Professor Christof von Kalle, doctor and scientist at the Charité. Photo: PF
“Medical innovations have led to a continually increasing life expectancy” – says Professor Christof von Kalle, doctor and scientist at the Charité and one of the leading oncologists in this country. Especially in the case of cardiovascular diseases and increasingly also in cancer, we can see how mortality has reduced or is decreasing: “Medicines play a significant role in this,” says von Kalle. And emphasizes: “Many of the drugs that we use in the cardiovascular area have a preventive effect: you lower your blood pressure, you adjust your blood lipid levels, you look at the risk profile – and treat the problems that lead to the later illness, such as a heart attack or stroke.” He sees the benefits of modern medicine in the area of infant or childbed mortality as more or less forgotten. Or “how pharmaceutical development pulled the HIV problem out of the fire.” Or with the Covid vaccines, which greatly limited the impact of the pandemic. “Especially in Germany, we have this navel-gazing of costs and are therefore not able to enjoy the effects enough.”
When it comes to cancer, scientist von Kalle sees the problem that far too little is being done in the area of prevention. “At the same time, we are making very rapid clinical-therapeutic progress.” This will accelerate in the coming years – keyword: personalized medicine. “Genetic tests for cancer allow us to carry out a completely different type of diagnosis. There’s still a lot of potential.”
Affordability: Hypnotizing drug costs
Christof von Kalle also has a clear opinion on the affordability of modern medicine: “We are always hypnotized by the cost of medicines.” For cancer drugs, “we always hear that they bring the system down when we do personalized medicine , we see: They make up around 20 percent of the pharmaceutical expenditure of the statutory health insurance companies, around 4 percent of the statutory health insurance revenues and correspond to 0.4 percent of the gross domestic product. If that were to double by tomorrow, it would still be lost in the background noise.” With regard to the alcohol and tobacco taxes – the federal government takes in 16.4 billion euros from them per year – he says: “These – let’s say – cancer-causing ones Taxes are almost as high as the entire therapy costs us.”
Medicines: A “prescription against the cost disease”
Professor Dr. Stefan Felder, health economist at the University of Basel. Photo: PF
An economist naturally has a different view of pharmaceuticals. Professor Dr. Stefan Felder, health economist at the University of Basel, emphasizes how independent the entire health sector is from economic fluctuations. Even during the financial crisis of the noughties or during the pandemic, health spending remained stable: “From an economic point of view, the health sector is much more resilient than other sectors.” Overall, Felder sees the demographic effects in the development of health spending as overestimated: “We become wealthier and the demand for health services increases with income development.”
What’s weighing on the healthcare sector is labor intensity, Felder said; The area is suffering from Baumol’s disease, also known as cost disease. It affects professions in which rationalization is difficult, as is the case with caring for sick people. The professor sees digitalization as a possible solution because many processes can be simplified. This starts with the help of bureaucratic processes and does not stop with the use of robots that can be used in care. Medicines are also “a prescription for Baumol’s disease,” he says. In this way, they can help to shorten lengths of stay in clinics or reduce consultations, thereby contributing to greater efficiency in the healthcare sector.
Medicine as an element of social peace?
Prof. Dr. Bertram Häussler, doctor and sociologist. Photo: PF
Prof. Dr. makes a completely different point. Bertram Häussler. The doctor and sociologist sees politics confronted with problems of legitimacy and loyalty on the part of the population. In the period after the World War, the state developed into an interventionist state and thus fueled the expectation that everything would be taken care of. The payoff for this: If this doesn’t work, dissatisfaction grows and the state system loses the loyalty of its citizens. An example of this: the discussion about the shortages of medicines. Because “health” has become increasingly important to people in recent years, they expect the availability of medicines in general and the supply of drug innovations in particular; they expect to participate in medical progress. Häussler’s conclusion: Given the number of issues that are currently challenging people’s loyalty to their state – be it rising prices, housing shortages, wars or migration – “you should also use issues that build loyalty, such as pharmaceuticals.”
After the 3 impulses, the “drug as a pure cost factor” was effectively eliminated. In the subsequent discussion, Dorothee Brakmann, head of the German Pharma Association, made it clear that the intense cost pressure on medicines had led to problems such as delivery bottlenecks. “I encourage people to rethink things. Pharmaceuticals as part of the healthcare industry – that is a job driver. We contribute a lot to Germany’s performance. We keep the population healthy.” Dr. Stefan Plenk from the Mining, Chemical and Energy Industrial Union (IGBCE) shed light on the employee perspective: “We agree with the employers when it comes to the future of pharmaceuticals as a key factor. We represent around 1 million employees here who generate gross added value of around 90 billion euros per year. It is a sector with very good wages.” Very innovative collective agreements have been concluded that also strengthen the social system, such as company nursing care insurance.
Politicians have recognized the value of the drug; The National Pharmaceutical Strategy states: “Medicines are essential for people’s health and an essential factor in medical progress. The pharmaceutical industry is a key sector and a leading industry in the German economy. A long-term strong pharmaceutical industry is of great importance for health care and the business location.” Medicines can do a lot: it is an instrument that promotes health, can relieve the burden on social security funds, provides economic policy impulses, has a stabilizing effect in economically weak phases, and creates high-quality jobs as well as research, development and innovation.
And yes: it also costs something.
