A little bit of politics.
May 3rd, 2010 by Dr Wheeler
The purpose of this post isn’t to support any one political viewpoint over another. All of the main parties have aspects of their health policy which to me seem problematic.
I do get irritated when information regarding health is misrepresented however – especially when facts and figures are bandied around with little understanding.
The first leaders debate was particularly egregious in this regard – with David Cameron either failing to understand or wilfully misrepresenting information that is highly emotive. Almost as bad – the other leaders failed to grasp the problems with what he was saying, either suggesting that they agreed with his ideas or (more likely) they are unable to grasp the concepts involved.
The subtext to this is the often repeated idea that the UK is a dreadful country to get cancer in. Compared to just about anywhere else in Europe your number is up before your time… despite our hugely expensive NHS. This statement might be true… but there is a good chance that it is a load of rubbish. All of these comparative figures come from ‘EUROCARE‘ studies – which unfortunately are highly suspect. The UK has a very comprehensive cancer registry and nationwide reporting systems. France only records cancer diagnoses for about 10%-15% of its population… Germany on the other hand has figures for 1% (yes that’s right – 1%) Comparing our comprehensive data with countries that have wildly different levels of coverage and recording is of limited use as you can imagine. In fact there is a lot of evidence that the UK does things very well in cancer diagnosis and treatment, but until the reporting systems in Europe are standardised we can never really know for sure. (There are steps to redress these problems in future EUROCARE reports I believe.) It is of course politically expedient to try and scare the public rather than accept nuances in the data however…..
Which leads on to the next point. Mr Cameron raised the issue of cancer drugs approved for use in the NHS. In particular ‘Sutent’ an oral drug licensed for use in advanced kidney cancer. Conservative policy is to create a £200 million cancer drug fund to pay for cancer drugs which aren’t currently available in the NHS.
In the debate he said that “I have a man in my constituency … who had kidney cancer who came to see me with seven others. Tragically, two of them have died because they couldn’t get the drug Sutent that they wanted..”.
This sounds tragic and scary at first glance… but it doesn’t take a lot of thought to realise that there is a major problem with the statement in a logical sense. The idea that if these two unfortunate souls were given sutent they would live long and happy lives is simply not credible. For an excellent and easy to understand explanation of what taking drugs like this can achieve I urge you to read this excellent post on the subject from the ‘Understanding uncertainty’ web site.
In a nutshell the author highlights the fact that no drugs work for all people, and that it is impossible to predict an individuals exact outcome from a treatment with any certainty. This is because drug trials deal with populations (the larger the better) – meaning that the data we base decisions on relates to populations in general – not individuals. With some interesting maths (albeit maths which needs to make a number of assumptions for it to be valid) it can be calculated that taking Sutent would have given each of those two patients just a 58% chance of living longer than if they didn’t have it. Even if they were responders however it is impossible to say what benefit they would have gained… or what quality of extra life they would have enjoyed.
The bottom line is that a lot of the incredibly expensive cancer drugs that have hit the headlines over the past few years a) have been approved by NICE (the National Institute of Clinical Excellence) anyway (Sutent for example HAS been approved for the NHS – but only for patients where trial evidence has been supplied demonstrating efficacy), b) have minimal effects on prognosis – often at best giving some patients a few extra months of life, and c) are (in my view) horribly and cynically overpriced by the drug companies involved.
In a world where we had unlimited resources then of course giving drugs to cancer patients that may extend their life by a few months is worthwhile… but in the real world, the 200 million pounds earmarked for the Conservative drug fund must (by definition) be 200 million that isn’t spent on other things. Other things that could potentially make huge differences to the health of millions of people rather than providing marginal benefits to a few thousand.
The real story here is that the drug companies are somehow flying under the radar. It is a scandal when a health board won’t approve an experimental cancer drug for a patient that hasn’t been assessed by NICE, but on the other hand it seems to be perfectly acceptable for drug company’s to charge tens of thousands of pounds for a few tablets?
The average yearly cost of taking Sutent in the UK (after a recent deal that meant the first course of treatment is given free) is £24,168. Why does it cost so much? Research and development costs have to be recouped… advertising… share holders profits. Maybe the company that makes it is struggling financially?
In fact Pfizer (the drug company involved) in just the last 3 months of 2009 (the most recent figures I can find) made £481 million in profit. Worldwide revenues for Pfizer are said to be $16.5 billion!
They (along with the other companies) will no doubt be rubbing their hands in glee that politicians will be helping push forward cancer drugs based on the number of votes available rather than analysis by experts who take cost effectiveness into account. Where better for that £200 million to go than into the big pharmaceutical companies coffers after all?
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