The open letter recently published by Haute Autorité de Santé (HAS) and Lionel Collet in Les Echos is still echoing across the industry, and for good reason. Read closely, it functions less like a defence and more like an involuntary confession.
HTA is not pure science; it is a purchasing decision informed by scientific inputs. Variables like discount rates, the acceptance of surrogate endpoints, and the willingness to pay for clinical outcomes are ultimately political and fiscal judgements. The agency admits as much, citing its mandate to reconcile “better care” with “better spending.” Yet, by claiming their assessments represent “the very nature of science,” HAS borrows unearned authority from independent science.
It is a clever rhetorical device that recasts critics of a state buyer as attackers of scientific integrity.
HAS rightfully notes they have official committees for stakeholder feedback. That should be acknowledged. But when patients and clinicians feel their testimonies are politely logged but ultimately ignored, they inevitably turn to the public square. And rightfully so. How a state allocates its healthcare budget is a matter of profound public interest, and debates of this magnitude should never be confined to closed-door committee meetings.
Demanding that such discussions only happen within bureaucratic confines — or worse, only after a decision is finalised — is an empty concession. The only rational window to influence a life-altering access decision is before the ink dries.
When an institution attempts to assert this kind of absolute authority over the debate, it accidentally reveals its own anxieties. By lashing out at the entire healthcare ecosystem, HAS tells on itself.
Their “emotion versus evidence” dichotomy is a perfect example. By claiming the industry exploits “distraught families and distressed patients,” HAS confesses to viewing patients as naive bystanders. It ignores the reality of modern rare disease and oncology communities, who read clinical data and understand exactly what a hazard ratio means for their survival. Relegating their testimony to “emotion” isn’t scientific neutrality; it is an admission that the agency refuses to genuinely listen to lived expertise when it challenges their models.
Physicians are sidelined using a similarly revealing tactic. The letter dismisses doctors who advocate for access as operating “on the fringes” of a conflict of interest. When clinical specialists argue that a treatment’s real-world benefit outweighs a rigid data requirement, attacking their integrity is much easier for a bureaucracy than debating their medical judgement.
Of course, the pharmaceutical industry itself is not a neutral participant. They possess a clear profit bias. But this is not a moral failing; it is a legal fiduciary duty. Dismissing pharma’s arguments purely on the basis of their financial motive is intellectually lazy. Both HAS and the industry are, at their core, economic actors fighting over capital allocation.
All of this reveals a glaring democratic deficit. HAS is a public agency managing public funds. How a society allocates its healthcare budget is inherently a political choice, and citizens and stakeholders have a fundamental right to challenge those choices while they are being made. By labelling this normal democratic friction as “coercive pressure,” the agency is attempting to immunise itself from public accountability.
Publishing an open letter in a business newspaper is a political act. Ultimately, HAS isn’t defending science — they are confessing their refusal to genuinely listen to patients, their instinct to dismiss medical expertise, and their desire to shut down democratic debate when it threatens the budget.
A state purchasing agent is a legitimate, necessary role. It simply requires owning the economics of the job, rather than retreating behind the illusion of scientific neutrality.