Medical expenses: regions bought ineffective medicines for 10 billion rubles
Russian regions have spent about 10 billion rubles on purchases of homeopathic and herbal medicines, as well as other medicines that are not included in clinical recommendations. This follows from the procurement analysis for 2024. Among the most popular drugs are those containing calendula: the purchase justifications state that it will help with viral pneumonia, in particular. And for patients with nasopharyngeal cancer, they bought, for example, plantain, calamus, arnica, oak bark, peppermint, chamomile and sage. About how regions justify purchases and why doctors may not follow official recommendations for the treatment of diseases — in the material "Izvestia".
What the regions bought
In 2024, Russia spent 16.2 billion rubles on the purchase of medicines that are not included in the clinical guidelines for the treatment of diseases. According to a report by the analytical company B3-Med, most of these drugs were purchased in Yakutia, Udmurtia, Chechnya, Karachay-Cherkessia, Dagestan, as well as in the Arkhangelsk and Leningrad regions, Stavropol and Krasnoyarsk territories, as well as in Chukotka.
About 10 billion of these 16 billion rubles are, for example, homeopathic remedies, dietary supplements and phytotherapeutic agents, and even drugs "without an active substance", which, nevertheless, were prescribed for patients with cancer and other serious diagnoses.
For example, homeopathic and herbal medicines were purchased for people with cancer. Flowers, leaves, and extracts of birch, St. John's wort, tansy, and milk thistle were purchased for patients with neuroendocrine tumors. For the treatment of nasopharyngeal cancer — calamus, arnica, oak bark, peppermint, fir, chamomile, sage and valerian — for a total of 13.5 million rubles.
Oncologists interviewed by Izvestia noted that in the treatment of cancer, it is strictly not recommended to prescribe drugs that can change the effect of the main drug, this also applies to herbs.
"All of these drugs have no proven effectiveness, are not included in clinical recommendations, and their use may negatively affect the treatment process," oncologist Igor Utyashev confirmed. — The use of homeopathy for oncological diseases is also useless.
The regions spent about 19 million on preparations with psyllium. It was purchased for patients with irritable bowel syndrome, mental and behavioral disorders caused by the use of nicotine-containing products, as well as for pregnant women. Purchases of drugs containing calendula have also become very popular. They spent almost 9 million rubles on them. 7.4 million rubles were spent on drugs with althea.
Currently, there are no strict regulations in Russia that restrict the purchase of drugs that are not included in clinical recommendations, recalled Evgeny Korovin, founder of B3-Med and therapist.
"But such purchases attract attention, because instead of effective therapy, budget funds are spent on medicines that have been little studied and can harm the patient's health," he said. — It is more logical to direct funds to clinical trials of drugs with low proven efficacy or to purchase proven drugs.
According to Evgeny Korovin, the use of herbal medicines or dietary supplements can lead, for example, to liver damage in patients.
— It is impossible to calculate the concentration of a medicinal substance in phytopreparations and dietary supplements. This means that there is a high probability of prescribing the wrong dosage. And this can lead to serious complications," he explained.
Nikolay Bespalov, Director of Development at RNC Pharma, an analytical company, noted that the demand for dietary supplements and herbal medicines in the country is growing.
"Doctors are increasingly prescribing various vitamins and dietary supplements to patients to normalize their condition," he said.
When should I buy non-recommended medicines?
But there are cases when it is simply necessary to buy drugs that are not included in the clinical recommendations, the experts surveyed noted.
For example, the list of purchases includes medicines for the treatment of rare genetic diseases. For example, type 2 neuronal ceroid lipofuscinosis (the disease causes progressive epilepsy, motor and intellectual disorders — Ed.) and Laron syndrome (impaired production of growth hormone — Ed.) and Pompe disease. We are talking about drugs based on cerliponase alpha, mecasermin and alglucosidase alpha.
Nikolay Bespalov recalled that purchases of drugs not included in the clinical recommendations are also carried out through the activities of the Krug Dobra state Fund, which provides medicines to children and adults with rare and chronic diseases under the age of 19.
"This opportunity to purchase drugs that are not based on clinical recommendations is aimed at patients and increases their access to innovative therapy," the expert emphasized.
A total of almost 4.5 billion rubles worth of orphan drugs that are not listed in the registry were purchased.
The press service of the Ministry of Health reminded Izvestia that if there are medical indications (individual intolerance, for vital reasons) and according to the decision of the medical commission, medications that are not included in the standards of medical care or not provided for in the relevant clinical recommendation can be prescribed. Also, under such conditions, it is possible to prescribe by trade names, whereas usually patients should be prescribed treatment using international nonproprietary names.
For example, based on sotorasib, which is used for the treatment of non-small cell lung cancer, asparaginase and ivosidenib, which are used in the treatment of acute lymphoblastic leukemia. 30.9 million rubles were spent on sotorasib, 21.6 million rubles on ivosidenib and 131.5 million rubles on asparaginase.
Alexey Starchenko, a medical lawyer and member of the Public council for the protection of patients' rights at Roszdravnadzor, confirmed that drugs for the treatment of oncological, oncohematological and rheumatological diseases that are not included in clinical recommendations can also be purchased.
—But prescribing drugs not based on clinical recommendations requires systematic checks for abuse by medical organizations," he added.
Alexey Starchenko stressed that if a patient has a complication, he has the right to file a claim for damages.
Izvestia sent requests to the Ministry of Health of the regions with a request to confirm the purchase of drugs not included in the clinical recommendations and to justify it.
Clinical recommendations are one of the foundations of the organization and provision of medical care in Russia, Ivan Sovtsov, Deputy Chief Physician for Clinical and expert work at the UNI Clinic Medical Center, reminded Izvestia.
"These documents contain structured information based on scientific evidence on the issues of prevention, diagnosis, treatment and rehabilitation of the patient, options for medical intervention and a description of the sequence of actions of the medical professional," he said. — Failure to comply with clinical recommendations leads to undesirable interpretations and speculation about the unsatisfactory quality of care in a medical organization.
But clinical guidelines do not cover the full range of cases that doctors have to deal with and are not always updated promptly, lawyer Irina Hrytsenko added. Therefore, according to her, doctors have the right to depart from them.
"The incidence situation may vary in certain regions," the expert noted. — Regions can allocate their funds for any purchases, but with justification.
Nevertheless, the use of drugs that are not officially registered as a medicinal product is potentially dangerous to health, agreed endocrinologist and nutritionist Alexei Kalinchev.
— No one keeps centralized statistics on the effectiveness of such drugs. Therefore, their appointment and use is at the peril and risk of the doctor and the patient," he said.
At the same time, according to the expert, by prescribing herbal medicines and dietary supplements, doctors do not pursue malicious intent against the patient.
Specialists are most often guided by the knowledge gained during training about the harmlessness of such drugs and do not assume that their appointment may harm the patient's health, said Alexey Kalinchev.
Переведено сервисом «Яндекс Переводчик»
