If things are so bad in France, just imagine what is it like in India .....

French drug consumption

Pass the pills

A scandal reminds patients of the health risk from taking 

too many drugs

Feb 10th 2011 | PARIS | from the print edition of the Economist

THE French are Europe's champion medicine-takers. No self-respecting family leaves the doctor's surgery without a multiple prescription for drugs to treat even minor ailments. There are substances to squirt up the nostrils for a cold, suppositories for all sorts of complaints and treatments for such bizarre ills as "heavy legs". Every so often, the health authorities strike a batch of drugs off the list for reimbursement under the social-security rules, because of "insufficient therapeutic value". Last year the reimbursement rate was cut for 150 medicines judged, in effect, useless.

A public-health scandal has now awoken the French to the dangers of a heavy drug-consumption culture. This week Jacques Servier, founder and boss of Servier Laboratories, was due to appear in court in connection with a criminal lawsuit (The pharmaceutical lobby in France is strong. Before the drug was withdrawn, Mr Servier was awarded the country's highest distinction, the Légion d'Honneur, by President Nicolas Sarkozy)  brought by patients who took a drug called Mediator. It was originally licensed for diabetics, but family doctors began to prescribe it in the mid-1990s as an appetite-suppressant. Despite the ringing of alarm bells over the years about its links to heart disease, both in other countries and within the French medical profession, the drug was not withdrawn in France until 2009. By that time, according to different estimates, between 500 and 2,000 people who had been taking the drug had died.

The story has rattled the French, knocking their faith in the competence of the public-health authorities. A report into the Mediator affair ordered by Xavier Bertrand, the health minister, published last month, is devastating. It observes "grave failings" on all sides, from the laboratory's "relentless" campaign to continue to market the drug "out of line with its medical properties", to the health authorities' cumbersome bureaucracy. "The medical-drug chain functions today in such a way that the doubt benefits not the patients or public health, but the companies," it concludes.

The French Agency for Health-Product Security has now hastily decided to publish a list of 77 drugs it has "under reinforced surveillance", because of undesirable side-effects. Yet this list, says Prescrire, a non-profit medical body, is also misleading, since it mixes drugs that should be urgently withdrawn with ones that, for certain patients, are justifiable. It urges patients not to swallow prescribed medicines uncritically. Professor Philippe Even of the Institut Necker, a research body, reckons that, of 5,000 or so drugs available in France, "nearly half serve no useful purpose", and many of those may be harmful. In 2010 the French public-health system had a €12 billion ($16 billion) shortfall. Spot the connection.
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