20 December 2018

Pharmaceutical policy is often effective, but be aware of unintended effects

Inaugural lecture by Aukje Mantel, Professor of Pharmacy and Global Health

Prof. Aukje Mantel, Professor of Pharmacy and Global Health, studies global access to medicines and the effects of policy measures on access. “Policies should ensure that medicines are optimally accessible, but sometimes have unwanted side effects”, says Mantel. “We should be much more alert to that.” Prof. Mantel will give her inaugural lecture in the University Hall on 10 January.

Mantel uses the recent shortage of birth control pills in the Netherlands as an example. “The pill isn’t being produced as much at the moment, and our neighbouring countries are affected as well. But why is the shortage so much more serious in the Netherlands than in Germany or Belgium? That is the result of several different factors, possibly including the low price in the Netherlands. As a result, manufacturers would rather distribute their scarce stocks somewhere else. That’s an unintended consequence of the Dutch pricing policy.”

Access and excess

Mantel studies an exceptionally wide range of research questions, from the accessibility of contraceptives in Uganda to policies for reimbursement of medicines in Europe. “The connection between those topics is the kind of research question we study. For me, it all revolves around understanding how policy is made, and then measuring the impact that the policy has. It almost always comes down to the balance between access and excess: between making medicines available and prevent irresponsible use.”

More thorough and systematic

Mantel explains that policy shouldn’t be made ‘in a vacuum’. She would prefer to see evidence-based policies, or otherwise at a minimum based on logical reasoning and with consideration for all of the possible effects. “You often see that policymakers stack one measure on top of the other, for example during economic recessions, without taking the time to evaluate the possible effects. There is a lot of monitoring going on, but that’s not the same thing as conducting scientific research. Policymaking should be much more thorough and systematic, so that you can consider any possible undesirable side effect of the policy as well.”

Antibiotics

Mantel emphasises that it is not enough to simply study the effects of a policy. “The Netherlands is often praised for its relatively constrained use of antibiotics. Some former Soviet countries use just about as much antibiotics as we do, but when you look closely, you see that they have completely different reasons for that. In the Netherlands, there is a conscious policy to limit antibiotic use, but in Uzbekistan and Azerbaijan, antibiotics are often unavailable, but at the same time they are administered incorrectly or excessively to some patients. The countries have the same statistics, but the actual situation and the underlying reasons are completely different.”

Outside the pharmacy

Mantel considers herself to be a connector between scientists, pharmacists, and policymakers. “Pharmaceutical researchers should look beyond their own fields and pharmacy practice. And on the other hand, it is vital that policymakers have enough academic and scientific knowledge. That’s why I have several external PhD candidates who also work as policymakers. The questions I study often come from outside the academic community, and I want to help them make sure that their questions are scientifically sound.”

Teaching

In addition to her research activities, Mantel also serves as Director of the School of Pharmacy. “I love teaching, and that’s where a big part of my passion lies. Students should have a good idea of what’s going on in the policy world, and understand the context of medicine use. I think it’s important that they know that pharmaceutical systems can be different in other countries. In principle, we train our Pharmacy students to become pharmacists, but more and more students want to build a career outside of the pharmacy. They could offer a lot of added value, for example in governmental organisations, at NGOs, or as consultants. In the end, no matter what role you play, we do what we do for the patients and their access to medicines.”