7.15.15 | Forbes
By Steve Brozak
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Over 2,500 years ago, Thucydides, known as the father of scientific history because he relied on facts and his observations rather than divine intervention to explain events, once described a plague that struck Athens. As disease spread unchecked and healthcare standards disappeared almost 1/3 of the city’s population perished. The sick were left to fend for themselves and social order disappeared. The Plague of Athens took a prominent position not just in Greek, but in world history. Now a new type of plague is emerging in Greece involving healthcare and we can’t wait for future historians to really understand what is happening to Greece. Though the Greek economic crisis may have been pushed back to page two in the news by Janet Yellen’s Federal Reserve testimony and the Iranian nuclear deal, Greece faces a medical crisis as deadly as the Plague of Athens, one that could throw the country deeper into economic crisis. Today, in the face of severe pharmaceutical drug shortages, 12,000 pharmacists throughout Greece will begin an open-ended strike to protest changes to draft legislation that they say will limit the role of pharmacies and threaten their livelihood. Such a prolonged strike could prove catastrophic to diabetics, heart patients, cancer patients and others. With this in mind there are three indications that the Greek medical system, once one of the best in Europe, is on the verge of collapse. The first and most immediate disaster to the Greek medical system, a drug shortage, has already begun. The impact on most Greeks is difficult to quantify immediately, but expensive biological drugs have been unavailable for the ordinary citizen for quite some time. It’s now a question of when inexpensive generic medicines and other commonly used but necessary therapeutics become hard to get. For example, Denmark’s Novo Nordisk is the world’s biggest maker of insulin and suspended shipments of modern insulin to Greece in May 2010. The company only resumed shipping to Greece after prices for the drugs were raised. There is no substitute for insulin to treat diabetes. Expensive, first-line anti-cancer drugs often cannot be substituted or duplicated either and are also in short supply. What makes a drug shortage even more problematic is that even if Greece imports these drugs, the government must work to ensure that they are not hoarded, placed into the black market, or exported by wholesalers into other markets for more reliable profit. Turmoil in the Greek drug market already exists. Greece owes pharmaceutical manufacturers $1.2 billion for drugs previously delivered, patients are having to make hard decisions in the face of drug shortages, and the head of the Hellenic Association of Medicine Wholesalers has accused pharmaceutical companies of placing quotas on drugs shipped to Greece to limit losses. The protests specifically identified Novartis, AstraZeneca, and the Janssen unit of Johnson & Johnson. The complaints have yet to be verified, but the Greek government put exportation limitations on 25 drugs from these three companies.
The second indication of a Greek crisis is behavioral changes within the country leading to increased death and disability. People are already going to the doctor less frequently, even though there is no co-pay for primary care physician visits. Greece’s 132 hospitals had a budget of $735 million for the first four months of 2014. This year the budget for the same time period was $50 million total. Historically, reports have shown generally low suicide rates in Greece compared to other countries, but the economic woes of the country have had a dramatic effect on this phenomenon. A study published in the British Medical Journal reported that the mean suicide rate rose by 35% between 2010 and 2012 in response to austerity measures. The study concluded “increased suicide risk in Greece is a health hazard associated with austerity measures.” Though the reported increase in suicide is dramatic, the available data masks the true extent of the problem since suicides tend to be under-reported in Greece to spare families and the departed the stigma of suicide.
Over the long-term other, more intractable problems will be exacerbated. Heart attacks and heart failure will continue to rise, especially as people stop taking anti-cholesterol medications. Complications from type 2 diabetes will proliferate as an accumulated impact of failure to keep blood glucose under control becomes obvious. Common medical devices like eyeglasses and hearing aids, which enable normal living standards for people as they age, may no longer be available and more expensive devices like defibrillators, pacemakers and artificial joints will become luxury goods.
The third and most dangerous health impact of a Greek financial meltdown is a healthcare “Brain Drain” as migration of doctors, especially young doctors, to other European nations occurs. Although the practicalities of employment vary from country to country, doctors from The European Economic Area (EEA), which is comprised of the European Union and European Free Trade Association, are entitled to full registration in any country in the EEA providing they are citizens of a member state, they have completed primary training in a member state and hold a recognized qualification. This gives Greek doctors up to 33 different countries to move to and practice medicine in. According to one report, approximately 3,500 doctors have left Greece to practice medicine in Germany alone. Once physicians relocate for better economies, they rarely return to the country of their origin. The practice of modern medicine is complex and interconnected. If any one element of the medical care system is disrupted, the entire structure will collapse. Once it has fallen it would take years, perhaps generations, to revive. With these three flashpoints, it is highly likely that there will be a breakdown in healthcare in Greece that will further exacerbate its financial and social woes. Thucydides took great pains to preserve the events around the Plague of Athens in painstaking detail in case symptoms showed themselves again in the future. Remarkably, what he captured were the ramifications of disease left unchecked. He understood then that a failure of a healthcare system to respond to systemic threat could ruin a society. The significance of a healthcare meltdown in Greece would not be confined. In an interconnected world, if deadly infectious diseases like TB and hepatitis become entrenched in Greece, they could easily spread throughout Europe. Most European capitals are a plane ride away from Athens, and Greece is a popular tourist destination in the region. Without a humanitarian effort to provide essential drugs and healthcare services for Greece in the coming years, the country could descend into a healthcare crisis that would further depress the economic conditions of the country. As classical history should remind us, it’s not just in Greece’s interest to prevent a healthcare meltdown; intervention would benefit all of society.