̽��ֱ�� of Cambridge - Eastern Europe

Bringing Ukraine to the screen

sjr81 — Fri, 06 Nov 2015 10:16:14 +0000

Today and tomorrow (November 6/7), the Annual Cambridge Festival of Ukrainian Film once again offers UK audiences a unique opportunity to experience some of the best of Ukrainian cinema. Free and open to the public, the event is organised by Cambridge Ukrainian Studies, an academic centre in the Department of Slavonic Studies at Cambridge.

Since 2008 the Festival has premiered prize-winning new releases as well as provocative forgotten masterpieces; invigorated silent classics with live piano accompaniments; made world headlines with a documentary about Stalin’s man-made famine of 1932-33; and hosted contemporary Ukrainian filmmakers, film scholars, preservationists and musicians who have educated and engaged with well over a thousand attendees.

This year Cambridge Ukrainian Studies is partnering with the Docudays UA International Documentary Human Rights Film Festival to bring six powerful new documentaries to local audiences. DocuDays UA was launched in Kyiv in 2003 as a non-profit organisation dedicated to the development of documentary cinema and to the flourishing of democratic civil society in Ukraine.

Many of the films in the Festival programme confront the tumult of revolution and war in today’s Ukraine with an uncommon honesty, sensitivity and maturity. They avail the viewer of the perspectives of the volunteer doctor, the wounded veteran, the soldier preparing to leave home for war. Other films in the programme meditate upon the passing of generations in a Ukraine very far from today’s headlines: the village and countryside.

“We are very proud and very honoured to collaborate with DocuDays UA in this year’s Cambridge Film Festival of Ukrainian Film”, said Dr Rory Finnin, Head of the Department of Slavonic Studies and Director of the Cambridge Ukrainian Studies programme. “We share their passion for documentary cinema and their belief in its ability to foster an open dialogue about human rights and social justice in Ukraine and around the world.”

“For the Cambridge Festival of Ukrainian Film we have chosen both full-length and short documentaries produced during the last two years,” explained Darya Bassel, Docudays Programme Coordinator. “With these screenings we hope to bring Ukraine and its documentary scene closer to international audiences and to create space for a discussion of problems relevant not only for Ukraine but for the whole world.”

Admission to the Eighth Annual Cambridge Festival of Ukrainian Film on 6-7 November 2015 is free and open to the public, but online registration is required. ̽��ֱ��screenings of Maidan Is Everywhere; ̽��ֱ��Medic Leaves Last; Living Fire; Post Maidan; This Place We Call Home; and Twilight take place in the Winstanley Theatre of Trinity College, Cambridge. Wine receptions follow both the November 6 and 7 screenings.

Over the past eight years, the ̽��ֱ�� of Cambridge has become Britain’s pre-eminent showcase for documentary and feature films from and about Ukraine.

Documentary cinema fosters an open dialogue about human rights and social justice in Ukraine and around the world.

Rory Finnin

Still image from the Ukrainian documentary 'Twilight'

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̽��ֱ��Crimean Tatar Sürgün: Past and Present

fpjl2 — Tue, 20 May 2014 11:11:19 +0000

On 18 May 1944 a young Crimean Tatar poet named Idris Asanin began a torturous journey to Central Asia at the gunpoint of Stalin’s secret police, the NKVD. Along with hundreds of thousands of other Crimean Tatars, a Turkic-speaking Sunni Muslim people indigenous to Crimea, Asanin’s family endured an ordeal of mass death and brutal dispossession that claimed the lives of at least thirty percent of the entire population, mainly women, children and the elderly. Thirty percent – that is thirty times the percentage of the British population killed in the Second World War.

̽��ֱ��deportation is known as Sürgün ( ̽��ֱ��Exile) in the Crimean Tatar language. Asanin’s mother and father did not survive it. In Soviet Uzbekistan, where he was forced into a ‘special settlement camp’, the young poet channelled his grief into verse. ‘Menim antım’ (My Pledge, 1944), one of the first literary works in the Crimean Tatar language to confront the deportation, is a defiant scream into darkness. Its stanzas – which would be later cited by Soviet authorities in a trial that sentenced Asanin to twenty-five years in prison – are a catalogue of abuse and alienation: Crimean Tatar funerals are mocked by onlookers, their sacred prayers are interrupted, their dead are forgotten. His lyrical persona cries out and asks, ‘How can I bear it all without succumbing to rage?’

This week, as we mark seventy years since the deportation of the Crimean Tatars, Asanin’s question resounds with a tragic new relevance. After struggling for generations to return to and resettle on the Black Sea peninsula, the Crimean Tatars are now under new threat from ‘local authorities’ under the nominal jurisdiction of the Russian Federation, which illegally occupied and annexed Crimea from Ukraine in March. Many have fled to mainland Ukraine since the annexation, becoming the largest community of IDPs (Internally Displaced Persons) in the country. And only days ago, the Crimean Tatars were even forbidden by decree to gather in public and commemorate the deportation and its victims.

On 18 May 2014, they had to break the law to mourn and honour their dead.

̽��ֱ��Crimean Tatars defied the prohibition without – somehow – succumbing to rage. Disavowing religious and political extremism, they have engaged for decades in a committed practice of non-violent resistance against state injustice and oppression. In the late 1980s they prevailed over the Soviet system and won the right to return to Crimea. (In the post-Soviet period, this return from exile was financed by the Ukrainian state. In 1999 alone, for instance, Kyiv allocated twenty million hryven – approximately five million US dollars – to fund Crimean Tatar resettlement programs and attendant infrastructure projects.) Today’s prohibitions and provocations are nothing the Crimean Tatars cannot overcome.

But the resilient dignity of the Crimean Tatar people should not exempt us from outrage. In Britain our public understanding of the present war between Russia and Ukraine – and make no mistake, it is a war – has been clouded by a relentless Kremlin propaganda campaign and by Western media ignorance of a complex ‘theatre’ of conflict. A casual observer seeking to make sense of the diplomatic recriminations, ubiquitous balaclavas, and proxy violence at this point may be tempted to throw her hands up in exasperation and confusion. To navigate between rhetoric and reality and understand what is generally happening along the eastern border of the EU, simply look to the case of the Crimean Tatars since the Russian annexation.

̽��ֱ��reality is that Crimean Tatar civil society and identity are under cruel assault, while the rhetoric from the Kremlin would have us believe otherwise. Only days ago, on Friday 16 May, Vladimir Putin sat down with selected Crimean Tatars in Sochi to mark the anniversary of the ‘inhuman’ (beschelovechnaia) deportation, announcing that the new ‘local authorities [in Crimea] are ready to work’ with them. At that very moment, these ‘local authorities’ in Crimea did exactly the opposite. Sergei Aksenov, the new ‘head’ of the Crimean government known as ‘Goblin’ in the criminal underworld, outlawed all public demonstrations in the entire territory of Crimea until 6 June. ̽��ֱ��purported reason was fear of potential ‘provocations’ from ‘extremists’ tied to the violence in ‘Ukraine’s south-east’. Keep in mind that the interim Ukrainian government in Kyiv – which has actual cause to fear mass gatherings at the moment – has issued no such kind of blanket prohibition on public assembly. In fact, over the weekend of 17-18 May, the Ukrainian capital and other Ukrainian cities were host to a series of solemn public events commemorating the seventy years since the Crimean Tatar Sürgün.

̽��ֱ��real reason for Aksenov’s decree was fear of the content, form and number of the commemorative events being organized by the Crimean Tatar community in Simferopol, Bakhchisarai and beyond. These demonstrations were a powerful refutation of the neo-Soviet pageantry resurgent in Crimea and the Russian Federation. They recalled the atrocities of Stalinism and restored many of the names, faces and stories of its victims. ̽��ֱ��demonstrations also sounded a note of Ukrainian national pride and gave lie to the ‘Potemkin referendum’ that hastily preceded the March annexation. There is a saying: naibilshymy ukraintsiamy v Krymu ie krymski tatary. ‘ ̽��ֱ��greatest Ukrainians in Crimea are the Crimean Tatars.’ ̽��ֱ��vast majority of Crimean Tatars, who comprise more than 12% of the population, recognise Crimea as a part of independent, sovereign Ukraine. They identify overwhelmingly with the Ukrainian national project. And on Sunday, 18 May they made ubiquitous the national flag, the kök bayraq, which evokes the Ukrainian yellow and blue.

On this day in Bakhchisarai, the ancient capital of the Crimean Tatar khanate, two Russian military helicopters flew directly over the crowds of Crimean Tatars who defied the protest ban. Among the assembled, many of whom were schoolchildren, there was an initial moment of quiet terror as the first aircraft passed overhead. ̽��ֱ��sound was deafening. Those speaking via microphones to the crowds could not be heard. But then the crowds shouted in unison at the skies: ‘Qırım Vatan Millet!’ ‘Crimea, Motherland, Nation!’

Undaunted in the face of such intimidation, they also chanted ‘Mustafa! Mustafa!’ They were calling for the man who has prominently represented them for many decades, the seventy year-old Mustafa Dzhemiliev (Mustafa Cemiloğlu, aka Mustafa Abdülcemil Qırımoğlu). He was in Kyiv on this solemn day, and not by choice. Dzhemiliev is presently not allowed to set foot in Crimea. ̽��ֱ��Kremlin’s ‘authorities’ are in effect subjecting him to a new exile.

Although physically diminutive, Dzhemiliev is a giant. As a child, he survived the deportation; as a young man, he survived the Gulag, enduring a 303-day hunger strike in the mid-1970s that garnered headlines around the world. In 1989 he made an emotional return to the ancestral homeland that he fought his entire life to see.

To separate this man from his home today is an extreme injustice, yet it is Dzhemiliev and his compatriots who must fend off accusations of ‘extremism’. On 3 May, when Dzhemiliev attempted to cross at Armiansk from mainland Ukraine into Crimea, many hundreds of Crimean Tatars pushed past Russian troops to meet him. ̽��ֱ��new Prosecutor-General of Crimea characterized this abortive encounter at the border as an ‘extremist action’ and threatened to dissolve the Crimean Tatar parliament, the Mejlis, in recompense. ̽��ֱ��Kremlin’s ‘local authorities’ then made a more targeted threat against Dzhemiliev as well: last week his residence was among a number of Crimean Tatar houses searched by the Russian Security Service (FSB) for evidence of ‘terrorism’. ̽��ֱ��incident led to the hospitalization of his wife, Safinar Dzhemilieva.

In war, wrote Carl von Clausewitz, ‘all action takes place, so to speak, in a kind of twilight.’ Information is elusive and unreliable, suspended between recessive daylight and an encroaching darkness of ignorance, confusion and deception. In Crimea, this darkness has lifted; in Donbas, it has grown. What we now see is that the Kremlin’s presumed gains on the Black Sea peninsula have already meant very real losses for the long-suffering indigenous people of the Black Sea peninsula. Seventy years after Sürgün, the question returns: how to bear it all?

In this article, originally published on the CRASSH website, Dr Rory Finnin - ̽��ֱ�� Lecturer and Director of the Cambridge Ukrainian Studies programme - addresses the banning by Russia of the public commemoration of the deportation of the Tatars in illegally annexed Crimea.

̽��ֱ��vast majority of Crimean Tatars, who comprise more than 12% of the population, recognise Crimea as a part of independent, sovereign Ukraine. They identify overwhelmingly with the Ukrainian national project

Rory Finnin

Jordi Bernabeu Farrús

A woman walks along a railway crossing near Ukrainian tanks on freight cars before their departure from Crimea -- now annexed by Russia -- to other regions of Ukraine in the settlement of Gvardeiskoye near the Crimean city of Simferopol

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A divided Ukraine: Europe’s most dangerous idea

fpjl2 — Fri, 28 Mar 2014 12:49:23 +0000

Pick up any news clipping about Ukraine from the past twenty years, and you are likely to find a cursory description of the country along these lines: ‘Ukraine, roughly the size of France, divided between a pro-EU west and a pro-Russian east’.

A journalist once admitted to me that his editors routinely appended such a refrain even to articles and reports attesting to a different, more complex reality – to a highly diverse but ultimately coherent country. Ukraine was too poorly known in the West beyond nuclear accidents and feuding politicians, he explained. In media discourse it needed a 'brand', an easy shorthand, a consistent diagnosis to account for a host of geopolitical maladies.

A consensus emerged: bipolar disorder.

Ukraine became known as the perennial ‘house divided against itself’, riven along a deep west/east, pro-EU/pro-Russia fault line. Months ago, this reductive cliché used to irritate me. Now it keeps me up at night. As Russian troops amass along Ukraine’s eastern border, it may be the most dangerous idea circulating in Europe today.

Ukraine is not existentially divided. Its body politic is scarred and fractured, but it is whole. Labelling its eastern regions ‘pro-Russian’ – ontologically disposed to a neighbouring state and culture – is not only inaccurate as an historical matter but perilous as an analytical one. We need to appreciate the gravity of this likely scenario: if the Russian Federation invades the east of Ukraine, most residents of such eastern cities as Kharkiv and Donetsk will not open their arms or shrug their shoulders. There will not be a repeat of the Crimean affair, which saw little violence thanks to a Ukrainian military determined not to legitimate Russian provocation with compensatory force.

If Russia invades beyond Crimea, Ukrainians will defend themselves. And Europe will be witness to a war between its largest countries, with dire economic and human costs for us all.

Each day brings new details of a Russian theft of Ukrainian strategic assets – nearly all of Ukraine’s Black Sea Fleet has been sunk or stolen outright – and of a massive Russian military build-up along Ukraine’s eastern border. How massive? ‘Very, very sizeable’, in the words of NATO Supreme Allied Commander Philip Breedlove. ‘Tens of thousands’, say members of the US Armed Services Committee. Andrii Parubii, Secretary of Ukraine’s National Security and Defense Council, recently quantified it in this way: 100,000 Russian troops and more than 370 artillery systems, 270 tanks and 140 combat aircraft.

Meanwhile, across the border, Ukrainians in eastern cities like Kharkiv are organizing masterclasses in triage and first aid, and crowd-sourcing the translation of books about the tactics of light infantry. Others in a vocal minority, by contrast, are beckoning the Russian armed forces in public with enthusiastic shouts of ‘Rossiia!’. Many of these demonstrators are actually touring Russian provocateurs. Kharkiv journalists have devised a canny way to determine their provenance: they simply ask them what time it is. Western Russia is two hours ahead of Ukraine. As it turns out, watches and smartphones tend to run very fast at these demonstrations.

This Russian military escalation and these coordinated public demonstrations in support of Russian intervention may not alarm the casual observer in Britain, who has been told a story about the ‘pro-Russian’ complexion of Ukraine’s east for far too long. But we should be alarmed. Let me explain by stating what should be obvious: Ukraine’s east is ‘pro-Ukrainian’. Its Ukrainian identity is idiosyncratic and contested, but it is dominant. Moreover, it has been historically influential. Kharkiv, in fact, is a central birthplace of the modern Ukrainian national idea.

In the first decades of the nineteenth century, Kharkiv ̽��ֱ�� was a seminal bastion of Ukrainian Romantic thought, a site of vigorous heritage-gathering and artistic creation. ̽��ֱ�� ̽��ֱ��’s professors – Amvrosii Metlynsky, Petro Hulak-Artemovsky – as well as its students – Mykola Kostomarov, Levko Borovykovsky – strove to elevate the Ukrainian vernacular to the status of a literary language, publishing original poetry and historical research in such Kharkiv journals as ̽��ֱ��Ukrainian Herald, ̽��ֱ��Ukrainian Digest, ̽��ֱ��Ukrainian Journal and ̽��ֱ��Ukrainian Almanac. By 1876, when the tsar explicitly banned the Ukrainian language from the public life of the Russian Empire, such periodicals ceased to exist in Kharkiv. But they nonetheless laid the ground for an explosion of Ukrainian cultural production in the twentieth century, when Kharkiv was the capital of the Ukrainian Soviet Socialist Republic, and in the twenty-first century, when Kharkiv became accustomed to celebrating the accolades of its native son Serhii Zhadan, one of Ukraine’s most popular writers.

And what about Donetsk, widely known in the West as a ‘pro-Russian’ city populated by miners, oligarchs and football stars? Founded in 1879 by Welsh industrialist John Hughes, Donetsk is an unofficial capital of the Ukrainian national rukh oporu, the dissident ‘defence movement’ that championed the rights of Ukrainians and many other groups in the Soviet era. Ivan Dziuba, who graduated from the Donetsk Pedagogical Institute, wrote the classic underground exposé of Soviet nationalities policy, Internationalism or Russification?; Mykola Rudenko, who penned touching poetic reflections about his Donetsk childhood, led the Ukrainian Helsinki Group; Vasyl Stus, who also attended the Donetsk Pedagogical Institute, was a member of the Ukrainian Helsinki Group and the greatest Ukrainian poet of the twentieth century; and Oleksa Tykhy, who worked in Donetsk as a biology teacher, courageously confronted Soviet officialdom over the suppression of Ukrainian national culture. All of these prominent figures were imprisoned for ‘pro-Ukrainian’ activities; both Stus and Tykhy died in the gulag as late as the mid-1980s.

And today? Over the past decade, poll after poll of respondents in Ukraine’s eastern oblasts reveal – to entertain the reductive label one final time – a majority ‘pro-Ukrainian’ sentiment. In a 2005 Razumkov Centre study, for instance, 67% of citizens from Ukraine’s east answered positively in response to the question ‘Do you consider yourself a patriot of Ukraine?’, while 22% answered negatively and 11% found it difficult to answer at all. Likewise, in a 2006 Razumkov Centre study, 62% of respondents in the east said ‘Yes’ to the question ‘Would you choose Ukraine as your fatherland if you had the choice?’, while 20% said ‘No’ and 18% ‘Hard to say’. Keep in mind that in Ukraine per capita GDP was $2,303 in 2006; in Russia it was $6,947. Even despite economic disparity with its powerful neighbour, most residents in Ukraine’s east have made a point of embracing the Ukrainian state as their home.

It is high time we listened to them. With another Russian invasion of Ukraine’s sovereign territory on the horizon, we cannot afford to retreat to stale, intellectually lazy and above all dangerous clichés about Ukraine’s ‘pro-EU’ and ‘pro-Russian’ halves. Ukraine is a large, diverse country that has managed its many differences admirably since winning independence in 1991. Today the Kremlin is trying to fetishize, manipulate and exaggerate these differences through brute force, intimidation, provocation, and propagandistic deception – simply because the Ukrainian people ousted a corrupt, criminal president and fought to determine their own destiny. War is imminent, and the Kremlin is counting on our ignorance and on our tacit questioning of Ukraine’s sovereignty over its eastern territory. We need to respond not only by supporting the new Ukrainian government with ambitious financial assistance but by making Ukrainians, at last, the subjects of their own story.

Originally published with the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at the ̽��ֱ�� of Cambridge.

In this article, originally published on the CRASSH website, Dr Rory Finnin - ̽��ֱ�� Lecturer and Director of the Cambridge Ukrainian Studies programme - addresses the notion of a 'divided' Ukraine and the current military escalation by Russia.

We cannot afford to retreat to stale, intellectually lazy and above all dangerous clichés about Ukraine’s ‘pro-EU’ and ‘pro-Russian’ halves

Rory Finnin

Sasha Maksymenko

Pray for Ukraine

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Totalitarianism, violence and the silent majority

sjr81 — Wed, 06 Mar 2013 15:07:52 +0000

Her lecture ‘True Believers: Collaboration and Opposition under Totalitarian Regimes’ takes place at the Umney Theatre, Robinson College, tonight at 5pm.

Applebaum won the Pulitzer Prize for her 2004 book Gulag: A History, and is also the author of Between East and West: Across the Borderlands of Europe, and Gulag Voices: An Anthology. Her most recent book is Iron Curtain: ̽��ֱ��Crushing of Eastern Europe, 1944-1956.

She said: “ ̽��ֱ��horrifying genius of Soviet communism - as conceived in the 1920s, perfected in the 1930s and then spread by force to Soviet-occupied Europe was the system's ability to get the silent majority in so many countries to play along without much protest.

“A small proportion of people protested and small proportion collaborated. But carefully targeted violence, propaganda and state's monopoly on economic and civic institutions persuaded the rest to go along. These techniques were used to great effect in Eastern Europe after 1945.”

Applebaum, who is currently Philip Roman Visiting Professor at the London School of Economics, a columnist for the Washington Post and Slate, is also a former Editor of ̽��ֱ��Economist, where she provided in-depth coverage of Eastern Europe before and after the fall of the Berlin Wall in 1989.

Dr Rachel Polonsky, a lecturer at the Department of Slavonic Studies and organiser of tonight’s event, said: “We are proud to be hosting Anne Applebaum, whose work and life centre on the areas we study in the Department.

“As a historian of the twentieth century, Anne reminds us how intricately interwoven the political destinies and cultures of Russia, Ukraine and Poland have been, and how important it is to study them together. She is one of a series of high-profile lecturers (including the Polish intellectual Adam Michnik and the British historian Norman Davies) whose visits to Cambridge demonstrate the commitment of the ̽��ֱ�� to securing a future for Polish studies within the Slavonic Department, and the hope that this commitment will resonate outward to a wider public, both within and beyond the ̽��ֱ��.”

Head of Slavonic Studies, Dr Emma Widdis, said: “Our research and teaching in Ukrainian, Russian and in future, as we hope, Polish, reflect our sense of the importance of understanding this complex European 'neighbourhood', in which historical legacies remain politically contested. We are all very much looking forward to Anne’s talk this evening.”

Tonight’s talk at Robinson College is part of the CamCREES 2013 public lecture series, which also runs alongside a series of public lectures on Resistance in Russia and Eastern Europe.

Upcoming events in this series include:

'Resistance and Rights' on Thursday 7 March 2013, given by Professor Benjamins Nathans, ̽��ֱ�� of Pennsylvania
How and with what effects was the rhetoric of rights - the lingua franca of liberalism - deployed in an avowedly illiberal society like the Soviet Union? How do activists invoke rights in today's Russia? This lecture will analyse continuities and ruptures in the career of civil and human rights as a mode of resistance from the period of "developed socialism" to the Putin era.

'Resistance and Performance' on Thursday 25 April 2013, given by Dr John Freedman (writer, translator, critic, and scholar of Russian theatre)
Political resistance and social commentary are deeply ingrained in the Russian theatre tradition. Rarely, however, have they been as open and obvious as in recent years. Throughout the Soviet period (and Imperial era) theatre artists "spoke the truth" by way of metaphor and implication. This tended to remain true even after the collapse of the Soviet Union, when artists, who achieved new freedoms, were more intent on creating new kinds of art than on speaking about social ills. But in one of the biggest breaks with tradition in the history of Russian theatre, some writers, directors and actors are currently becoming extremely outspoken in their works. This discussion will focus on current developments, putting them into a historical context.

'Resistance and Gender' on Thursday 2 May 2013, given by Dr Olesya Khomeychuk, ̽��ֱ�� of Cambridge

̽��ֱ��‘horrifying genius’ of Soviet totalitarianism and its ability to control and quell protest will be examined tonight by Pulitzer Prize-winning author Anne Applebaum.

̽��ֱ��horrifying genius of Soviet communism - as conceived in the 1920s, perfected in the 1930s and then spread by force to Soviet-occupied Europe was the system's ability to get the silent majority in so many countries to play along without much protest.

Anne Applebaum

Newhouse Design

Russian Poster 38

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Drug pushing in the New Europe

ns480 — Fri, 23 Sep 2011 08:43:41 +0000

An investigation by academic researchers has revealed how backroom deals and discreet pressure by pharmaceutical corporations are determining which drugs are delivered to hospital patients in Poland.

̽��ֱ��study, which is described by one of its authors as a "warning for the New Europe", was led by sociologists at the ̽��ֱ�� of Cambridge, UK. It calls for an overhaul of Poland's drugs reimbursement system - the process by which government effectively signs off new drugs for use - and suggests that flaws in the system allow some treatments to be employed for therapeutic programmes even though their effectiveness is not guaranteed.

̽��ֱ��fact that pharmaceutical corporations lobby decision-makers in an effort to ensure that their products are taken up by national health programmes is well-documented in countries such as the UK. Less clear is how far this is happening in the former Eastern Bloc states which entered the European Union in 2004, and whether it is properly acknowledged and controlled.

̽��ֱ��new research, published in the journal, Health Economics, Policy and Law, identifies serious loopholes in the drugs reimbursement system used by the Polish government, arguing that it leaves companies with too much room to influence the final decisions taken by the Ministry of Health. Interviews the researchers conducted with industry insiders revealed that companies commonly try to buy the favour of key policy-makers, or “outflank” them by winning over expert advisors and pressure groups.

Dr. Lawrence King, from the Department of Sociology, ̽��ֱ�� of Cambridge, said: "This may be part of a broader syndrome of the prominence of informal institutions in post-communist policy-making, rather than something which is unique to Poland. For the New Europe, this could be a warning."

Reimbursement is usually the final hurdle for a company trying to get its drug on to the market and is typically determined by government. Final checks about the product's cost-effectiveness and efficacy are made before a decision is taken about how the manufacturer will be paid. This means that flawed reimbursement systems can lead to the wrong drugs being sanctioned for use by health service providers, resources being wasted and, potentially, patients not getting access to the treatments they need.

Poland was chosen for the study because it is the largest pharmaceutical market in Central and Eastern Europe and an important player in influencing the balance of power in the pharmaceutical sector. ̽��ֱ��researchers focused on a major state reimbursement schemes that funds free therapies, used by hospitals to treat rare diseases and certain types of cancer. Typically it means funding innovative and emerging drugs rather than generic treatments.

Between February 2009 and April 2010, the team carried out 109 in-depth interviews with people involved with this policy - among them government officials, drug company representatives, national consultants and representatives from patient groups. They also reviewed existing legislation, policy documents, official reports and media articles. Two specific disease awareness campaigns in Poland were also tracked by the researchers.

They found a lack of regulation in Poland concerning the development of therapeutic drug reimbursement programmes, and of the way in which drug companies approach ministers. One lawyer they spoke to described reimbursement as "legal terra incognita", while others described the process of decision-making as akin to "black magic".

In addition, the study found that the Polish Agency for Health Technology Assessment (AHTA), which recommends drugs to the Minister of Health, rarely has conclusive data from the drugs companies about their products. One official told the team: "In half of research results, we deal with drugs whose effectiveness cannot be established."

These factors conspire to create loopholes which pharmaceutical companies can then exploit. While the Polish Ministry of Health does have a formal consultation procedure for receiving clients, those who use it described it less as a means of access, and more as a technique used to muzzle “unfriendly" manufacturers.

Meanwhile, informal deals are taking place outside the system, the study found. Companies build up relationships with key decision-makers by offering them mutual favours, such as support for sick relatives, or lucrative positions in the industry. In one case referred to in the paper, a cardiology drug was accepted for reimbursement even though the scientific evidence supporting it was doubtful. Later, the press discovered that the decision had been taken after the relative of a high-ranking ministerial official had a new flat "arranged" by the drug company.

Where pharmaceutical companies cannot access ministers directly, the researchers found that they attempt to reach expert national consultants instead. ̽��ֱ��state offers little renumeration for these expert scientists' work, which enables drug firms to offer their own financial support, or the consultants access to trials and medical knowledge that will help them to raise their academic profile.

Similarly, firms also help out patient groups whose cause matches the treatments they are trying to sell. In extreme cases, they even manufacture them. One former official in the AHTA told the researchers about a case in which a reimbursement application for a kidney cancer drug was submitted. Almost simultaneously, a patients' association lobbying for precisely this kind of treatment appeared on the scene. "It could not have been a coincidence," the interviewee is reported as having said.

Other informal lobbying methods are also identified in the paper. ̽��ֱ��researchers spoke to newspaper journalists who had been telephoned by drugs manufacturers wanting to "order an article" in the paper. They also encountered cases where firms had approached different ministers in an attempt to exert indirect pressure on the Ministry of Health, or, in the case of international pharmaceutical corporations, asked their own governments to exert diplomatic pressure on Polish decision-makers.

̽��ֱ��paper notes that while some of these methods resemble techniques long-since recognised in western Europe and the US, they are exaggerated in Poland by the imbalance between the economic resources of drug companies, and those of other players such as patient groups or consultants.

In response, the researchers recommend comprehensive reform of the current system in Poland, which would involve more effective regulation of consultations between the Ministry of Health and drug companies, and a beefing up of financial and organisational support for third parties, so that they can adopt a genuinely independent role. ̽��ֱ��authors also recommend strengthening the AHTA as a check and balance against the Ministry, and measures making the Ministry's own considerations more transparent, so as to decrease "the opacity of pressures from other ministries or states."

̽��ֱ��full paper, Pharmaceutical lobbying under postcommunism: universal or country-specific methods of securing state drug reimbursement in Poland? is published in the latest issue of Health Economics, Policy and Law.

A new study reveals how drug reimbursement policy in Poland is leaving gaping loopholes for pharmaceutical firms to exploit, raising questions about other, post-communist, EU member states.

This may be part of a broader syndrome of the prominence of informal institutions in post-communist policy-making. For the New Europe, this could be a warning.

Lawrence King

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Meds

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