefficient is statistically significant (the p-value is 0.0003).

To conclude, it will take a long time and careful research to sort out why some countries and regions have gone through the Covid-19 pandemic much less damaged than others. That said, one thing seems to be increasingly clear. When the dust settles it will be clear that testing will be a significant factor, and that the importance of social distancing will be diminished. 

Guest Author: Daniil Gorbatenko


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Il Sistema Lombardo Funziona

Nelle ultime settimane la gestione dell’emergenza in Lombardia è stata oggetto di grande dibattito. Le critiche maggiori sono state rivolte al sistema sanitario regionale. Gli aspetti problematici potrebbero, però, risiedere altrove e le cause di una gestione non ottimale andrebbero ricercate più a fondo.


PERCHÈ È IMPORTANTE?   Una polemica oramai quotidiana riguarda il ruolo della sanità privata, soprattutto in Lombardia, e di come il sistema di cooperazione tra strutture pubbliche e private avrebbe fallito. Proviamo a capire se veramente è il sistema sanitario lombardo a non aver funzionato oppure qualcosa d’altro.

LA RIFORMA   La sanità privata è figlia di una riforma voluta dall’allora maggioranza di centrodestra guidata dal Presidente Roberto Formigoni, che pose erogatori privati e pubblici sullo stesso piano, purché il sistema rimanesse universale (tutti i cittadini hanno accesso alle cure nello stesso modo) e solidale (le prestazioni sono pagate dalla fiscalità generale e non direttamente dal singolo paziente).

Per il paziente nulla cambia, ci si può rivolgere agli ospedali pubblici o privati senza distinzione. Al contrario, secondo i dati ANGES – Regione Lombardia del 2018, gli ospedali lombardi sono parimenti nei primi 10 ospedali italiani, come per esempio il San Raffaele di Milano, il San Matteo di Pavia, l’Istituto dei Tumori di Milano e il Papa Giovanni XXIII di Bergamo.

INVESTIMENTI E RICERCA   Inoltre andrebbe considerato che questa competizione tra pubblico e privato ha fatto sì che la spesa sanitaria privata e pubblica dedicata alla ricerca e alla cura della persona crescesse di quasi il 28% annuo (dati UniBocconi), creando centri di eccellenza riconosciuti in tutto il mondo, sia privati sia pubblici, come ad esempio gli Spedali Civili di Brescia, il Gruppo San Donato, Humanitas e tanti altri.

Questo è un tempo di emergenza, come dimostrano le parole di medici ed operatori sanitari che parlano di una vera e propria guerra, guerra nella quale combattono a nostra difesa sia operatori privati sia operatori pubblici.

Gli operatori privati si sono impegnati a mettere a disposizione il proprio personale sanitario nelle strutture pubbliche, nonché le loro stesse strutture. Regione Lombardia ha riorganizzato la rete ospedaliera creando hub specializzati divisi per patologia e prestazione sanitaria, al fine di liberare posti per pazienti COVID-19.

IL PRIVATO FUNZIONA?   Se tutto questo è stato possibile lo si deve anche alla capacità della sanità privata di riorganizzarsi in tempi brevissimi per poter ospitare il maggior numero di pazienti provenienti dalle strutture pubbliche sommerse dall’ondata di pazienti affetti da Coronavirus, spesso fatto senza attingere a risorse pubbliche, come dimostra il nuovo reparto di terapia intensiva realizzato con donazioni private al San Raffaele di Milano. Ovviamente, la sanità privata è in prima linea anche nella gestione diretta di pazienti COVID lombardi, con circa il 30% di quest’ultimi ospitato presso strutture private.

COME LA COREA DEL SUD   Se il sistema è andato in tilt non è per colpa della competizione pubblico privato, la quale ha fatto sì che i lombardi potessero ancora usufruire di cure ospedaliere di qualità, grazie alla maggiore flessibilità della quale l’erogatore privato è portatore. Ad ulteriore prova dell’assoluta bontà dell’apporto privato nella gestione della crisi dovuta al Coronavirus, andrebbe ricordato che il sistema sud-coreano, portato da molti come modello, è costituto per la grande parte da operatori sanitari privati, e dove la ripartizione della spesa sanitaria tra pubblico e privato è quasi paritetica.

Purtroppo, restano le migliaia di morti e quindi la necessità di porsi una domanda: perché la politica lombarda non ha attuato una strategia di contenimento e di prevenzione come quella veneta, fondata su un intervento di test preventivi, che è risultata più efficace? Se finora non lo si è attuato, perché, alla luce degli evidenti risultati, ora non si procede in questa direzione?


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

The ‘Bad Boys’ of the Private Sector turn into Corona-Angels

In light of the Corona virus, businesses that are usually on the top of politicians’ lists to be taxed, regulated, nationalized, or shut down are demonstrating how much value they produce for society.

Covid-19 will help us identify which regulations are holding back productivity and innovation

At a time like this, those of us who believe in free markets and limited government face challenges in justifying adherence to those principles. It is hard to argue against governments doing “whatever it takes” to combat the spread of the disease and save lives and livelihoods. In fact, as my colleague Christopher Snowdon set out in the Daily Telegraph last week, there is no need to make such arguments. There no inconsistency insupporting individual freedoms in normal times and acceptingcoercive measures by the state in a public health emergency.

Similarly, the massive expansion of the state comprised in the chancellor’s rescue package is broadly welcome for giving people the assurance they need that their homes, incomes and businesses will have some protection in highly unusual circumstances. However, there are many areas where reductions in government intervention should be urgently pursued. 

The New York Times reported that a biotech lab had carried out tests and identified cases of Covid-19 in the Seattle area, well before it was known that the virus had taken hold in the United States. The lab did not have the correct accreditations for this activity from the FDA and was ordered to cease testing. The regulators in the US have since relaxed their position on this, but the question must surely be asked, what was the purpose of the restriction in the first place and how can it be right that it applied so strictly that it actively worked against important research at a vital time?

Europe is also suffering under the burden of pointless bureaucracy in healthcare: the Consumer Choice Center has highlighted that 20 countries in Europe don’t allow online ordering of prescription medicines and 18 require even non-prescription medicines like paracetamol to be sold in pharmacies only. Thankfully the UK is not in the guilty groupof countries in either case, but we still have many regulations that are holding people back from getting the support that they need.

Some steps in that direction are being taken here. The Coronavirus Bill, published yesterday, gives the government emergency powers, but it also suspends various regulations, like the ban on recently retired doctors from returning to work more than 16 hours per week. It reduces the administration tasks and paperwork that health and care workers have to carry out – surely welcome at any time and not something that should take a global crisis to enact.

The Department for Housing Communities and Local Government has announced that planning rules will be relaxed so that pubs and restaurants can operate as hot food takeaways. These are the kind of rules that inspired the hashtag #NeverNeeded, urging Twitter users to identify regulations that are holding back efforts to counter the virus and were surely never needed in the first place. 

Health Secretary Matt Hancock tweeted that people and organisations should not feel restricted from doing what they need to do to help people because of data protection laws. This is an example of a regulation (the GDPR) that has been shown to be so badly formulated and poorly understood that people are not able to make decisions with certainty as to what is permitted without an ad hoc intervention from the secretary of state.

In my recent paper for the IEA, Rules Britannia, I noted that regulations are often put in place based on quite dubious cost/benefit analysis, and then not reviewed to see if they actually achieved their objective. The way in which regulations have been relaxed as a matter of urgency by governments around the world, in some cases after they have caused serious barriers in battling the spread of the virus, has highlighted this in stark terms. This is also why calls to impose ‘emergency legislation to remove “morally unacceptable” conspiracy theories’ from social media platforms should be resisted. Misinformation at this is time is deeply damaging, but a perception that government is controlling the media to hide things from citizens could be even worse. Knee jerk responses that unnecessarily curtail freedoms run the risk of being counterproductive, and such measures have a history of being be retained long after their original purpose has been forgotten.

When this public health emergency is over, we will need all of the productive capacity and innovation that free markets can provide to ensure that the economy recovers and there are jobs for people to go back to. Wealth is the strongest predictor of health in a society and free economies grow the fastest. If dealing with Covid-19 allows us to identify regulations that are holding back productivity and innovation in healthcare and across the economy as a whole we must not waste the opportunity to re-examine whether they were in fact ever needed.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Apakah Perlindungan Hak Kekayaan Intelektual di Bidang Medis Menguntungkan Konsumen?

Penulis Haikal Kurniawan – Usia harapan hidup dunia kian naik dari tahun ke tahun. Pada tahun 2020, diprediksi ada lebih banyak penduduk dunia yang berusia di atas 64 tahun daripada anak-anak di bawah usia 5 tahun (Roeder, 2019). Hal ini tentu merupakan suatu capaian yang mengagumkan, dan sangat perlu untuk diapresiasi.

Salah satu hal yang memainkan peran besar atas hal tersebut adalah inovasi dan perkembangan sains dan teknologi di bidang medis. Berbagai kemajuan di bidang tersebut telah membantu umat manusia untuk memiliki usia jauh lebih panjang daripada leluhur mereka yang hidup di masa lalu.

Konsumen tentu merupakan pihak yang paling diuntungkan dari perkembangan tersebut. Melalui berbagai inovasi, konsumen diberikan berbagai macam pilihan untuk memilih obat-obatan medis yang lebih beragam dan ampuh untuk mengatasi berbagai penyakit.

Lantas, apakah perlindungan Hak Kekayaan Intelektual memiliki kaitan erat perkembangan sains dan teknologi tersebut?

*****

Hak Kekayaan Intelektual, atau HAKI, merupakan salah satu hak yang diakui secara global oleh dunia internasional. Deklarasi Universal Hak Asasi Manusia (DUHAM), Pasal 27 UDHR, menyatakan dengan eksplisit bahwa “Setiap manusia memiliki hak untuk mendapatkan perlindungan, baik secara moral, maupun kepentingan material, yang dihasilkan dari hasil karya saintifik, literatur, maupun seni yang dibuatnya.”

Perlindungan HAKI merupakan salah satu instrumen yang dibuat untuk melindungi para inovator dan seniman atas hasil jerih payah mereka. Tanpa adanya perlindungan terhadap HAKI, tentu mustahil para inovator dan seniman yang sudah bekerja keras membuat karya tertentu untuk menikmati hasil kreatifitas yang mereka buat. Orang-orang lain, yang tidak melakukan apa-apa, akan dengan mudah mengkopi dan membajak hasil karya tersebut untuk keuntungan mereka sendiri.

Hal yang sama juga berlaku untuk inovasi di bidang teknologi kedokteran, pangan, dan kesehatan. Satu hal yang memiliki peran sangat besar untuk mendorong perkembangan tersebut adalah para investor yang menginvestasikan dana mereka untuk riset dan penelitian.

Jumlah dana yang diinvestasikan tersebut tidaklah kecil. Profesor dari Fakultas Kesehatan Universitas Tufts, Joseph Dimasi, dalam jurnalnya yang berjudul “Innovation in the pharmaceutical industry: New estimates of R&D costs” memberi estimasi, agar sebuah obat bisa dipakai oleh pasien dari nol, dibutuhkan waktu riset selama 12,5 tahun dan dana sebesar 2,8 milyar Dollar Amerika, atau lebih dari 35 triliun rupiah (DiMasi, 2016).

Dana tersebut tentu bukan jumlah yang sedikit. Tanpa adanya perlindungan terhadap HAKI, tentu insentif para investor untuk menginvestasikan uang yang mereka miliki menjadi berkurang, dan bahkan hilang. Hal tersebut tentu akan sangat merugikan banyak pihak, terutama konsumen yang membutuhkan obat-obatan medis terbaru, karena riset dan penelitian menjadi terhambat.

Akan tetapi, bukankah HAKI di bidang medis akan mendorong perilaku rakus yang dilakukan oleh berbagai perusahaan farmasi demi keuntungan sebesar-besarnya?

Memang, kerakusan perusahaan farmasi demi meraih keuntungan sebesar-besarnya merupakan karikatur yang kerap digambarkan oleh para aktivis dan para politisi yang memiliki haluan kiri.

Namun, kenyataannya tidaklah demikian. Perusahaan farmasi asal Britania Raya GlaxoSmithKline (GSK) misalnya, memberlakukan kebijakan pemotongan harga obat yang mereka jual di negara-negara berkembang sebesar 25% dari dengan harga di negara-negara maju. Selain itu, perusahaan farmasi asal Swiss, Novartis, sejak tahun 2011, telah mendistribusikan lebih dari 850 juta obat anti malaria ke lebih dari 60 negara dengan jumlah penderita malaria tertinggi, tanpa mengambil profit sama sekali (Medicine for Malaria Venture, 2019).

Lantas, bila demikian, bagaimana kita dapat mengatasi biaya obat-obatan medis yang tinggi?

Cara untuk mengatasi hal tersebut bukanlah dengan menghapus HAKI, karena hal tersebut akan menghilangkan insentif yang sangat dibutuhkan untuk mendorong kemajuan di bidang medis. Solusi yang paling efisien untuk menurunkan harga obat-obatan agar terjangkau adalah menghapuskan berbagai kebijakan pemerintah yang mendorong kenaikan harga tersebut, diantaranya adalah tarif impor dan izin birokrasi yang rumit.

Tarif impor untuk produk obat-obatan medis tentu akan mendorong kenaikan harga barang tersebut di pasar, dimana yang paling dirugikan adalah masyarakat kelas menengah ke bawah. Nepal misalnya, memberlakukan kebijakan tarif impor untuk produk medis sebesar 14,7%. Tarif impor untuk obat-obatan medis di Indonesia sendiri adalah 4,3% (IDN Times, 2019).

Izin yang rumit dan berbelit juga merupakan hal yang tentu sangat menghambat perkembangan dan membuat biaya obat menjadi meningkat. Berdasarkan laporan Tempo misalnya, Menteri Kesehatan, Terawan Agus Purwanto, menyatakan bahwa izin peredaran obat baru di Indonesia bisa memakan waktu hingga berbulan-bulan, ia berjanji akan mengatasi persoalan tersebut (Tempo, 2020).

HAKI di bidang medis merupakan hal yang patut untuk dijaga demi mendorong perkembangan sains dan teknologi di bidang medis, yang tentunya akan membawa manfaat besar bagi umat manusia. Pemerintah dalam hal ini seharusnya menjadi pihak yang menjaga hak tersebut, bukan menjadi aktor yang mempersulit inovasi melalui berbagai regulasi ketat yang nantinya akan merugikan masyarakat.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Побороти коронавірус з допомогою редагування генів: що це таке і як працює

Кордони закриваються, літаки скасовують рейси, а заводи призупиняють діяльність. Вчені та лікарі працюють над тестами, методами лікування та вакцинами, щоб незабаром надати медичну відповідь. Коронавірус може бути одним з найбільших випробувань, з якими людство стикалися за останні десятиліття, але він не буде останньою загрозою яку нам потрібно перемогти. Саме тому настав час звернути увагу на напрацювання біонауки та дозволити застосування методів генетичної зміни.

Для звичайної людини весь хайп навколо технологічного прогресу, мутагенезу та генної інженерії важко осмислити. Мені особисто знадобилось багато читати, щоб почати розуміти, які існують різні методи, і як вони можуть масово покращити нашу якість життя.

Давайте спочатку розглянемо чотири найпоширеніші способи зміни генів рослин чи тварин:

Доктор Ікс – Мутації самі по собі просто трапляються регулярно в природі. Саме таким чином деякі амінокислоти призвели до виникнення людини мільярд років пізніше. Біологічна еволюція може відбутися лише завдяки мутаціям. Мутації в природі відбуваються випадковим чином або викликані екзогенними факторами, такими як радіація (наприклад, сонце). Для читачів коміксів, люди-X мають мутації які у більшості випадків сталися випадково.

Халк – Мутація через опромінення (мутагени): Один з найпоширеніших способів маніпулювання насінням – це піддавати їх радіації та сподіватися на виникнення позитивних мутацій (наприклад, більшу стійкість до шкідників). Цей метод є дуже поширеним з 50-х років минулого століття, однак є дуже неточним підходом, який має на меті зробити посіви більш стійкими або приємними. Позитивний результат вимагає тисяч спроб. Цей метод широко застосовується та законний майже в кожній країні. У світі коміксів Халк – хороший приклад мутацій, викликаних радіацією.

Людина-павук – генетично модифіковані організми (трансгенні ГМО): процедура створення ГМО заснована на вставленні генів одного виду в гени іншого. У більшості випадків посіви ГМО ін’єктуються білком іншої рослини або бактеріями, що змушує урожай швидше рости або бути більш стійким до певних захворювань. Інші приклади можна побачити при схрещуванні лосося з рибою тилапії, завдяки чому лосось росте вдвічі швидше. Людина-павук укушена павуком раптом яка змогла піднятися на хмарочоси завдяки своїй посиленій павуко-людській ДНК (трансгенній) – приклад з коміксу.

GATTACA / Гнів Хана – редагування генів (ножиці): останній і найточніший спосіб зміни генів організму – так зване редагування генів. На відміну від традиційних ГМО, гени не імплантуються з іншого організму, а змінюються всередині організму завдяки точному методу або дезактивації певних генів, або їх додаванню.

Це можна зробити навіть у дорослих людей, які живуть, що є благом для всіх, хто страждає генетичними порушеннями. Ми здатні «відновити» гени в живих організмах. Редагування генів також в тисячі разів точніше, ніж просто бомбардування насіння радіацією. Деякі застосовані приклади дезактивації гена, відповідального за вироблення глютену в пшениці: Результат – пшениця без глютену. Існує кілька методів, які цього досягають. 

Однією з найпопулярніших в наші дні є так званий CRISPR Cas-9. Ці “ножниці” є зазвичай перепрограмованими бактеріями, які передають нову інформацію про ген або деактивують неіснуючі або небажані гени. Багато науково-фантастичних романів і фільмів показують майбутнє, в якому ми можемо деактивувати генетичні дефекти і вилікувати людину від страшних захворювань. Деякі приклади історій, в яких використовувались подібні до CRISPR методи, – це фільми, такі як GATTACA, Зоряний шлях: Гнів Хана, або серіал Expanse, в якому редагування генів відіграє вирішальну роль у вирощуванні сільськогосподарських культур у космосі.

Яке відношення це має до коронавірусу?

Біологи-синтетики почали використовувати CRISPR для синтетичного створення частин коронавірусу, намагаючись запустити вакцину проти цього захворювання легенів і зможуть дуже швидко його масово виробляти. У поєднанні з комп’ютерним моделюванням та штучним інтелектом найкраща конструкція такої вакцини розраховується на комп’ютері та потім синтетично створюється. Це прискорює розробку вакцини і скорочує її з роками до лише місяців. Регуляторні органи показали, що в кризові періоди вони також можуть швидко затвердити нові процедури тестування та вакцинації, які зазвичай потребують років назад та назад з такими агенціями, як Міністерство Охорони Здоров’я?

Серед іншого, CRISPR дозволяє “шукати” конкретні гени, також гени вірусу. Завдяки чому стало можливим створення створити швидких та простих процедур тестування пацієнтів на коронавірус.

Зрештою, редагування генів може дати нам можливість підвищити імунітет людства, змінивши наші гени та зробивши нас більш стійкими до вірусів та бактерій.

Коронaвірус – це не остання криза

Хоча коронавірус є своєрідним екзаменом для сучасного суспільства, ми також повинні усвідомлювати, що він не буде останнім збудником, який може вбити мільйони. Якщо нам не пощастить, корона може швидко мутувати і з ним стане важче боротися. Наступні небезпечні віруси, грибки чи бактерії, ймовірно, не за горами. Отже, нам потрібно підтримувати новітні винаходи біотехнології, а не блокувати генетичні дослідження та доступ до їх результатів.

Наразі чимало тяганини і навіть прямо заборони стоять між інноваціями з величезним потенціалом, такими як CRISPR та пацієнтами по всьому світу. Нам потрібно переосмислити нашу неприязнь до генної інженерії та прийняти її. Постійна боротьбa з новоявними хворобами потребує сучасних відповідей.

Originally published here.


Merci la science! Un guide d’auto-assistance pour le coronavirus

Comment répondre à nos besoins en période de confinement ? Voici un guide des innovations qui nous permettent de passer ce désagréable moment.

Les deux dernières semaines ont probablement été les moments les plus étranges de la plupart de nos vies. Peu d’entre nous ont connu une restriction aussi massive de leurs voyages et de leur vie sociale avant l’apparition du coronavirus. Même en tant que passionné d’aviation et grand voyageur, je n’ai même pas vu l’immobilisation au sol de flottes entières d’avions au lendemain du 11 septembre 2001.

Les réunions d’affaires, conférences ou événements sportifs semblent être suspendus pendant au moins les six à huit semaines à venir. Ce n’est probablement qu’une question de temps avant que la plupart des pays ne ferme les salles de sport et les pubs.

Ce sera un défi non seulement pour l’économie, mais aussi pour notre vie sociale. Il sera important de garder le moral et la santé mentale. Il s’avère que des conversations vidéo régulières, mais très informelles avec des amis et des collègues, autour d’un verre, peuvent beaucoup aider à soulager l’anxiété accumulée par l’hystérie médiatique et le sentiment de ne pas être maître de la situation, impuissant.

Alors que nous essayons tous de nous adapter à une nouvelle réalité pour les 6 à 10 prochaines semaines, il y a aussi des raisons pour lesquelles je suis très heureux que cette crise survienne en 2020 et non en 2000. Beaucoup d’innovations se sont produites dans ce nouveau millénaire dont nous devrions être extrêmement reconnaissants.

Avant tout, nous devrions bien sûr être reconnaissants envers toutes les infirmières et tous les médecins qui ont aidé les patients en première ligne de l’épidémie. Ce seront des mois difficiles pour tous les professionnels de la santé et ils devraient recevoir tout le soutien nécessaire.

Et avant de nous plonger dans l’innovation médicale et la recherche d’un vaccin, regardons qui d’autre nous aide à prendre de la distance sociale, à nous isoler et à aplatir la courbe.

BESOIN DE TRAVAILLER ?

Les outils de travail à distance tels que Zoom, Asana ou les outils de Google ont déjà révolutionné le monde du travail. La plupart des réunions peuvent être converties en appel vidéo.

Ainsi, l’économie du savoir ou les emplois de défense des droits, comme ceux de mon organisation, peuvent au moins continuer à être productifs. Mais il est évident qu’il y a aussi la vie au-delà du travail et qu’il faut s’en occuper, y compris la garde des enfants.

BESOIN DE NOURRITURE ?

Grâce à des services de livraison de produits alimentaires tels qu’AmazonFresh et Ocado, j’ai pu constituer une bonne quantité de réserves de conserves, de produits secs et de produits pour la salle de bains, sans même avoir à me battre pour les derniers produits dans certains supermarchés presque vides. Au cours des prochaines semaines, nous aurons des livraisons régulières de produits frais, vu que je ne me contenterai pas de pâtes tant que corona ne sera pas vaincu. 

Les services de livraison de nourriture permettent de travailler encore plus facilement à domicile, tout en créant de la valeur, et d’être nourri par Papa John’s, Nando’s ou notre restaurant indien local. Domino’s Pizza est allé encore plus loin et vient de m’envoyer un courriel annonçant « Contact Free Delivery » au Royaume-Uni et en Irlande (j’habite à Londres) :

« En introduisant la livraison sans contact, nous pensons que nous donnerons à nos clients la tranquillité d’esprit lorsqu’ils commandent un Domino’s, tout en protégeant nos livreurs.

Vous pouvez sélectionner une livraison sans contact lors du passage de votre commande sur notre application ou notre site web. Votre chauffeur vous appellera à son arrivée pour convenir de l’endroit où vous souhaitez que votre nourriture soit laissée. Une fois la commande passée à l’endroit convenu, le chauffeur se tiendra à au moins deux mètres de vous pendant que vous irez chercher votre commande. Pour que le service soit vraiment sans contact, toutes les commandes de livraison sans contact doivent être prépayées en ligne ou par téléphone ».

Après m’être occupé de toute la pizza et du papier toilette dont j’ai besoin dans un avenir proche, il est maintenant temps d’examiner quels seront les besoins en matière de divertissement.

BESOIN DE DIVERTISSEMENT ?

Netflix et Amazon arrivent directement dans ma vie et, comme l’a fait remarquer ma collègue Maria, « c’est un fléau avec le WiFi ». Il n’est donc pas nécessaire d’aller dans le magasin de location de vidéos qui a fermé ses portes, mais vous pouvez diffuser en continu toutes les saisons de Buffy, et si cela dure plus longtemps que prévu, même Angel, directement chez vous.

Ma salle de sport vient de m’envoyer un e-mail m’informant qu’ils avaient un cas de COVID-19 et qu’ils sont actuellement fermés pour un nettoyage en profondeur. C’est bien que Kelli et Daniel de Fitness Blender aient plus de 500 vidéos d’entraînement gratuites sur YouTube. Sortez vos tapis de yoga !

Mais Buffy et HIIT ne sont pas disponibles en quantité suffisante pour une journée. Heureusement, les jeux vidéo (auxquels je n’ai pas prêté attention depuis longtemps) sont maintenant surtout diffusés en streaming ou téléchargés. Mes amis des médias sociaux m’ont recommandé Red Dead Redemption 2The Witcher 3 et Europa Universalis IV (probablement trop compliqué pour moi). Je pense donc que nous sommes tous prêts ici aussi !

BESOIN DE MÉDICAMENTS ?

Passons maintenant à l’une des plus grandes inventions de ces dernières décennies : les pharmacies en ligne ! Venant d’Allemagne et ayant travaillé dans le domaine de la politique de santé, je suis toujours perplexe quant à l’ampleur de la lutte contre les pharmacies en ligne et les ordonnances électroniques. En ces temps d’isolement et de distanciation sociale, ces deux mots sonnent comme de la musique à mes oreilles. 

J’ai pu commander et stocker toutes sortes de médicaments délivrés uniquement sur ordonnance, tels que des médicaments contre l’asthme, des inhibiteurs de la pompe à protons et des antibiotiques, sans même quitter mon appartement ; et tout cela LÉGALEMENT (avertissement : je souffre d’asthme) ! Il vous suffit de consulter un médecin en ligne ou de répondre à un quiz et de recevoir une ordonnance électronique.

C’est un soulagement énorme pour le système de santé, déjà mis à rude épreuve, car les patients n’inondent pas les cliniques juste pour demander des ordonnances et les pharmaciens peuvent se concentrer sur la production d’un plus grand nombre de désinfectants.

RÉJOUISSONS-NOUS DE CES INNOVATIONS

La plupart de ces services et entreprises mentionnés ci-dessus n’existaient même pas il y a vingt ans. Grâce à l’innovation et à la concurrence, les entrepreneurs ont mis au point ces nouvelles façons de servir les clients. C’est étonnant et, même si ce n’était peut-être qu’un simple gadget il y a quelques semaines, tout, de la vidéoconférence aux prescriptions électroniques, rend cette crise beaucoup plus gérable. Nous devrions nous en réjouir !

Il est évident qu’il existe des groupes vulnérables et que de nombreuses personnes souffriront lourdement du virus. C’est pourquoi nous avons besoin de plus d’innovation. Il y a déjà une course au premier vaccin et d’autres sociétés pharmaceutiques travaillent à la réorientation des antiviraux utilisés par exemple pour lutter contre le virus Ebola.

Certaines études suggèrent que certains médicaments contre le paludisme pourraient être utiles pour renforcer le système immunitaire des patients gravement malades atteints de coronaropathie. Il s’agit souvent de médicaments récemment découverts dont le développement nécessite beaucoup de temps et de capitaux. 

Nous devrions être reconnaissants pour l’innovation en médecine et admettre que ces percées ne sont possibles que grâce à des chercheurs enthousiastes et à l’appétit d’innovation risqué du secteur privé.

C’est pourquoi, à l’Agence pour le choix du consommateur (Consumer Choice Center), nous continuons à nous battre (depuis nos ordinateurs portables) pour le choix, l’innovation et l’élaboration de politiques pro-science. Nous en tirerons profit lors de la prochaine crise (un robot de garde d’enfants inclus) !

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

In times of Coronavirus: policy-makers won’t stop legislating your consumer choice away

Disclaimer: Independently of my arguments in this blog post, it remains very important that sanitise your hands regularly, avoid physical contact with other people, and reduce your social interactions to the necessary levels. Particularly avoid contact with elderly people, and those with underlying health conditions. Consult your local government health websites for more information, particularly on detecting symptoms. 

As the world is paralysed by the Coronavirus crisis, many people have altered schedules. Working from home, different commute, restrictions on crossing borders and severely impacted air travel: for a while, our lives will look very different. While healthcare workers and medical researchers are working around the clock to provide life-saving help and discover possible cures, our media attention is shifting away from our day-to-day worries to the well-being of our friends and family.

Meanwhile, policy-makers are not on a break. In the United States Senate, the re-authorisation of the Patriot Act was passed, giving warrantless collection of personal data an extension of 77 days. The French National Assembly is currently suspended, yet set to resume next week with a debate on nuclear deterrence, as President Macron has been criticised for not keeping his word on the reduction of nuclear weapons capabilities. In Russia, President Vladimir Putin changed the constitution on March 14, allowing him to run for yet another two terms. Just last week, the UK Parliament narrowly voted down an amendment that would have banned the Chinese telecommunications operator Huawei, under considerable flack for not guaranteeing consumer privacy, from engaging in the UK market. 

What we’re also experiencing is a number of media stories on harm-reduction tools such as e-cigarettes and heat-not-burn products being dangerous in times of the virus, leading the way to further restrictions from governments. As consumers are paying attention to their own health and that of their families, authorities have an easier time passing otherwise unpopular decisions. Thus, consumers remain forced to consider their own attention as a valuable resource: the fight for consumer choice doesn’t rest.

Note that as a follower of the work of the Consumer Choice Center, you can send in tips through this website, making us and our volunteers aware of current events in the realm of consumer choice. Your local municipal council or government might be in the midst of trying to pass certain measures unnoticed, as news outlets are focused on this pandemic. Consumers will know that it is always a bigger struggle to repeal active legislation, than it is to stop those rules that are in the process of being made.

Some bans limiting consumer choice hurt especially in times of self-isolation: Home deliveries of alcohol, bans on online pharmacies, and limited opening hours of supermarkets are things you really don’t need right now.

Ultimately, legislators and regulators should give consumers a break, not only because people have more important things to do, but also because from a democratic standpoint, new restrictions ought to be carefully weighed and debated, before they pass the houses of parliament on the same day as people see their loved ones transported into emergency rooms. There are smart rules and relief for consumers that are being passed as we speak, and they should be applauded, but reductions in consumer choice need their fair share of input before they go to a vote.

For the sake of the standards we expect governments to abide by, let’s give consumers a break on new taxes, new bans, new infringements on their personal privacy, and new paternalistic policies. 


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

What we should be thankful for: A CORONA SELF HELP GUIDE

The last couple of weeks were probably some of the strangest times in most of our lives. Only few of us have seen such a massive restriction of travel and social life prior to the coronavirus. Even as an aviation geek and frequent traveler, the grounding of entire fleets of planes is something I haven’t even seen in the aftermath of 9/11.

Physical business meetings, conferences, or sports events seem to be off for at least the next six to eight weeks. It is probably only a matter of time until most countries close down gyms and pubs. This will not only be a challenge for the economy but also for our social lives. Keeping up morale and mental health will be important and I figured out that regular but very casual video chats with friends and colleagues (over a drink) can help a lot to ease the anxieties built up by media hysteria and the feeling of not being in control of the situation (helplessness).

So while we are all trying to adjust to a new reality for the next 6-10 weeks there are also reasons why I am very happy that this crisis happens in 2020 and not in 2000. There are many innovations that happened in this new millennium we should be extremely thankful for.

First and foremost we should of course be thankful for all the nurses and doctors helping patients at the frontlines of the outbreak. This will be some challenging months for all healthcare professionals and they should receive all necessary support.

And before diving into medical innovation and the search for a vaccine let’s look who else is helping us to social distance, self-isolate, and flatten the curve.

Remote working tools such as Zoom, Asana, or Google Suite have already revolutionized the workplace. Most meetings can be switched to a video call. So at least the knowledge economy or advocacy jobs such ours can still keep being productive. But obviously there’s also life beyond work and that needs to be taken care of (including child care).

Thanks to grocery delivery services such AmazonFresh and Ocado I was able to build up a good amount of supplies of canned and dried foods and bathroom supplies even without having to fight for the last products in some nearly empty supermarkets. For the next few weeks we have regular deliveries of fresh foods so I won’t run fully on Mac n Cheese until corona is defeated. 

Food delivery services make it even easier to work from home, still create value, and being fed by Papa John’s, Nando’s, or our local Indian restaurant. Domino’s Pizza went even further and just sent me an email announcing ‘Contact Free Delivery’ in the UK and Ireland:

“By introducing Contact Free Delivery, we believe that we will give our customers peace of mind when ordering a Domino’s, while also protecting our delivery drivers.

You can select a Contact Free Delivery at the checkout on our app or website when placing your order. Your driver will call you when they arrive to agree where you want your food left. Once the order has been placed in the agreed location, the driver will stay at least two meters away while you collect your order.  To ensure the service is truly contact free, all Contact Free Delivery orders must be pre-paid online or over the phone.”

Having taken care of all the pizza and toilet paper I need for the foreseeable future it is now time to look at what entertainment needs will be important. Netflix and Amazon stream directly into my living and as my colleague Maria pointed out “It’s a plague with WiFi”. So no need to go to the defunct video rental store but be excited to stream all seasons of Buffy (and if this goes longer than expected even Angel) directly into your home.

My gym just emailed me that they had a case of COVID-19 and they are currently shut down for deep cleaning. Good that Kelli and Daniel of Fitness Blender have over 500 free workout videos on YouTube. Get your Yoga Mats out!

But there’s only so much of Buffy and HIIT you can take a day. Fortunately video games (which I haven’t paid attention to for a long time) are now mainly also being streamed or downloaded. My social media friends recommended me Red Dead Redemption 2, The Witcher 3, and Europa Universalis IV (probably too complicated for me). So I think we are all set here as well!

Now to one of the greatest inventions of the past decades: Online pharmacies! Coming from Germany and having worked in health policy I am always puzzled how much vested interest fights against online pharmacies and e-prescriptions. In times of self-isolation and social distancing these two words sound like music to my ears. 

I was able to reorder and stock up all sorts of prescription only drugs such as asthma medicine, proton pump inhibitors, and antibiotics without even leaving my flat – and all of this LEGALLY (disclaimer: I do have asthma)! You just have an online consultation with a doctor or take a quiz and receive an electronic prescription. This is definitely a massive relief on the already challenged health system as patients don’t flood clinics just to ask for prescriptions and pharmacists can focus on producing more sanitizers.

Most of these above mentioned services and companies did not even exist two decades ago. Thanks to innovation and competition entrepreneurs carved out these new ways of servicing customers. This is amazing and while it might have been a mere gimmick some weeks ago, everything from videoconferencing to electronic prescriptions makes this crisis much more manageable. We should be thankful for that!

Obviously there are vulnerable groups and many people will suffer heavily from the virus. That’s why we need more innovation. There’s already a race to the first vaccine and other pharmaceutical companies are working on repurposing antivirals that are being used for instance in fighting the Ebola Virus. Some studies suggest that certain Malaria medication might be helpful to boost the immune system of severely sick corona patients. These are often recently discovered drugs that require a lot of time and capital to be developed. 

We should be thankful for innovation in medicine and acknowledge that these breakthroughs are only possible thanks to keen researchers and a risky appetite for innovation shown by the private sector. This is why we at the Consumer Choice Center keep fighting (from our laptops) for choice, innovation, and evidence-based policy making. We will benefit in the next crisis from it (a child care robot included)!


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Scroll to top