Tuesday, 16 August 2011

Swiss Federal Health Office: nicotine addiction is a disease

The Swiss Federal Health Office has determined that basic insurance should cover the cost of treating of nicotine addiction, which is to be treated officially as a disease – 'under certain conditions', yet to be decided. The story is here.

Pfizer has successfully put the case that Champix, among other smoking cessation medications, should be on a list of medications funded under basic insurance. (Not only does this drug have an extensive history of adverse effects – it has also allegedly attempted to conceal these effects from the general public.)

Health care free at the point of delivery is a miracle that our ancestors might only have dreamt of but like any other dream it has a downside. Defining what is 'essential', basic, becomes a matter of political lobbying according to the priorities of the day and is no longer a matter of common sense.

Treating something that is not a disease as if it were a disease and getting the treatment paid for whether by the health department or an insurance company is removing control of the situation from the individual with the affliction. It is also giving easy money to the person supplying the treatment. They don't have to sell it to the public – they have to sell it to the authorities.

Ironically even those who support the reimbursement of smoking cessation costs by insurance schemes are aware of the shortcomings of the medication:
CIPRET says Champix can double the chances of heavy smokers giving up in three months. But Gianfranco Domenighetti, professor of health economics at Lugano University, warns that the controversial medication needs to be well tolerated. “According to a Canadian study, this medicine increases cardiovascular risk by 73 per cent,” he said. Tolerance and effectiveness issues have also been raised for other treatments such as nicotine substitutes or Zyban, an antidepressant used against addiction. But most of all, according to de Haller, “their effectiveness is not 100 per cent guaranteed”. [...]
Some voices, notably in parliament, have suggested that anti-smoking drugs should only be reimbursed if the treatment is successful. De Haller is sceptical about “making people pay in relation to the therapy’s success, when the effectiveness is not 100 per cent guaranteed”.
'Not a hundred per cent guaranteed' is euphemism in style. We learned just the other day that when people  get shopping vouchers to take smoking cessation medication in Scotland they achieve a rate of only 50 per cent at four weeks. The rate drops further in the following weeks.

Health risks and hit-and-miss success rates acknowledged, the court ruling requires that smoking cessation medications can be paid by insurance schemes in the right conditions. The qualifier itself indicates that this medication is not 'basic'. Even if limited in application, the ruling will still provide drug companies with a guaranteed market for a drug that treats a state of mind.

I wonder what Simon Chapman would make of it all?

1 comment:

budgie said...

Some interesting and telling responses to the Simon Chapman article....