[Can environmental impact be considered as a dimension of the proper use of medicines? From the 5th Forum of the Association for the Proper Use of Medicines]. / L'impact environnemental peut-il être considéré comme une dimension du bon usage des médicaments ? Retour sur le 5e Forum de l'Association Bon Usage du Médicament.

Through their footprint throughout their life cycle, from production to use, medicines have a significant impact on the environment. Reducing this impact is rarely considered from the perspective of the choices that healthcare professionals might have to make when prescribing or dispensing medicines. Should we consider environmental impact, alongside effectiveness and tolerance, one of the dimensions of the proper use of medicines? To address this question, the 5th Forum of the Association for the Proper Use of Medicines highlighted the main sources of pharmaceutical pollution: the carbon footprint linked to production, greenhouse gas emissions, the impact of residues on water and waste from packaging. While the eco-design of medicines should make it possible to limit their environmental impact upstream, there are still few initiatives aimed at their use. The Swedish "Hazard Score" assessment tool, which classifies compounds according to their potential to pollute the aquatic environment, was presented as a tool for guiding prescription choices. Through the exchanges between the various stakeholders (public authorities, doctors, pharmacists, manufacturers, patients) during this forum, recommendations were drawn up both on scientific and ethical grounds.

[The human resource: cornerstone of the digital transformation of the healthcare plan]. / La ressource humaine: pierre angulaire de la transformation numérique du parcours de santé.

The e-track, a real challenge for caregivers. We have known for more than twenty years that in order to "defragment" healthcare plan, break down the barriers between the city and the hospital and improve coordination between healthcare professionals, a better flow and sharing of information is essential. We are now talking about a digital shift in the light of accelerating technical progress with the rapid adoption of smartphones and mobile applications, and now the themes of big data and artificial intelligence, which are very present in the media.

Immunothérapie : une innovation de rupture non soutenable économiquement ?

IMMUNOTHERAPY: A NON-SUSTAINABLE BREAKTHROUGH?: The arrival of new immunotherapy anticancer drugs on the market marks a turning point. Their reference prices are fixed in the US and are positioned at the same level that the anticancer targeted therapies. They benefit from an accelerated approval process and often obtain the status of orphan drugs. The extensions of indications to many cancers and the likely combinations could significantly increase healthcare spending at a level that recently unveiled their non-sustainability, due to unrealistic prices approved by regulators. The current model of regulation needs to be revamped. HTA (Health Technology Assessment) could represent an appropriate response but face strong resistance especially because it would introduce a comparative assessment based on cost effectiveness with the greatest impact on prices of anticancer drugs. Market deregulation, allowing decentralized bargaining, could benefit from the transformation of the administered price into a maximum ceiling price. Two social bodies will have a great responsibility to influence policies that will necessarily be adjusted on a short term. The oncologists will be faced with difficult choices if they avoid the challenging debate on prices: they will be forced to accept rationing at the risk of being confronted with contradictory demands and a cognitive dissonance; they may also, following ASCO, accept that the increased co-pay and its "financial toxicity" represents a new drug side effect integrated in the medical decision process. The engagement of patients' associations will be equally decisive.