753
Bandages can not do
Hematology Alex Maschan: Bandages can not do, and the import ban scanners
Why are we so sorely lagging behind the developed countries, if we can find something good in the domestic oncology - reflects Alex Maschan.
Today, the situation with access to care are much worse than in the notorious capitalist countries, which are actually socialist when it comes to Europe. So how can we have good medicine?
Alex Maschan - Deputy Director of the Federal Center of Pediatric Hematology, Oncology and Immunology named Dima Rogachev, member of the advisory board of the fund "Give Life". Bone marrow transplantation for children with cancer - a "fad" Alexei Maschan. A state of the domestic oncology and hematology - this is his pain.
Source
Lies Russian statistics
- Can we say that in Russia the development of oncology treatment has kept pace with the rest of the world?
- First and foremost, there is no "rest of the world" does not exist. There are 20-25 of developed countries, from which we are sorely lagging behind, despite the claims of our leading oncologists. Apparently, our official speakers see only what is happening in their leading centers, and even then not all but only the most rosy side. The truth is that we are very far behind those countries that should be equal, and the diagnosis and as a result of cancer treatment.
Perhaps you can list a hundred countries, such as Uganda and Rwanda, and it will be even members of the UN, we are significantly ahead. But is it worth to be proud of?
After all, we are lagging behind Germany, France, England, Spain, Israel, America, and even from some of our recent blood brothers - former members of the Soviet Union. Many former Soviet republics have significantly added to the rate of development of medicine.
At us all the energy, unfortunately, goes on beating his chest and claim that we are not worse, and even in many respects better than the others. "There was a case in Germany have not cured the fact that we are here, too, could not cure" - this is the pathos of official rhetoric.
Abroad, too, there is not very good doctors. But the overall level of oncology, for example, in Germany disproportionately higher than the overall level of cancer in our country, so it's even funny to talk about it.
- This gap is reflected in health statistics?
- It is necessary to start with the question, how many cancer patients actually treated in cancer centers and cancer clinics. It seems to me that if the majority of them, it is insignificant. A huge number of cancer patients either do not come to oncologists, or in the district and city hospitals, they do palliative surgery, that is designed not to cure, and symptom relief.
Then they "quietly" die of cancer. These figures do something no one has ever published. The results of treatment for the patients who are known to be the best social conditions, obviously taking into account the best conditions. Therefore statistics, which operates our heads - it's just a lie.
If they are told that "in the center of the X 90% survival rate," that is, in principle, it is better for them not to shake his hand, because they give a false medical information. I'm in your heart can reach 100% survival rate if I will choose the most favorable patients. If they are discharged home on time, we will have 100% of the extract with the improvement. Manipulating such statistics - a low and unworthy. - Why are we so sorely lagging behind the developed countries?
- Because the Soviet Union was a very bad medicine, especially in recent years, and it has only gotten worse in the years of perestroika and, shall we say, of early capitalism. Only in pediatrics managed to keep the good traits of the Soviet health care (eg, availability of doctors, the relative cheapness of drugs).
But the worst features of Western medicine (partial access to doctors, the high cost of drugs and difficulties with the total equal to the involvement of patients in the treatment process), we just absorb like a sponge. Today, the situation with access to care are much worse than in the notorious capitalist countries, which are actually socialist when it comes to Europe.
So how can we have good medicine? We have a good medical education? No, worse. We have our own medical equipment? No, we do not. We own the production of medicines? No. We have not driven postgraduate education of doctors. To become a doctor and work with responsibility for a patient, we need seven years. In France and in America it takes years 12-13.
So why do we have the medicine could be better if all the basic, basic points on which the medicine is, we worse? - In addition, there is a question constantly about money.
- That's what I did not say. Money for medicine in Russia is spent in times less than in other countries. Recently, we had a delegation from the Parliament of the Netherlands, and we started talking about the share of the costs of their healthcare budget. It was found that the costs are the same as in Russia. Only people we have ten times more.
Posted in [mergetime] 1399476315 [/ mergetime]
Foreign not treated
- Recently discussed the draft regulations of the Government - to limit the budget for the purchase of imported medical equipment. You met scanner, assembled in the territory of the Customs Union? Do you know a similar Russian equipment?
- Recently, we have compiled a list of equipment that you need to buy in our center. Of the one hundred positions - two Russian. Yes, some Russian equipment there, but mostly poor, not high-tech. We have a good bandage can not do! Buy-Soviet Russian bandage, try to wrap them human. Like 30 years ago, bandages fibers are not tied, and the end is not torn. Bandages can not do, and talk about scanners.
- Probably, production listed in the draft plan to transfer the technology orders in Russia.
- The question of localization of production - a good and proper. Well, when there is their production, but if the assembly of imported equipment in Russia Russian-made - the question. If someone wants to report the beautiful figures, we can say that we have produced 100 thousand vehicles, "Volkswagen", but it is clear that this screwdriver assembly.
I have not read the draft limits the foreign procurement of medical equipment, and even look at him do not want to.
- However, if the government stops buying imported scanners who will buy them?
- Tomography - this expensive equipment. Its maintenance is also expensive. If such equipment will be buying private entities, so they will have it paid off. This means that the cost of each study will be a very, very high. Then tell me, what we are fighting: for the availability of medicine or someone's business interests? ..
- On it official answer: "In recent years, for natsprogramme" Health "bought so many scanners, that you must first learn how to use the available". We, they say, the density of scanners per capita than anywhere else in the world.
- It's true. But, firstly, it is necessary to consider not scanners per capita, and per square kilometer, which is the population resides. Secondly, even though a huge amount of purchased tomography, the problem is that they set, including at locations where they do not know how to use.
And bought them without service programs, that is, these scanners are not served, no matter what Olga Golodets neither spoke. Neither MRI nor KT-scanners are not served. Naturally, they are a year and a half rise. Not only do they not know how to use very well, so they are still in working order and require millions of repairs.
I'm faced with radiologists in the regions, and they are very good, they are able to assess those studies that do. But if the scanner gets into the hands of a nurse or technician who did not really know why you need it, and only able to pass the patient on the table here and there, that's another matter. But where physicians need to specifically exist at all, they know how to use scanners.
- So, what happens if the new regulation enters into force, and we will not buy any scanners or infusion pumps?
- Then we, like 30 years ago, on the eye drops believe high-dose chemotherapy, are mistaken in infusions. Nedolivaem, emptied ... I've seen domestic infusion pump 15 years ago - a terrible sight. No tears can not watch. The child's mother or rather drops to the eye thinks. This begins an infusion pump to pump air (and then easily into a vein), giving an irregular speed. I do not see any national infusomats that would normally worked. Incidentally, in the exact dosage and administration of medicines built all intensive therapy in modern medicine.
- That is, if the infusion pumps do not buy from the budget, you can either close the clinic, or to rely on charities?
- Foundation for a little, and they are not made of rubber. Hang on charities purchase what should buy a state - a "wonderful" way out. It will allow the State to put money on more useful projects, we know a lot of these.
- In parallel, the official speakers periodically declare that the funds dishonest work and must check the prosecutor's office.
- Prosecutors need more look in the mirror. It seems there is something to do in our country, in addition to verification of funds. Fraudulent charities I have not seen. Well, I made a noise fund "Federation» ...
The Foundation works mainly completely honest and committed people who can account for every penny. If there are minor technical violations - it is not criminal. Sometimes it is necessary to help quickly, sharply and now, rather than six weeks. Then, often need to use a scheme that financial legislation are not encouraged. But this does not mean that the funds are stealing money.
Generics: death as a side effect
- Instead of effective drugs have generic (drugs with the same active ingredient, but with unknown side effects due to the inaccurate formula), how much this problem has your patients?
- Generics - a huge problem. We were rushed generic drugs and so-called biosimilars, ie analogs of protein molecules that are produced by other technologies, by non-chemical synthesis. They have to prove equivalence, and no one does, but they are buying. Prove that they are less effective, it is very difficult: it takes years of observations.
For example, if the total dose chemotherapy in breast cancer after the operation is reduced by only 15% - nine outcomes are exactly the same as if the chemotherapy is not performed at all. Ie the negative effect of generics and biosimilars may appear in three, five, ten years. And to prove that something is impossible, for the statistical analysis we have not adjusted perfectly.
The problem with generics, by the way, is a worldwide, but in developed countries it has been solved. Firstly, there are manufacturers of generic drugs is ten times less. Second, they produce only high-end products, in controlled industries in which the chemical structure is selectively controlled, not once.
Unfortunately, for our patients 99% of generic drugs purchased in India and China. In China, there are no state certification of medicines - only internal control. He said the plant manager: "I have a good preparation," - so it is good.
By the same Chinese described horrific cases where, for example, makes the drug to be administered into the spinal canal when leukemia, on equipment that has already been used for the manufacture of other drugs. These microgram, milligram even traces of substances into the cerebrospinal fluid, and in patients developing irreversible paralysis and degeneration of the nervous system.
- In Russia, too, like that happening?
- Eight years ago, we had 10 cases of blood poisoning, ie sepsis caused by fungi, when using potassium chloride produced in some plant Novosibirsk old equipment. Ten patients were infected with fungus.
Other examples do not bring: we do not buy generics. The government gives us the money. How to spend it - it's our prerogative.
- But you are required to declare the tender, and cheaper generic drugs.
- Yes, unfortunately, it is. The workaround for this is impossible. Last year, a struggle, even the Legal Office of the President has instructed to make a list of medications that can be purchased by trade name, but not the name of the active ingredient. However, this list has not yet been formed and has not been adopted.
Our proposal is this: a few dozen types of critical medicines should be purchased by trade names. It established brands, which are used in life-threatening situations. This means cancer is antibiotics, which are used in the treatment of sepsis are drugs for the treatment of thrombosis.
Then begins the struggle of lawyers, lobbyists and idealists. So far, unfortunately, idealists treat patients that have ...
- Let's dream up: for example, today we have poured a lot of money to get rid of dependence on import in medicine. If you count all the research, all the development, construction industries, how many years we will be able to do the same drugs as those who buy now?
- By the way, it's not too long. Research on the effectiveness of generic drugs (if not talk about cancer drugs) do not take dozens of years. They may be held at a fairly limited patient populations, but they should be performed. But if we talk about domestic innovative drugs, I simply ridiculous. Where did they come from?
- You do not want to live up to this?
- No, I can not live forever. These drugs appear nowhere. Compare how many people work in the science of drug development in the West and in Russia. None of the top drug-1000 does not come out of Russia, and can not get out. Do not invest in research. Minds not, there is no equipment.
If a person owns a production, there gathered 50 scientists who are working on the synthesis of new drugs, it may seem that it is the intellectual center of the world. But abroad, huge corporations are working on the synthesis of new drugs on the new high-tech projects.
It is a mental problem of our managers: they think that they will hire good managers and give the money, and all of a sudden appear. But they can not make one an effective football team. How can they make one medicine? Never.
Russian treatment there. But in time it is not
- Chief Children's Oncologist Vladimir Polyakov says if Russia said that the child is incurable, then he is incurable. There are examples that we obviously incurable - cured abroad?
- Such examples are few, although earlier it was just all the time. Now incurable patients who reach the federal center - often indeed incurable. The problem is that they are incurable, not because they are inherently incurable, but because properly treated.
Plus case of recurrence of tumors resistant to treatment. But in the West they can be caught in some clinical trials. In Russia, there are very few studies. And all over the country we are alone do almost everything that can be in the West. We work in the beautiful, privileged conditions - some we no other.
- All lined up?
- Of course.
- Are there many cases, when you realize that you can take this child in three months, but after three months it is too late?
- Of course, how much ugodno.No officially we can only write that transplantation can be performed in 3-4 months. Waiting list in February, we painted until May. Then the parents often tend to go to a foreign clinic - and rightly so.
- How do they get treatment abroad at public expense?
- To do this, they must obtain the opinion of the federal government, that is our center, or even a pair of institutions that Russia can not be held to them right treatment. And we can not allow such a conclusion because we can carry out such treatment. But we can in three months, when it will be too late.
This is a huge lie. We give the conclusion that the inability to perform the treatment for such a period is shown treatment abroad. These patients only in our small area of bone marrow transplantation, at least 600 people a year. Six hundred people are guaranteed to die, not having received the transplant in Russia.
- Why Russia is not carried out 600 transplants a year more?
- Yes.
Why are we so sorely lagging behind the developed countries, if we can find something good in the domestic oncology - reflects Alex Maschan.
Today, the situation with access to care are much worse than in the notorious capitalist countries, which are actually socialist when it comes to Europe. So how can we have good medicine?
Alex Maschan - Deputy Director of the Federal Center of Pediatric Hematology, Oncology and Immunology named Dima Rogachev, member of the advisory board of the fund "Give Life". Bone marrow transplantation for children with cancer - a "fad" Alexei Maschan. A state of the domestic oncology and hematology - this is his pain.
Source
Lies Russian statistics
- Can we say that in Russia the development of oncology treatment has kept pace with the rest of the world?
- First and foremost, there is no "rest of the world" does not exist. There are 20-25 of developed countries, from which we are sorely lagging behind, despite the claims of our leading oncologists. Apparently, our official speakers see only what is happening in their leading centers, and even then not all but only the most rosy side. The truth is that we are very far behind those countries that should be equal, and the diagnosis and as a result of cancer treatment.
Perhaps you can list a hundred countries, such as Uganda and Rwanda, and it will be even members of the UN, we are significantly ahead. But is it worth to be proud of?
After all, we are lagging behind Germany, France, England, Spain, Israel, America, and even from some of our recent blood brothers - former members of the Soviet Union. Many former Soviet republics have significantly added to the rate of development of medicine.
At us all the energy, unfortunately, goes on beating his chest and claim that we are not worse, and even in many respects better than the others. "There was a case in Germany have not cured the fact that we are here, too, could not cure" - this is the pathos of official rhetoric.
Abroad, too, there is not very good doctors. But the overall level of oncology, for example, in Germany disproportionately higher than the overall level of cancer in our country, so it's even funny to talk about it.
- This gap is reflected in health statistics?
- It is necessary to start with the question, how many cancer patients actually treated in cancer centers and cancer clinics. It seems to me that if the majority of them, it is insignificant. A huge number of cancer patients either do not come to oncologists, or in the district and city hospitals, they do palliative surgery, that is designed not to cure, and symptom relief.
Then they "quietly" die of cancer. These figures do something no one has ever published. The results of treatment for the patients who are known to be the best social conditions, obviously taking into account the best conditions. Therefore statistics, which operates our heads - it's just a lie.
If they are told that "in the center of the X 90% survival rate," that is, in principle, it is better for them not to shake his hand, because they give a false medical information. I'm in your heart can reach 100% survival rate if I will choose the most favorable patients. If they are discharged home on time, we will have 100% of the extract with the improvement. Manipulating such statistics - a low and unworthy. - Why are we so sorely lagging behind the developed countries?
- Because the Soviet Union was a very bad medicine, especially in recent years, and it has only gotten worse in the years of perestroika and, shall we say, of early capitalism. Only in pediatrics managed to keep the good traits of the Soviet health care (eg, availability of doctors, the relative cheapness of drugs).
But the worst features of Western medicine (partial access to doctors, the high cost of drugs and difficulties with the total equal to the involvement of patients in the treatment process), we just absorb like a sponge. Today, the situation with access to care are much worse than in the notorious capitalist countries, which are actually socialist when it comes to Europe.
So how can we have good medicine? We have a good medical education? No, worse. We have our own medical equipment? No, we do not. We own the production of medicines? No. We have not driven postgraduate education of doctors. To become a doctor and work with responsibility for a patient, we need seven years. In France and in America it takes years 12-13.
So why do we have the medicine could be better if all the basic, basic points on which the medicine is, we worse? - In addition, there is a question constantly about money.
- That's what I did not say. Money for medicine in Russia is spent in times less than in other countries. Recently, we had a delegation from the Parliament of the Netherlands, and we started talking about the share of the costs of their healthcare budget. It was found that the costs are the same as in Russia. Only people we have ten times more.
Posted in [mergetime] 1399476315 [/ mergetime]
Foreign not treated
- Recently discussed the draft regulations of the Government - to limit the budget for the purchase of imported medical equipment. You met scanner, assembled in the territory of the Customs Union? Do you know a similar Russian equipment?
- Recently, we have compiled a list of equipment that you need to buy in our center. Of the one hundred positions - two Russian. Yes, some Russian equipment there, but mostly poor, not high-tech. We have a good bandage can not do! Buy-Soviet Russian bandage, try to wrap them human. Like 30 years ago, bandages fibers are not tied, and the end is not torn. Bandages can not do, and talk about scanners.
- Probably, production listed in the draft plan to transfer the technology orders in Russia.
- The question of localization of production - a good and proper. Well, when there is their production, but if the assembly of imported equipment in Russia Russian-made - the question. If someone wants to report the beautiful figures, we can say that we have produced 100 thousand vehicles, "Volkswagen", but it is clear that this screwdriver assembly.
I have not read the draft limits the foreign procurement of medical equipment, and even look at him do not want to.
- However, if the government stops buying imported scanners who will buy them?
- Tomography - this expensive equipment. Its maintenance is also expensive. If such equipment will be buying private entities, so they will have it paid off. This means that the cost of each study will be a very, very high. Then tell me, what we are fighting: for the availability of medicine or someone's business interests? ..
- On it official answer: "In recent years, for natsprogramme" Health "bought so many scanners, that you must first learn how to use the available". We, they say, the density of scanners per capita than anywhere else in the world.
- It's true. But, firstly, it is necessary to consider not scanners per capita, and per square kilometer, which is the population resides. Secondly, even though a huge amount of purchased tomography, the problem is that they set, including at locations where they do not know how to use.
And bought them without service programs, that is, these scanners are not served, no matter what Olga Golodets neither spoke. Neither MRI nor KT-scanners are not served. Naturally, they are a year and a half rise. Not only do they not know how to use very well, so they are still in working order and require millions of repairs.
I'm faced with radiologists in the regions, and they are very good, they are able to assess those studies that do. But if the scanner gets into the hands of a nurse or technician who did not really know why you need it, and only able to pass the patient on the table here and there, that's another matter. But where physicians need to specifically exist at all, they know how to use scanners.
- So, what happens if the new regulation enters into force, and we will not buy any scanners or infusion pumps?
- Then we, like 30 years ago, on the eye drops believe high-dose chemotherapy, are mistaken in infusions. Nedolivaem, emptied ... I've seen domestic infusion pump 15 years ago - a terrible sight. No tears can not watch. The child's mother or rather drops to the eye thinks. This begins an infusion pump to pump air (and then easily into a vein), giving an irregular speed. I do not see any national infusomats that would normally worked. Incidentally, in the exact dosage and administration of medicines built all intensive therapy in modern medicine.
- That is, if the infusion pumps do not buy from the budget, you can either close the clinic, or to rely on charities?
- Foundation for a little, and they are not made of rubber. Hang on charities purchase what should buy a state - a "wonderful" way out. It will allow the State to put money on more useful projects, we know a lot of these.
- In parallel, the official speakers periodically declare that the funds dishonest work and must check the prosecutor's office.
- Prosecutors need more look in the mirror. It seems there is something to do in our country, in addition to verification of funds. Fraudulent charities I have not seen. Well, I made a noise fund "Federation» ...
The Foundation works mainly completely honest and committed people who can account for every penny. If there are minor technical violations - it is not criminal. Sometimes it is necessary to help quickly, sharply and now, rather than six weeks. Then, often need to use a scheme that financial legislation are not encouraged. But this does not mean that the funds are stealing money.
Generics: death as a side effect
- Instead of effective drugs have generic (drugs with the same active ingredient, but with unknown side effects due to the inaccurate formula), how much this problem has your patients?
- Generics - a huge problem. We were rushed generic drugs and so-called biosimilars, ie analogs of protein molecules that are produced by other technologies, by non-chemical synthesis. They have to prove equivalence, and no one does, but they are buying. Prove that they are less effective, it is very difficult: it takes years of observations.
For example, if the total dose chemotherapy in breast cancer after the operation is reduced by only 15% - nine outcomes are exactly the same as if the chemotherapy is not performed at all. Ie the negative effect of generics and biosimilars may appear in three, five, ten years. And to prove that something is impossible, for the statistical analysis we have not adjusted perfectly.
The problem with generics, by the way, is a worldwide, but in developed countries it has been solved. Firstly, there are manufacturers of generic drugs is ten times less. Second, they produce only high-end products, in controlled industries in which the chemical structure is selectively controlled, not once.
Unfortunately, for our patients 99% of generic drugs purchased in India and China. In China, there are no state certification of medicines - only internal control. He said the plant manager: "I have a good preparation," - so it is good.
By the same Chinese described horrific cases where, for example, makes the drug to be administered into the spinal canal when leukemia, on equipment that has already been used for the manufacture of other drugs. These microgram, milligram even traces of substances into the cerebrospinal fluid, and in patients developing irreversible paralysis and degeneration of the nervous system.
- In Russia, too, like that happening?
- Eight years ago, we had 10 cases of blood poisoning, ie sepsis caused by fungi, when using potassium chloride produced in some plant Novosibirsk old equipment. Ten patients were infected with fungus.
Other examples do not bring: we do not buy generics. The government gives us the money. How to spend it - it's our prerogative.
- But you are required to declare the tender, and cheaper generic drugs.
- Yes, unfortunately, it is. The workaround for this is impossible. Last year, a struggle, even the Legal Office of the President has instructed to make a list of medications that can be purchased by trade name, but not the name of the active ingredient. However, this list has not yet been formed and has not been adopted.
Our proposal is this: a few dozen types of critical medicines should be purchased by trade names. It established brands, which are used in life-threatening situations. This means cancer is antibiotics, which are used in the treatment of sepsis are drugs for the treatment of thrombosis.
Then begins the struggle of lawyers, lobbyists and idealists. So far, unfortunately, idealists treat patients that have ...
- Let's dream up: for example, today we have poured a lot of money to get rid of dependence on import in medicine. If you count all the research, all the development, construction industries, how many years we will be able to do the same drugs as those who buy now?
- By the way, it's not too long. Research on the effectiveness of generic drugs (if not talk about cancer drugs) do not take dozens of years. They may be held at a fairly limited patient populations, but they should be performed. But if we talk about domestic innovative drugs, I simply ridiculous. Where did they come from?
- You do not want to live up to this?
- No, I can not live forever. These drugs appear nowhere. Compare how many people work in the science of drug development in the West and in Russia. None of the top drug-1000 does not come out of Russia, and can not get out. Do not invest in research. Minds not, there is no equipment.
If a person owns a production, there gathered 50 scientists who are working on the synthesis of new drugs, it may seem that it is the intellectual center of the world. But abroad, huge corporations are working on the synthesis of new drugs on the new high-tech projects.
It is a mental problem of our managers: they think that they will hire good managers and give the money, and all of a sudden appear. But they can not make one an effective football team. How can they make one medicine? Never.
Russian treatment there. But in time it is not
- Chief Children's Oncologist Vladimir Polyakov says if Russia said that the child is incurable, then he is incurable. There are examples that we obviously incurable - cured abroad?
- Such examples are few, although earlier it was just all the time. Now incurable patients who reach the federal center - often indeed incurable. The problem is that they are incurable, not because they are inherently incurable, but because properly treated.
Plus case of recurrence of tumors resistant to treatment. But in the West they can be caught in some clinical trials. In Russia, there are very few studies. And all over the country we are alone do almost everything that can be in the West. We work in the beautiful, privileged conditions - some we no other.
- All lined up?
- Of course.
- Are there many cases, when you realize that you can take this child in three months, but after three months it is too late?
- Of course, how much ugodno.No officially we can only write that transplantation can be performed in 3-4 months. Waiting list in February, we painted until May. Then the parents often tend to go to a foreign clinic - and rightly so.
- How do they get treatment abroad at public expense?
- To do this, they must obtain the opinion of the federal government, that is our center, or even a pair of institutions that Russia can not be held to them right treatment. And we can not allow such a conclusion because we can carry out such treatment. But we can in three months, when it will be too late.
This is a huge lie. We give the conclusion that the inability to perform the treatment for such a period is shown treatment abroad. These patients only in our small area of bone marrow transplantation, at least 600 people a year. Six hundred people are guaranteed to die, not having received the transplant in Russia.
- Why Russia is not carried out 600 transplants a year more?
- Yes.
