The Corner

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‘Death Panels’


“Death Panels” is an emotional term (to put it mildly) that, as a practical matter, is not necessarily inaccurate. Here are two stories from right-of-center British newspapers (the Daily Mail is the more tabloidy of the two) about the prescribing (or not) of one drug (sorafenib and Nexavar are the same compound) that show some of the issues involved in the way that the British system actually works.   From the Daily Mail (extract follows, but read the whole thing):

Liver cancer sufferers are being condemned to an early death by being denied a new drug on the Health Service, campaigners warn. They criticised draft guidance that will effectively ban the drug sorafenib – which is routinely used in every other country where it is licensed. Trials show the drug, which costs £36,000 a year, can increase survival by around six months for patients who have run out of options. The Government’s rationing body, the National Institute for Health and Clinical Excellence (Nice) said the overall cost was ’simply too high’ to justify the ‘benefit to patients’….
Nice had claimed it was approving more drugs under End of Life policies introduced in January meant to benefit small numbers of terminally ill people.So far two drugs have been approved for three cancers. But two drugs have been banned under the rules, with a ban pending on three further drugs including sorafenib…It is three years since Ann Marie Rogers won her famous court victory which forced the Health Service to give her – and other breast cancer victims – access to the wonder drug Herceptin. The drug had been turned down by rationing watchdog Nice but Health Secretary Patricia Hewitt told trusts that they could not deny the drug on grounds of costs. Now another group of cancer sufferers are facing a similar battle but it is unlikely that we will see Andy Burnham, the current Health Secretary, taking a similar stance –because this time the drug that has been turned down, Nexavar, is one that helps against liver cancer. The problem for campaigners is that liver cancer is not as high profile as breast cancer. This is partly down to the fact that fewer people get cancer of the liver than are diagnosed with breast cancer – around 3,000 a year compared with 45,000. But that is not the whole story. Breast cancer has two charities fighting its corner – Breakthrough Breast Cancer and Breast Cancer Care – both of which attract millions of pounds in donations, and help boost the profile. Other cancers tend to fade into the background. There is, for example, still no prostate cancer screening programme that compares to the major screening programme for breast cancer.
From the Daily Telegraph:
For patients with advanced liver cancer the decision made by the National Institute for Health and Clinical Excellence (Nice) not to approve a drug that may extend their lives is a bitter blow. They and their families will feel like their last hope has been pulled out from beneath their feet. But the National Institute for health and Clinical Excellence has to make dispassionate decisions for the good of all NHS patients. The painful truth is that Nexavar is an expensive drug that extends life by, on average, less than three months. It is not a cure and these patients will still die from their cancer. Data submitted to Nice shows that supplying the drug to the 600 to 700 people with advanced liver cancer would cost a total of £7.7m.

That would give those people the chance of an extra precious few months and admittedly some have lived for six months or longer on Nexavar. But the data shows that the median survival benefit is 2.8 months, and that means that for those who may gain six months, some will gain a lot less or nothing at all. Nice has decided that the £7.7m would be better spent elsewhere in the NHS, that could be on other cancer treatments, or heart transplants, on intensive care facilties for premature babies, or hip replacements. This will be of no comfort to those with liver cancer or their families but unless taxpayers are willing to increase their contribution to the health service, hard decisions like these will have to be taken.

Hard, horrible decisions, certainly. Then the ugly question comes: Who should take them? And on what basis? Note, too, the role that political clout (as indirectly represented in the Daily Mail story by the discussion of the influence of different cancer charities) has to play.