Cancer: There are life-saving drugs. So why can't we have them?

[cal04]

Thousands of cancer sufferers are being denied life-saving drugs because of delays and bureaucracy in making them available on the NHS. The hold-ups are a matter of life and death for desperate people who have been diagnosed with cancer of the breast, colon or lung, or with a brain tumour. Last week, a patient who was refused the drug Herceptin for her breast cancer launched a High Court challenge to the decision. But The Independent on Sunday has established that an "exciting" new range of drugs which work in a similar way is also being denied to patients.

Doctors are furious that drugs such as Avastin, which is used to treat colon cancer, and Cetuximab, a treatment for head and neck cancers, are being blocked by the National Institute for Clinical Excellence (Nice), a government-appointed quango set up to decide which drugs should be routinely prescribed on the NHS. But backlogs mean that Nice is taking up to two years to make its decisions. That means drugs such as Avastin, which have been officially licensed and approved for use, are currently denied to NHS patients although well-off people can obtain them privately.

In some cases, patients are being told they face a three-year wait if they want to obtain these life-saving treatments free. Cancer charities, MPs and leading specialists are warning that this is creating a two-tier system where only those with money, and the well-informed, can afford the drugs, which cost many thousands of pounds. They also condemn the postcode lottery over prescribing of cancer drugs, which means that some people are turned down for treatment but others are successful in proving that their case is "exceptional", depending on what part of the country they live in.

Senior Labour and Liberal Democrat MPs last night called jointly for a radical overhaul of how trusts provide treatment, with the public having a say in the decision on how cash is to be allocated. A prominent committee of MPs is also demanding that the Government ring-fence money for cancer treatment and that specialist networks, not NHS trusts, should be set up to decide where the cash is spent. The All Party Group on Cancer, which last week published a damning report revealing the huge inequalities in provision of cancer drugs, wants decisions to be fast-tracked by Nice. "It's now becoming a case of life or death for cancer patients," said Ian Gibson, the group's chair. "People are not getting the drugs they need and it's not acceptable to have one region where people survive and others who do not."

more
http://news.independent.co.uk/uk/health_medical/article355173.ece

[Warpy]

1. At least you have the possibility of getting them eventually

Here in the US, we can't get them unless we're unimaginably rich. Even if we have insurance, the companies balk at paying the prices that Big Pill charges for these drugs until it is too late to use them effectively.

[OzarkDem]

2. Costs are incredibly high

The cost for 1 year of Avastin here in the US exceeds $100,000. Drugs like Herceptin (from the same manufacturer - Genentech) is now $95,000 yr and there's still no evidence it needs to be taken that long.

Here's a good article about it

http://www.stopbreastcancer.org/bin/index.asp?strid=803&btnid=1&depid=20

[varkam]

3. Here's another fun NYT article...

Read this a while back regarding cancer drugs and big price hikes:
New York Times
A Cancer Drug's Big Price Rise Is Cause for Concern
Alex Berenson
March 12, 2006
Link

On Feb. 3, Joyce Elkins filled a prescription for a two-week supply of nitrogen mustard, a decades-old cancer drug used to treat a rare form of lymphoma. The cost was $77.50.

On Feb. 17, Ms. Elkins, a 64-year-old retiree who lives in Georgetown, Tex., returned to her pharmacy for a refill. This time, following a huge increase in the wholesale price of the drug, the cost was $548.01.

Ms. Elkins's insurance does not cover nitrogen mustard, which she must take for at least the next six months at a cost that will now total nearly $7,000. She and her husband, who works for the Texas Department of Transportation, are paying for the medicine by spending less on utilities and food, she said.

The medicine, also known as Mustargen, was developed more than 60 years ago and is among the oldest chemotherapy drugs. For decades, it has been blended into an ointment by pharmacists and used as a topical treatment for a cancer called cutaneous T-cell lymphoma, a form of cancer that mainly affects the skin.

<snip>

[FM Arouet666]

4. Chemotherapy tends to be a racket

An oncologist finds out that his patient has just died, he thinks to himself... "Perhaps I can get in one more treatment." He runs down to the morgue, pulls out the drawer where his patient rests and finds a small scrap of paper.
"Patient gone to hemodialysis." ;)

Unlike other medications, chemotherapy meds are sold to the oncologist who is free to mark up the price, often yielding a substantial profit. The oncologist and the pharmaceutical companies have the patients over a barrel, "take the drug or take death." (No alt medicine claims of cancer cures please, I am not interested.)

An interesting part of the article is that it is from the UK. The UK system, like that in Canada, offers regulated health care. Costs are controlled by limiting access to certain treatments and procedures based on need, expected outcome, effectiveness etc. In the U.S. you can get a CT or MRI on request, most treatments, surgeries will be available regardless of expected results. Terminal cancer patients are sold the latest chemo regardless of effectiveness, eighty and ninety year-olds on dialysis, heart surgery for the diabetic smoker octogenarian etc etc.

I cannot tell you how often I have exclaimed "this is utterly ridiculous, why are we treating this patient, it is pointless." Why?, we do it because that is the U.S. system. I suspect that these drugs, which I admit I have little experience with, are more available in the U.S. then in most socialized medical systems. Insurance programs and medicaid which offer low income people coverage do so by controlling costs, and these drugs will probably not be covered.

So what is better, the U.S. model where patients can get what ever they want regardless of cost or a socialized model where costs are contained and the patient is limited in what treatments are available? Something in the middle I suspect. How to achieve it, you got me, I am a doc and the first one to admit the system is broken. Perhaps I am part of the problem, another medical whore. I provided dialysis access for a demented 85 year old just yesterday. I got paid, so will the nephrologist for each dialysis treatment, the hospital got their dough as did the dialysis catheter company 'Bard.' The patient will be dead within the year, quality of life?, the family desired treatment, justification? Who pays? You do, the patient was on medicare.

[flaminbats]

5. this quote explains a big part of the problem..

"James has had diabetes since he was two years old. He cannot live without needles. He wants to know why there is no cure. For him, diabetes research is more than a science. The endless war he will fight with his own body makes it personal. He doesn't understand why diabetes receives so little research money compared with other diseases. Politicians still think insulin is the cure."

http://www.geocities.com/hotsprings/spa/4750/

Too many politicians simply view insulin as the cure for diabetis, chemotheropy as the cure for cancer, and kidney dialysis as the cure for kidney failure! until someone close to them suffers through this, most of these elected officials will never understand! :shrug: