The history of drugs is marked by changes that we can identify as successes and failures. An evolutionary path also necessarily goes through negative experiences that only seem to constitute failures. When Thomas Edison was asked how he had felt after failing thousands of times during the “invention” process of the light bulb he simply answered that he learned many ways not to build a light bulb. It is clear that failures are part of the journey that brings success. This same approach is also relevant whenever we deal with a complex theme such as healthcare and particularly access to drugs.
In the last decades we witnessed different changes in healthcare. One of the most important ones was the passage from the local healthcare units (USL) to the local health authorities (ASL). Some might think that creating the healthcare Reform in 1978 on a network of USL was a wrong decision, something that absolutely had to be changed because it no longer responded adequately to the developing healthcare and economic logics. In reality, the institution of local health authorities represented a strong improvement, which was the result of the healthcare experience we had with a system that is considered still now one of the best ones in Europe. The management of healthcare services is now the same as that of a company, starting first of all from the fundamental principle of the universality of the healthcare system. The closure of USLs should then be read as the result of an evolution rather than that of a failure.
Another process of change that I think should be considered as the result of an evolution concerns the role of the patient within the healthcare system. Not long ago the pharmaceutical governance was based on the so called “in silos” budget, which referred to specific pathologies. It was a characteristically rigid logic that clashed with the evidence of comorbidities and with the need for an integrated and multi disciplinary approach. Overcoming this vision is not the acknowledgment of a failure but the gained awareness of the need to evolve, shifting the perspective from the single pathology to the individuals, their social context and their condition as patients suffering from different pathologies. Therefore, the need to rapidly get access to a single drug turned into the need, as urgent, to be guaranteed a managed care plan, which is no longer limited to the prescription of a single drug but consists of a series of support services. It is a change of perspective that is more in line with our universal healthcare system which- as I always proudly reiterate- is one of the best practices in Europe.
It is necessary to have courage and not to fear failure.
Therefore the apparent failure represents the gained awareness of the need to evolve and enlarge the vision, abandoning the previously adopted solutions and developing alternatives that together aim to improve the patient’s quality of life. Nowadays we can see how the healthcare emergency caused by the coronavirus forcedly accelerated the digitalisation process of the healthcare system, which has been strongly criticised in the past, principally for its organisational shortcomings. Today then we could think that the pandemic, aside from the enormous hardship and the great suffering caused to the global population, might also lead to a faster evolution towards a more efficient care that, thanks to digitalisation, gets closer to the patients’ wellbeing and quality of life.
It is necessary to have courage and not to fear failure, but accept it and keep on walking successful paths. Our healthcare system is not lacking in courage, as this difficult period is confirming.