26 Nov 2018 - 28 Nov 2018
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TAKING STOCK - Taking Stock
EAPM Director Dialogues - Ian Banks
Ian Banks has been president of the European Men’s Health Forum since its launch in 2001.
He is a retired accident and emergency doctor and general practitioner as well as a former president of the Men’s Health Forum (England and Wales), past vice president of the International Society of Men’s Health, and past deputy editor of the Men’s Health Journal. He was, for six years, the medical editor for Men’s Health magazine. As well as several others, Banks penned the BBC book The Trouble with Men.
He was appointed visiting professor of men’s health in Europe by Leeds Metropolitan University in 2005 and awarded the Royal Society of Public Health Gold Medal for public health in 2007, followed by appointment to its Academy.
In January 2015, Ian was appointed Visiting Professor in cancer inequalities at Leeds University and to the European Society of Medical Oncologists’ (ESMO) patient advocacy committee.
At the 2015 ECCO/ESMO conference he had much to say about personalised medicine.
“It’s probably a cliché to say that personalised medicine has revolutionised patient care,” says Banks, “but the sad fact is that it has only revolutionised it for a certain number of patients. There’s a huge swathe of patients out there who have not benefited from the advances that are taking place. And I think that’s the biggest issue at the moment. It’s not whether there are the medicines – we know there are the medicines – it’s the access to the medicines which is the critical issue.”
“So I think it is true to say that there is a revolution going on out there but, unfortunately, not everybody has been invited to the revolution party. These are people missing out and we need to address that.”
But there are many barriers, he conceded, adding: “The barriers vary with the personal circumstances and the environments in which people live. It is particularly pertinent for the system of reimbursement in which people may find themselves in their particular country. Sadly, we have a case where the rich get healthier and the poor get less healthy. And personalised medicines will not address this inequality, in fact they’ll probably make them worse – unless we can do something about the access to them in the first place.”
Warming to the theme Banks says that: “We have the potential to change the lives of so many people and, paradoxically, the ones who would benefit most are the ones who are least likely to have access to those particular medicines. They will be the ones to develop the cancers, much more often than they will in the more affluent parts of the world.
”So, those most deserving of the medicines will not be the ones who have access. The barriers are there and are such that they are not insurmountable given the will, given the political importance, attached to using personalised medicines. (With the political will) we could actually see these barriers crumble.
“Yet the anomalies stand that the richest nations will benefit the most and the poorest nations will, yet again, miss out on what is the revolution in healthcare.”
Asked what role politicians, especially at EU level, have to play, Banks argues it’s about ‘presentation’. “I think it’s the case which is presented to them which is so critical,” he says. “It’s not enough to simply say that there’s a humanitarian need for these medicines, there has to be an economic base which the politicians will recognise. I think part of that base will be the economic structure of, not least, the European Union - which is so fundamentally dependent on the workplace.
”We know that people are living longer, we know that some of the diseases – not least cancer – are becoming long-term medical conditions, and we also know that people are being expected to work longer. But you can’t have all those things unless you are prepared to invest in that.”
He continues: “So unless you are prepared to invest in health, there is very little point, really, in raising the retirement age because we know that many of the conditions are age related. People are living longer and are much more likely to develop one of these conditions – particularly cancer – and therefore will be less able to work unless we invest in the medicines that will address that particular condition. The barriers are pretty well recognised, but I don’t think there’s the political will to actually prioritise things like personalised medicines as highly as we could.”
“Some of the places, like Romania, don’t even have chemotherapy, before we even talk about personalised medicines. So they’re a million miles away from what we consider to be not even the gold standard, not even the optimal standard.
“There is an argument here for the EU to take the lead on this,” he insists. “There has been an argument for some time that people should be able to move and migrate on a health basis – people from poorer countries should be able to migrate to the richer countries to obtain medicines and treatments which aren’t available in their own country. I’ve got no problem with this, in fact it sounds to me like a great idea, except that it flies in the face of the mantra which is now out there that ‘health drives the economy’.”
He elaborates: “If you have mass migration, based on health, from poor countries, there is no pressure on that country to actually improve its health record. So, therefore, it will get poorer because health drives the economy. Not the economy drives health – it’s the other way around.
“So there is a very good argument for the European Union – not to stop the health migration, they can’t stop the migration – (to) invest in those countries on health and that will have the impact of improving the economy of the country, so that then they can actually improve the health of the people and have that knock-on effect of improving the economy as well.”
Can ‘patient-power’ help? Banks absolutely believes so: “What is required is to have an even-more active patient advocacy structure which will put so much political pressure on the powers-that-be that they have no choice except to make directives that influence all of the countries in the EU when it comes to health.
“It’s really not good enough when you have an EU that can provide funding for the tobacco industry without actually being able to direct, at all, the health needs of the Member States. So I think what we need is the pressure from the patients…to be able to say ‘This is so important for the economy, as well as for the health of the people, that there has to be the ability for the European Union to make directives.’
And for the future? Banks has what may seem a radical thought: “In the next five years, I would bring in health literacy and health navigation for schools. I would have it as part of the national curriculum for every European state, where people are taught not only how to use the health service but self-care (and) how to use the political clout of patients groups to be able to bring about changes. And I think only in that way will the poorer people in Europe be able to do something about it.”Author: Denis Horgan