Tackling Disease: Europe Mulls Rival Approaches at the Level of Society or the Patient

October has offered a striking spectacle of contrasts in Europe's ponderous attempts to construct a comprehensive policy on health.   On the one hand, the month opened with calls from a cross-party group of MEPs seeking action from the European Commission in support of orphan drugs and rare-disease patients. "What measures has the Commission taken so far to ensure accurate and timely diagnosis of rare diseases," ask the MEPs. In addition, they pointed out, patient access to medicines for rare diseases varies widely across Europe-so what is the Commission doing to promote the availability of affordable medicines to treat rare diseases, they demanded.   Throughout the month, groups as diverse as the European Alliance for Personalized Medicine and the Multistakeholder Paediatric Strategy Forum have been urging vigorous action to promote targeted treatments, close collaboration on dialogue between regulators and drug developers, and early scientific advice-with much of the discussion centred on the emerging plan for coordinated European-level health technology assessment.   But on the other hand, the month was marked by a crescendo of concern that health policymakers may be looking through the wrong end of the telescope with their traditional focus on treatment. Right at the start of the month, one of Europe's biggest annual health policy gatherings, the Gastein forum, named for the mountain resort in Austria where it takes place, heard plenty of calls for a bigger and better European health policy-but with an emphasis on wider access and greater equality, and with a focus on prevention rather than treatment.   A series of prominent healthcare policymakers, from the WHO Regional Director for Europe, Zsuzsanna Jakab, to the Director of the European Centre for Disease Prevention and Control, Andrea Ammon, underlined what they saw as the need for a multisectoral, societal, and integrated response to health. There were repeated invocations of the United Nations' Sustainable Development Goals, and calls for Europe to lead by example in the SDG's global ambitions to tackle poverty, inequality, climate, environmental degradation, and injustice.   EU's Commissioner for Health Vytenis Andriukaitis has taken as his theme "the importance of our health-in-all-policies approach." He told a WHO meeting in Kazakhstan: "We need a much stronger focus on health promotion, protection, and disease prevention." And he has developed the theme throughout the month, with speeches endorsing the merits of a broader approach. The mantra is that the health sector cannot succeed alone. "We must address all the risk factors in a more holistic way: obesity and unhealthy nutrition, lack of exercise, tobacco, alcohol abuse, and also wider factors such as working conditions, unhealthy housing, and environment pollution" has become his anthem.   He followed a similar line at the G20 health ministerial meeting in Argentina where childhood nutrition was on the agenda, and at the recent United Nations high-level meetings on non-communicable diseases and tuberculosis.  Even in his remarks to a conference on oncologic diseases in Lithuania at the end of October, he opened with a restatement of how "I have taken every opportunity during my time as the EU Commissioner to focus on the promotion of health and prevention of disease"-and consequently, in his view, "We need to do more to get ahead of cancer and other non-communicable diseases. And that means talking about smoking, about alcohol, healthy diets, and physical exercise."   It is more than just a straw in the wind that the EU has set up a new steering group on health promotion and prevention of non-communicable diseases that is tasked with identifying priority areas for action and promoting exchanges of policies and practices between countries. Nor is it entirely a coincidence that it has chosen nutrition and physical activity as one of the areas for priority implementation. In the same vein, Austria, which holds the EU Council presidency until the end of the year, will host a conference on healthy and sustainable food systems in November.   The support for a broad social approach to health was often energized by strongly negative prejudice against medicines manufacturers. A degree of hostility to the classic approach of tackling disease with innovative therapies was discernible in numerous public meetings in Brussels throughout the month. A conference on access to medicines that the European consumers organization hosted in late October displayed deep scepticism about the merits of private-sector drug development, with accusations of industry's disease-mongering and over-medicalization, and allegations of abusive promotion of medicines of little or no therapeutic value. It heard loud calls for research funding to be directed towards socially useful development, depriving the private sector of what was depicted as a free ticket to unjustified profits in lucrative markets.   The month closed with heart-rending tales of the impotence felt by parents of children suffering rare and life-threatening disease, where hope lay uniquely in more effective research and innovation. A two-day meeting in Brussels on better medicines for children highlighted the challenges through the prism of regulators, academics, industry, and patient organizations.   It also highlighted the growing split in European healthcare thinking, where the micro-needs of individual patients for treatment come to be seen in opposition to the macro-needs of a society still negligent of prevention but shifting increasingly towards downgrading treatment as part of the harsh calculus of pursuing the benefit of the many.   Europe next year will have new management, with a new European Parliament, a new European Commission, a new European Council President-and the opportunity will present itself for everyone with an interest in health policy to present their arguments to influence the debate.     Peter O'Donnell is a freelance journalist who specializes in European health affairs and is based in Brussels, Belgium