"Big Prevention": the innovative prevention industry

"Imagine you're the Minister of Health, but on a tundra. And the tribal chief asks you to set up a healthcare system from scratch. The goal is to get the average life expectancy of the tribe as high as possible. Where would you invest the money from health premiums first?"

With this question, our lecturer opened the first lecture of the new subject "health economics" a quarter of a century ago. My fellow students and I quickly realised that if you sort out clean drinking water, sanitation, antibiotics and good maternity care, the average life expectancy of the tundra tribe soon rises to 45 years. After that, the investment required per life-year gained rises rapidly. In the Netherlands, in 2022, we're now reaching 85 years, with a healthcare system that costs more than 100 billion euros a year for just over 17 million people.

However good our healthcare system may be, people will keep falling ill, and that's partly why we need innovative medicines. Fortunately, wonderful new medicines keep being invented. Unfortunately, those new medicines are also increasingly pointed to as the cause of the cost pressure on healthcare. Big Pharma did it all.

At the macro level this is easy to refute; I looked into it myself as part of my work at the end of last year (for those interested: roughly 4% of our healthcare budget goes to innovative medicines, and this share is growing more slowly than the rest of healthcare spending). At the hospital level, however, things are genuinely different; in recent years innovative medicines have become concentrated mainly in a small group of the largest hospitals, without the budgets of these hospitals being allowed to grow accordingly. The result: pressure on the hospital budget.

When I listen to the rhetoric about medicines in the public debate, I get the feeling that in the Netherlands we want the best seats for the cheapest price; we do want new medicines, but we don't want to pay much for them.

But I think there's more going on.

“Do we keep investing in getting just a little bit older, or do we make the time up to our 85th more vital and happier?”

Could it perhaps be that in the predominantly Calvinist Netherlands we increasingly fail to see the added value of the medicine? And is there not something to be said for that? The Dutch healthcare system is often named as one of the best in the world. And we have a high life expectancy. If you ask me, we're now facing an important choice; do we keep investing our innovative power in getting just a little bit older at the far end of the curve, or do we try to make the time up to our 85th ever more vital and happier?

Concretely, that would mean investing more in, for example, a healthy food chain. In mental healthcare, in healthy living, in education, and less in medicines for people over 80.

So the solution is: cutting back. If we smoke less, eat and drink less, and sunbathe less, we'll need fewer medicines at a relatively young age.

And that is precisely where the opportunity lies for innovative pharmaceutical manufacturers to get back to the table with healthcare administrators and healthcare professionals. Thinking along and working together on initiatives that allow us to manage with fewer medicines. An innovative manufacturer that makes medicines against lung cancer or COPD could help with smoking prevention, and contribute to the fight against Big Tobacco. A manufacturer of diabetes medicines could help with a sugar tax, or with banishing soft drinks from primary schools and sports canteens. A manufacturer of skin cancer medicines could campaign against sunbeds, and for sunscreen.

Marketing guru Jos Burgers once said: "It's only when you advise against yourself that you truly become credible." So; for which patients would you advise not using medicines at all? How long should you keep treating cancer? Or; which patients perhaps shouldn't even start treatment?

“It's only when you advise against yourself that you truly become credible.”

I therefore propose transforming Big Pharma into Big Prevention; the industry that works worldwide and professionally to prevent disease, and helps keep healthcare affordable. And should you fall ill after all, then they'll have a fine new medicine for that too. They have everything needed for it; knowledge of disease and science, the drive to implement, and above all: many capable and highly educated employees with a passion for health.