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“Good and bad patients?”

In Belgium, patients with lung fibrosis will not get reimbursed for a treatment if they have smoked in the last 6 months. The smoking abstinence will be controlled by a urine test, which needs to be negative to open rights to reimbursement of the drug.

Dr Gérard Mathern, pulmonologist, said he was appalled by this policy that he considers “inadmissible”. According to the health professional, smoking is an addiction, the patient should not be considered a bad subject but as a sick person. “The physician should elect the good and reject the bad patient?”, he asks. Ethically, his vision ris clear: “this is more than questionable, it’s reprehensible.”

For the pulmonologist Gérard Mathern this restriction will be hard to explain to patients (Credit: G. Mathern)
For the pulmonologist Gérard Mathern this restriction will be hard to explain to patients (Credit: G. Mathern)

The former secretary-general of the French Society of Tobaccology (SFT) confirms that the urinary tests incriminate all nicotine consumers, including former smokers who continue to use substitutes such as patches or gums, and vapers.

For this type of consumers, cotinine (a nicotine metabolite measured in urine) might be measured in similar quantities than for current smokers. Furthermore there is no way to know from this test if a person consuming nicotine had stopped smoking for six months because of the absence of long-term markers.

Dr Benjamin Bondue, a Belgian pulmonologist, told RTL that the restriction may be “difficult” to explain to patients.

Pulmonary fibrosis is a rare disease that affects about 1,000 people in Belgium (including approximately 600 men). It refers to a form of excessive lung scarring that generates progressive respiratory failure. Life expectancy for untreated patients ranges from 3 to 5 years. The current treatment, Nintedanib, does not cure the disease but stabilizes it.

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