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"It Is Essential That a New Leader Is Really Neutral"

"It Is Essential That a New Leader Is Really Neutral"

Photo: Shaking hands of two business men Mr. Wasem, Sawicki – this has been a synonym for the IQWIG. Is the institute without its former leader more or less dead?

Juergen Wasem: No, I don’t believe so. I really think that somebody else will be able to take over that job. The IQWIG has done a pretty remarkable job professionally – with a few exceptions – and I think that it will also do a good job in the future, regardless of who is going to lead the institute. So not extending Sawicki’s contract doesn’t smell like some clientele policy of the Liberal Party (FDP) to you?

Wasem: If you think about it it should be obvious to everyone: we cannot let prices for medicine get more and more expensive. Mr. Roesler knows this as well. Going on like this will eventually lead us to a dead end street. Of course, there are conflicts of interest between economic and health policies. But the Minister of Health is not responsible for profits of the pharmaceutical industry and this is not what he is being judged for. And any other goal than economy in the health sector is not sustainable in the long run anyway. And the accusation that Sawicki published a few assessments on the side that were not completely unbiased towards the pharmaceutical industry, are – in my opinion – totally justified. That means that you think Sawicki was not neutral.

Wasem: Sawicki was a person who polarized a lot. There were a few studies where I could not completely follow all statistics and proofs and which made me feel that not all data was fairly treated because of a unilateral and skeptical basic position and that in the end some innovations were rejected on that basis. Why should Mr. Sawicki follow that approach?

Wasem: Since its introduction, it has been one of the objectives of the IQWIG to also save money. It is supposed to remove expensive but ineffective drugs from the market. This is a very important task which I think is the basis for our health care system and which has definitely to be continued. At his appointment, it was already known that Mr. Sawicki was very critical towards the pharmaceutical industry and that he would interpret the role of the institute primarily in this direction. So how would you judge the overall performance of the institute since its foundation in 2004?

Wasem: The institute has achieved a lot. It has developed its methods and has published a lot of reports. But, on the other hand, it has evidently also made some mistakes in regards to transparency and communication. It is essential that a new leader is really neutral – in every possible direction, so that there is a chance for innovations to hit the market. But the new leader must not, under any circumstances, be a “friend of the pharmaceutical industry”. If he should be that, we might as well close the IQWIG. Then it would have definitely lost its purpose. But that’s not my assumption at all. What makes you so sure about that?

Wasem: Because a leader close to the industry would contradict the purpose of the IQWIG. He must not be a friend but he should also not be a foe of the pharmaceutical industry. As a neutral authority, the institute could perhaps even improve its work. But the heir of this position also has to be a tough cookie. After all, he will be pulled back and forth between all the different interest groups. In this case, don’t you have to be the type of person to polarize?

Wasem: No, I don’t think so. On occasion, as the leader of the institute you have to be able to stick to your opinion even if not everybody likes it. But you also have to be willing to act within the rules of politics and the lobbyists. Whoever takes this position without being aware of this is naïve and not suited for it. It might make sense to put sort of an assertive diplomat in this position. So you do agree with the decision not to extend Sawicki’s contract?

Jürgen Wasem; © private

Wasem: Yes, I do. It seems that Mr. Sawicki does not get a whole lot of support from the doctors either. At any rate, only 800 of them signed a petition to demand an extension of his contract. But there are over 300,000 doctors in Germany.

Wasem: I don’t think that the majority of doctors are viewing him critically as a person. Many are not very interested in the topic – as everybody else, not every one of them is active in politics outside their professional life. And on the other hand, I do think that many of the doctors have a totally different agenda: since the introduction of the IQWIG, they were very critical towards this authority, apart from who was the leader because they felt their competence had been cut back. A doctor might want to prescribe a drug that he has prescribed many times before and he had a rather good subjective experience with it and suddenly, he is not allowed to do it anymore because a “senior physician” is not allowing it. Right from the start, this has angered many doctors. This is why so few of them are protesting. Is there any mentioning as to who might be Sawicki’s successor?

Wasem: I have heard a few names. Basically we need to be clear if it has to be a doctor or if it could also be an economist. He could be as good a leader for the IQWIG as a doctor. Mr. Sawicki has also always worked with specialists. An economist would do the same. But there is the question if patients would accept it if an economist withdrew a drug that would have given many of them a new sense of hope. There is the possibility that they might question his competence in regards to judging a drug. Isn’t an economist more likely to rather be on the industry’s side?

Wasem: No, I don’t think that you can say that in general. I am an economist myself but my main goal after all is a well functioning health system including its ethical foundation. If a doctor is able to have an economic perspective and act on it why shouldn’t an economist be able to integrate different perspectives in his assessments as well? So you can see a health economist leading the IQWIG?

Wasem: No, that’s not what I said. I only said that this would also be a possibility.

The interview was conducted by Anke Barth


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