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					Essential Medicines List for
      Palliative Care

        Salzburg 2006
   We are here today because…..…..

• We are committed to providing, and
  encouraging others to provide, the highest
  standards of palliative care world-wide.
• We bring to this meeting vast experience in
  palliative care in countries very different
  from each other but all with thousands of
  people needing palliative care.
    We are here because………
• There are now > 8,200 palliative care services
• Increasingly such services are Hospital Palliative
  Care Teams in secondary and tertiary referral
• Palliative care training of doctors and nurses in
  many developing countries is still minimal. They
  are eager to learn.
All, whether in a developed or a developing country,
  need as much help as we can give them
We are here because, hopefully, we
   would all agree that………
Every person with a life-threatening
  illness has the right to receive
     appropriate palliative care

    Irrespective of their colour, class,
         creed, or financial means
It is the responsibility of every clinician
to provide appropriate palliative care to
             those who need it

     ( Such care might not always be
    given by a primary care doctor but
   might mean the patient being referred
   to a palliative care service or advice
             sought from one )
Patients receiving palliative care should
 be enabled to receive it in the place of
their choice - home, hospital, hospice,
         nursing or care home.
     The options vary from country to
   country as do the chances of patients
          achieving their wishes
 Many of us know from experience…..,,

• That people or groups starting palliative care
  services keep “ re-inventing the wheel” – making
  the same mistakes we have all made, trying out
  therapeutic regimens we have already found
  ineffective or too costly.
• Many of our textbooks are too expensive for those
  in developing countries
• These are some of the reasons why the WHO
  Analgesic Ladder was needed and why we are
  here to produce an Essential Medicines List
   Like the WHO ladder the Essential
        Medicines List……..….
• Will not be prescriptive or legally-binding
• Will not suggest therapeutic regimens
• Will not deal with financial costs (though
  they will be well known to most of us)
• Will represent the distillation of our clinical
  experience with 100,000s of patients
• Will, hopefully, be easy to explain,
  substantiate, disseminate and update.
       The Essential Medicines List

• The question of cost and „value for money‟
  will be addressed by those who follow me.
• The question of robust evidence on efficacy
  of medicines in the list will be addressed by
  others who follow me
• Here we address the need for a list and the
  principles associated with its use and
  dissemination world-wide.
      The Essential Medicines List

• Will not contain proprietary preparations
  or deliberately encourage their use
• Will predictably contain some medicines
  not available in countries we represent
• Will be reviewed and updated on a regular
• Will carry the authority of the WHO
   Question : Are we agreed on that ?
 The Essential Medicines List will be of
        little use unless………
• Governments legislate for availability and
  accessibility of the listed medicines for
  patients wherever they are being cared for.
  This applies to all on the list and not only
Question : How do we influence governments
            and make this happen ?
        It will be useless unless…….

• It is brought to the attention of, and explained to,
   all bodies briefing and trying to influence
   members of parliament and departments of health.
  [Such bodies now function in many countries
   explaining palliative care and encouraging
   government support and appropriate legislation]
   Question : How do we establish such lobbying
   groups and keep them informed ?
     It will be of little use unless…..

• It is brought to the attention of all
  physicians and nurses working in generalist
  and specialist palliative care services
  Question : How do we achieve this ?
• It is brought to the attention of all doctors
  and nurses providing palliative care,
  whatever their specialty.
  Question : How do we achieve this ?
   It will be useless unless …………..

• It is brought to the attention of all
  pharmacists, wherever they work
  Question : How do we achieve this ?
• It is brought to the attention of all students
  of medicine and nursing, and especially all
  intending to practise palliative care.
  Question : How do we achieve this ?
    It will be useless unless………….

• It is brought to the attention of all charities
  involved in supporting / funding/ enabling
  Palliative Care worldwide.
  Question : How do we achieve this ?
• It is brought to the attention of all national
  and international professional associations /
  societies of those working in palliative care
  Question : How do we achieve this ?
   It will be of little use unless…….

• It is brought to the attention of editors of
  medical, nursing and pharmaceutical
  journals and given good coverage by them
  (This is particularly important for all
  journals dedicated to palliative medicine
  and palliative care issues)
  Question : How do we achieve this ?
      What are your brief comments
• The need for a WHO Essential Medicines List
• Lobbying for availability and accessibility
• Making it known to all doctors and nurses
• Making it known to all students and pharmacists
• Making it known to professional associations
• Making it known to editors of professional
• Making it known to palliative care charities
  Have I missed out anything vitally important ?
  A few final thoughts and questions !

• How often should the list be reviewed and
  updated ?
• Should each country adapt the list to take
  costs into account ?
• Are we prepared for the displeasure and
  criticisms of pharmaceutical companies if
  they see the list as threatening sales ?
Thank You

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