Low-quality life, low-quality death
Irina Vlasova, Gazeta, 25.06.2008
The two-day All-Russian Medical Forum "Medicine for Quality of Life" ended in Moscow yesterday. It was opened by the first deputy chairman of the State Duma Committee on Health Protection, United Russia Nikolay Gerasimenko. Deputies, representatives of the scientific world and practicing doctors unanimously recognized that the level of quality of life of Russians and the level of medical services provided currently leave much to be desired.
"Health is only 10% dependent on medicine," health officials like to repeat, speaking about the quality of life of patients. Apparently, this percentage is greatly overestimated. "Today, every third diagnosis is made by Russian doctors by mistake," Vladimir Kucherenko, Deputy director of the Sechenov MMA Research Institute of Public Health and Health Management, announced to the forum participants.
Even if the diagnosis is correct, it still does not give any guarantees to the patient to survive or die with dignity. Russia has the lowest life expectancy in Europe after an oncological diagnosis – only 43% of patients live with cancer for five years. At the same time, in 20 countries of Europe and the USA, in the period from 1995 to 2003, the use of new cancer drugs reduced cancer mortality by 30%. In Russia, this indicator is only growing.
The reason is simple – there is no system of guaranteed access of citizens to innovative antitumor drugs in the country, and only they cure the disease. At the same time, there are 2.5 million such patients in Russia, 300 thousand people die from cancer every year, and 150 thousand become disabled. The patient gets access to modern effective medicines only in the later stages of the disease after the disability is registered.
The program of additional drug provision allows only 15% of cancer patients whose diagnoses are included in the federal program "Seven Nosologies" to receive modern drugs. 800 thousand people remain outside this system. Despite the fact that they have a good chance of recovery if treatment with innovative drugs begins on time.
A survey of 3 thousand patients by the Public Opinion Foundation in the summer of 2007 showed that only 44% of cancer patients know that such drugs exist and can provide them with an acceptable quality of life. 50% of respondents stated that their cancer patients are not provided with the necessary medicines at all.
A separate federal program of drug provision of cancer patients with modern drugs that ensure a normal quality of life requires 55 billion rubles. It would seem that where to get them is a difficult question, but world experience gives an answer to it. For example, there are special measures to change the excise policy on tobacco products. Another real measure may be tax incentives for corporate and personal voluntary health insurance programs with coverage for the provision of cancer drugs.
However, if limited resources could serve as an excuse for the inaction of the authorities in relation to oncology, then such large expenses are not required for the medical provision of a decent life for dying patients. Vasily Shakhgildyan, senior researcher at the Federal Scientific and Methodological Center for the Prevention and Control of AIDS, called the level of palliative (relieving the condition) medical care for HIV patients in the AIDS stage at yesterday's forum nightmarish and prehistoric. Hospices, in which cancer patients are living out their last months, do not take people dying of AIDS, just as they do not take them to ordinary hospitals. At the same time, 63% of these patients suffer from pain that could be stopped. We are not even talking about psychological suffering.
"Today our pharmaceutical department has narcotic analgesics, which are only enough for 200 people," Olga Osetrova, the head physician of the autonomous non–profit organization Samara Hospice, said in her speech. According to her, only the Samara region needs six times more analgesics. At the same time, the chief physician believes that the lack of medicines is due to outdated norms for narcotic drugs.
Sergey Rudoy, Associate Professor of the Department of Palliative Care at the Sechenov MMA, said that currently the regulatory documents have been updated. The problem is that local officials still do not know how to make high-quality applications for the required drugs.
Portal "Eternal youth" www.vechnayamolodost.ru25.06.2008