Monday, August 30, 2010

Avastin or not.

Sometimes personal experience makes logic difficult to accept. This is how I feel about last week's decision by NICE (National Institute of Clinical Excellence) to recommend that the NHS should not make the drug, Avastin available to bowel cancer sufferers. If I'd not been away on holiday in the US, I would have done some media interview work on this decision, accepting that it would not have been easy to challenge the NICE judgement. But I would have tried. Dr. Spock wasn't always right.

I've always thought of NICE as standing for 'national institute of control of expenditure'. And actually, there's nothing wrong with that. When Professor Mike Rawlins, Chair of NICE says "The question is not whether care is rationed, but how" he is being no more than honest and logical - unless you happen to be a bowel cancer sufferer or know someone whose life has been extended by years as a consequence of using Avastin.

Anyway, the purpose of this post is to highlight Alastair Palmer's article in yesterday's Sunday Telegraph which is more about the 'supposed' freedom of people to buy Avastin with money from their own wallets (£21,000 for a year's course of treatment) to 'top up' the care that the NHS will pay for. Until last year the rule was that patients who 'topped up' NHS care from their own pockets sacrificed the right to any NHS care at all. There was a ban on what were referred to as co-payments. Following some high profile cases the then Labour Government supposedly changed the position to allow co-payments. Palmer's article suggests that this change might not have taken place in practice - because of a rule that the private treatment must be carried out separately from the NHS treatment. This is not always practically possible. It depends whether the particular hospital has 'separate facilities'. In my opinion, any ban on co-payments, or any device to make co-payments more difficult is egalitarian stupidity. If an NHS patient decides to enhance treatment by paying for Avastin, it makes not a jot of difference to anyone else, or to the NHS's finances. Its just cruel and spiteful. I shall be writing to the hospitals that serve Montgomeryshire tomorrow to ask what the position is on this issue.


Anonymous said...

Maybe the attacks should not be on NICE,but on the drug companies who make huge profits from these lifesaving or enhancing drugs
Surely they can trim the fat they suck.
The production costs are nowhere near as high as the charge at the end of the process.
OK they have to recoup development costs and make money , but in these percentages, come on fellas.

Anonymous said...

I'm afraid that NICE's refusal to allow this drug, for me calls into question the allowance of prescribing of heroin substitutes to drug users/addicts/abusers. THEY have by choice got themselves into dependance, however cancer is the roll of the dice....I personally am slim, active, healthy diet, non smoker, very seldom drink alchohol, yet the roll of the dice dictated I got time of writing this, I am waiting on a decision by PtHB on whether or not I can have a drug I need, that is on the Grey list, it can be prescribed, but my consultant at Shrewsbury informed me that I i live in Shropshire I would get this just as any other prescribed drug, but I live in Powys, and they dont prescribe it here, so we have had to apply for funding for it (post code lottery) will prevent osteporosis, and calcium depletion caused by my illness, and prescription drugs I have to take to treat that illness - double edge sword -this could turn into bit of a rant Glyn, so i'll shut up now !!!!
But Avastin should be on the NICE list....

Anonymous said...

The government rakes it in too as they take a big % of the profits in taxation and from employee pay packets. In fact, the UK Treasury makes more money than most of the shareholders.

And no, the prescription drug business is very risky. It's not just the development cost of the drug that happens to be a blockbuster, but all the development costs of drugs that didn't make it. For every blockbuster there are many more failures that cost millions of dollars too.

Yes, the production costs of the drug that gets through, e.g., FDA testing is often not very high, but getting to that point costs tens if not hundreds of millions of dollars. There are lots of drug companies that have gone to the wall, it is no accident that the big fish survive - they can cope with one or two huge failures/drug withdrawals, a smaller pharmaceutical company goes under.

There are plenty of consultant doctors who earn such large amounts of money that it is borderline disingenuous to pick on a drug company for making profits.