HealthSpeak: May 2007 Archives

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May 15, 2007

There'll always be an England, but ...

by Peter Pitts

There may very well "always be an England," but there won't always be the drugs you need to survive if you live there. Welcome to the world of heathcare technology assessment aka comparative effectiveness aka evidence-based medicine.

When it comes down to brass tacks, what all these fancy phrases means for patients is "sorry -- no medicines for you." So much for "universal" health care. "Government" health care is more like it.

It's reached such a state in the UK that the following appears in today's edition of The Telegraph:

The drugs the NHS won't give you

Suninitib (Sutent)
For kidney cancer.
Licensed, but the Department of Health has yet to refer it to Nice for a recommendation.

John Quance, 57

The former fireman was told he could not have the drug Sutent because the NHS would not pay for it.

Mr Quance, who has been diagnosed with kidney cancer, cashed in his pension and remortgaged his house to pay for it privately, but fears that he may have to sell his home unless the NHS steps in. Cornwall Primary Care Trust said it was not prepared to pay the £22,000-a-year cost of the drug until it was approved by Nice.

Mr Quance said: "I have worked all my life, I have been in the forces, the prison service and the fire service for 30-odd years and I feel a little bit abandoned.

"The staff and the hospital have been excellent but it is a little disappointing not to get funding when it has been proved [the drug] is working."

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Bevacizumab (Avastin)
For bowel cancer.
Licensed for colon cancer in January 2005, but turned down on the grounds of cost-effectiveness in January.

Victoria Otley, 56

Miss Otley was diagnosed with bowel cancer at the end of 2005. She had complained of being in pain but doctors told her that it was nothing to worry about.

By the time her cancer was diagnosed it had spread. She took other drugs and later asked about getting Avastin after her sister read about it on the internet. Yesterday, Miss Otley, a former hairdresser from Dagenham, said: "I asked my consultant but he said it wasn't available on the NHS."

She and her sister paid £15,000 for a course of Avastin and the cancer shrunk, however they cannot afford to pay for any more. "You work all your life and pay your taxes and this is what you get. I think it's disgusting."

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Cetuximab (Erbitux)
For bowel cancer.
Licensed in June 2004 and turned down by Nice in January this year.

Ian MacDonald

The former bridge inspector's doctor told him that he would have liked to have prescribed Erbitux, but that he could not because it was not available on the NHS.

Mr Macdonald has tried various drugs and radiotherapy since being diagnosed with bowel cancer in the year 2000.

His wife Catherine, who has given up work to care for him full-time, said yesterday: "My husband has worked all his life in this country and never had a day off sick and yet he is refused a drug that might stabilise or shrink his tumour.

"I can't understand why it is not available here but it is in other countries. It's awful."

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Erlotinib (Tarceva)
For non-small cell lung cancer.
Licensed in Sept 2005, approved by the Scottish Medicines Consortium in June last year and rejected by Nice in March on the grounds that it was not clinically or cost effective. Manufacturers Roche are appealing against the decision.

Susan Allen, 43

She was told she had ten months to live after being diagnosed with lung cancer in December 2005.

A non-smoker, whose hobbies include cycling and running, the mother-of-one underwent chemotherapy and radiotherapy and was prescribed Tarceva by her oncologist in October last year. She had to pay for the daily pills herself initially, at a cost of £70 per day, until her local health authority eventually changed its mind.

She said: "Denying the drug is condemning patients to death."

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(Bortezomib) Velcade
For bone marrow cancer patients who have had at least one earlier therapy or are unsuitable for a bone marrow transplant.
Nice has agreed to review its rejection of the drug in March. Patients in Scotland, Wales and Northern Ireland have been able to get it since last year.

George King, 57

Mr King, who is terminally ill with bone marrow cancer was forced to consider moving to Scotland to get access to Velcade in an attempt to prolong his life.

Mr King, an electrical engineer from Teesside, said earlier this year: "People with terminal illnesses shouldn't have to fight for treatment. It's so frustrating. This drug is available not only in Europe, but just a few miles north of where I live. I don't have any option but to move away from my family, friends and the people who have helped me through the cancer until now."

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Pemetrexed (Alimta)
For mesothelioma, a cancer caused by exposure to asbestos, and small-cell lung cancer.
Patient groups are waiting for the results of an appeal against Nice's rejection of the treatment in February for lung cancer. A decision on funding for mesothelioma is expected in September.

Bernard Hoyland

The retired mechanical fitter spent the last years of his life fighting to make Alimta available for patients in his area.

After he was diagnosed with mesothelioma he was told his primary care trust would not pay for him to receive Alimta because it was too expensive. He launched a legal attempt for compensation against his former employers, began travelling to London every three weeks to receive cancer treatment and joined a campaign to force NHS bosses in Teesside to fund Alimta. Six months after funding was agreed, Nice ruled that it was too costly.

Mr Hoyland, who called the decision "simply unacceptable", died last November.

His son Paul said: "He ended up having to travel to central London after finding he could get the chemotherapy down there. He was a victim of the postcode lottery."

Posted by peterpitts at 02:38 PM
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May 10, 2007

Dogmatic Day Afternoon

by Peter Pitts

Many opinions out there on the FDA Revitalization Act just passed by the Senate.

Here's mine: Don't be dogmatic.

Change is not an all-or-nothing proposition. Small movement in the right direction is the beginning of momentum. (And small victories are better than explosive defeats.)

And remember the words of Plutarch, "Time is the wisest of all counselors."

Posted by peterpitts at 05:27 PM
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May 07, 2007

Bleak House 2007

by Peter Pitts

For those pols and pundits who think that we need a health care system "just like Europe," some harsh reality from the other side of the Pond.

The Observer (one of the leading liberal-left newspapers in Europe) reports that British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiraling demand from patients.

In a major report, the British Medical Association will warn that patients face a bleak future because they will increasingly be denied treatments. The BMA will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing.

Dr Michael Wilks, one of the BMA's senior office holders, revealed the organization’s radical thinking in a recent letter to its 139,000 members updating them on the progress of the BMA working group. He told them the group had concluded that '"hile the service should remain universal, the challenges raise questions about how comprehensive the service can continue to be. This will depend on whether politicians and the taxpayer are prepared to contemplate either increasing expenditure or explicit rationing."

Here's a link to the Observer article:

http://observer.guardian.co.uk/uk_news/story/0,,2073633,00.html

Posted by peterpitts at 12:06 PM
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May 02, 2007

Wow! Indeed

by Peter Pitts

Got an e-mail this morning with a one word subject line, "Wow!"

And "wow" it was. And "wow" it is.

In just six years, death rates and heart failure in hospitalized heart attack patients have fallen sharply, most likely because of better treatment, the largest international study of its kind suggests.

The promising trend parallels the growing use of cholesterol-lowering drugs, powerful blood thinners, and angioplasty, the procedure that opens clogged arteries, the researchers said.

“These results are really dramatic, because, in fact, they’re the first time anybody has demonstrated a reduction in the development of new heart failure,” said lead author Dr. Keith Fox, a cardiology professor at the University of Edinburgh.

The six-year study involved nearly 45,000 patients in 14 countries who had major heart attacks or dangerous partial artery blockages. The percentage of patients who died in the hospital or who developed heart failure was nearly cut in half from 1999 to 2005.

And the heart attack patients treated most recently were far less likely to have another attack within six months of being hospitalized when compared to the patients treated six years earlier -- a sign that the more aggressive efforts of doctors in the last few years are working. There have been other signs that better treatment of heart patients has been saving lives, but not on a scale as large as this international study, the researchers said.

“It’s much more dramatic than we expected, in the course of six years,” Fox said.

The study appears in Wednesday’s Journal of the American Medical Association. It was funded by a grant from Sanofi-Aventis, maker of several heart drugs including Plavix and ACE inhibitors. Fox and several other authors reported getting fees and grants from Sanofi and other drug makers.

Dr. Steven Nissen, former president of the American College of Cardiology and a Cleveland Clinic heart specialist, said the study doesn’t prove the recommended treatments were saving lives but he suspects that’s the case.

“I really am encouraged that those things that appear in our guidelines are being used by physicians around the world,” Nissen said.