Brendan Shaw
Every month since I first started Shawview Consulting back in 2017, I have written a blog.
Shawview has just celebrated its five-year anniversary, and ever since I first started the business from my living room in our old house in inner London, I’ve tried to write something every month.
Usually a blog, sometimes an article or opinion piece and occasionally a peer-reviewed academic article. I’ve tried to keep the discipline of writing something each month partly to keep my brain active, to help keep my ‘hand in’ on key issues, or to just because I got inspired by something at the end of a long week.
There have been few rules I’ve set myself on what I write. Sometimes it’s a sagely written piece on the state of health technology assessment, sometimes a reflection on leadership either in cricket or managing catastrophic bushfires, or a look at the history of 'Black swan theory' and dealing with disruption. But in all of them I’ve had the freedom, more or less, to write about what I feel like writing.
The only rule I’ve really stuck to is to publish something every month.
A collage of policy, economics, health and politics over five years
The interesting thing for me today is to go back and look over what I have written over the last five years. Of course, a lot has happened in the world since Shawview started and the blogs tend to reflect the roiling sea of issues in politics, economics, policy, global health, industry, business and society over that period.
Whether it’s looking at global and national trends in cardiovascular death rates over 30 years, the global impact of Alzheimer’s Disease, the rise of non-communicable diseases and the UN 2030 Sustainable Development Goals or reviewing 10 years of data in the Access to Medicines Index, there are a suite of health policy issues there.
It is good to use some data or evidence to analyse global trends and issues in health, the economy and society. It might sound like nerd-speak, but I love that moment when a story or key point leaps out at you from the data, something buried in facts and evidence that suddenly explains clearly what's going on.
Politics has featured in the blogs, whether it’s looking at the Trump Administration’s forays into medicines pricing policy, the unspoken issues in Australian election campaigns or the state of British politics. Also featuring prominently has been trends in the pharmaceutical industry, including tracking to growth and development of the life sciences sector in emerging pharmaceutical countries like China and India.
Five years ago, people would have thought we were daft to talk about the innovative pharmaceutical industry in China and India, but today these countries' industries are rapidly expanding and becoming part of the innovation-based sector.
And then there’s some issues which I’ve just got plain angry about. Whether it’s the deaths of almost 80 children in Samoa from measles as a result of the anti-vax movement, biodiversity and species extinction, the dynamiting of 46,000-year-old Aboriginal caves in remote Western Australia to sell a few more bucks worth of iron ore, or a consulting firm that ignores the pharmaceutical industry’s work on ethical rules and standards during the opioid epidemic in the US, sometimes I’ve just got annoyed enough to have an educated rant about something.
And, of course, we’ve had the COVID-19 pandemic within the last few years which, predictably, led me to do more blogging as I was dealing with being locked in my office and in my country for two years during lockdowns and travel bans. Not being able to travel internationally, let alone drive down the highway to meet clients in another city leaves you lots of time to ruminate and write.
The blogs during the pandemic reflect many of the issues I’m passionate about in global policy, economics and where the world is going. Whether it’s about the need for us to drop nationalistic jingoism and try to think about pandemic responses as a collective global problem or recognising the economic and social value of vaccines and medicines, or the social and economic imperative of investing in the growth and resilience of health systems, the blogs and articles through this period perhaps point to some of the lessons we should not forget as we try to move on from COVID-19.
The sublime - guest blogs and articles with others
As with lots of things in life, some of the most interesting and insightful blogs and articles tend to come when other people are involved. Sunanyana Shah’s explanation of cell and gene therapies is a must read for anyone trying to understand that space, Ambrish Singh’s evaluation of the Indian pharmaceutical industry offers some great insights, while guest articles on COVID-19 diagnostics from Evan Lee and colleagues provide the clearest explanation I’ve seen on what the different types of tests mean and their significance.
Working with other academic partners since the business has started has been a joyous revelation for me. Whether it’s writing with Orin Chisholm on disruption in healthcare or with Jorge Mestre-Ferrandiz on the economics of the global debate on transparency of medicine prices, it’s been a pleasure to explore these global health issues in such esteemed company.
The ridiculous
And then there’s the blogs that explain the problems of the world while trying to have a bit of fun. Sometimes in life the risky, creative urge takes precedence over the rational or safe thing to do and you just have to embrace it.
In my case this has given rise to such ‘gems’ as reflections on my failed try at rock music as a lesson on why to embrace technological disruption, using Elvis Presley to talk about global issues in antimicrobial resistance, Dr Who and time travel to explain the macroeconomic effects of pandemics, Martian invaders and their role in the politics of managing health budgets, the NHS' penchant for pigeon resuscitation as evidence of the need for economic reform, and deciding that the best way to summarise the ructions going on in British politics and its exit from the European Union was to come up with ‘Brexit the Musical’.
Well, not everyone gets it right all of the time.
Global pharma spending 5 years on
Finally, the first blog I wrote five years ago when I first started the business - 'Myths and legends in pharmaceutical spending' - was a look at OECD data on trends in pharmaceutical spending compared with other parts of health expenditure across OECD countries. The blog from back then makes the point that while the pharmaceutical industry is often demonised as the source of all fiscal gloom and doom in health systems, in the end growth in pharmaceutical expenditure has been low compared to other parts of the health sector.
So, five years later I have dug out the latest data and nothing has changed. After seeing the largest falls in expenditure across the OECD following the 2009 Global Financial Crisis, average real (inflation-adjusted) spending on pharmaceuticals did start to grow again across the OECD after 2013. However, as was the case five years ago, growth in pharmaceutical spending across the OECD up to 2019 was significantly lower compared to other parts of health expenditure.
While pharmaceutical spending across the OECD only grew by an annual 1.3% in real terms from 2013 to 2019, outpatient care grew by 3.4% per annum, long-term care grew by 3.1% per annum, prevention grew by 2.5%, administration by 2.2%, and in-patient care by 2.1%.
Over the last decade, spending on pharmaceuticals across the OECD has been the slowest growing component of health expenditure, by a long shot. Moreover, because pharmaceuticals account for less than 19% of total OECD health spending, the limited growth in pharmaceuticals means that it is is unlikely to be a major contributor to overall health spending growth.
But you wouldn't know it based on policy debates. Even today, the pharmaceutical industry is disproportionally blamed for breaking the health care bank, perhaps reflecting more the politics of health care finance reform and less so the economic reality.
Some things never change.