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Friday

 

Drugs farce shows up meddling politicians























The Cancer Drugs Fund was as much a creation of political necessity as it was medical. This was never more obvious than last week, when it was announced that up to half the drugs it currently makes available are likely to be removed from its list because they are deemed too expensive.

This exposes the illogical thinking that underpins the whole project.

The fund was started in 2010 to give people access to cancer medications that haven’t yet been approved by the National Institute for Health and Care Excellence (Nice) and aren’t available within the NHS in England. Last year it overspent by £30 million. This is what happens when you say you’re going to provide medication, irrespective of cost, and effectively sign a blank cheque. But it also serves as a salutary lesson in what happens when politicians meddle in medicine.

To me, it always seemed grossly unfair that cancer was being treated differently from other devastating illnesses. It was the worst kind of gesture politics.
Heart failure, for example, has a worse prognosis at the point of diagnosis than a lot of cancers. Fifty per cent of older people admitted to hospital with heart failure die from it within one year. Yet no politician is advocating throwing money at expensive new heart failure treatments before their efficacy and cost-effectiveness are established.

Cancer, however, is an emotive subject, so in this case that is exactly what happened. It was a PR exercise – until, of course, the costs got out of hand. What next? A drugs fund for drugs that haven’t been approved by the Cancer Drugs Fund?

The money allocated to the Fund could have been spent so much more effectively. Take lung cancer. It kills more women than breast cancer. It kills more men than bowel and prostate cancer combined. The five-year survival rate is about six per cent. That is abysmal. Yet in the past few years there have been incredible advances in the understanding of lung cancer biology.

We now know that there are certain receptor molecules on the surface of a lung cancer cell that can stimulate the growth of a tumour. It’s similar to oestrogen receptors on breast cancer cells – oestrogen can fuel the growth of malignant cells in some forms of the disease. And just as drugs have been developed to block the oestrogen receptors, so there are a range of drugs to block the receptors on the lung cancer cells and limit tumour growth and spread. This is a major breakthrough.

The treatment depends on the genetic profile of the tumour, but it requires a biopsy of the cancerous tissue. There are various biopsy methods, all of which are largely inefficient (not enough tissue is gathered), painful and unpleasant – or there is surgical removal of tissue, which carries its own risks. However, a new technique, called endobronchial ultrasound, uses a special probe to take the tissue sample and is much more efficient. It is employed in around 100 specialist units in Britain.

Each sample is then subjected to molecular testing to match it with a specific drug. But there is no infrastructure in Britain to enable quick and cost-effective processing of samples. We lag significantly behind the rest of Europe in this. In France, molecular testing is routine, with 70 per cent of all lung cancer tumours tested. In the UK, rates are less than 30 per cent.

So we have a ridiculous situation. Innovative drugs for cancer are being funded by the NHS because they are known to be cost effective and to work, but patients are denied them because of a lack of funding for the necessary biopsy test facilities.

Politicians won’t make headlines or win votes by promising to buy extra machines for a laboratory or improve access to a better biopsy method. Yet, if we funded the tests needed and invested in coordinated laboratory facilities nationwide, we could ensure that people with lung cancer would swiftly get the drugs that work.

If politicians really want to help cancer patients, they must recognise that sometimes it is about more than just costly drugs.

GPs should not be cashing in on diagnoses
The news that GPs would be offered £55 for each person they diagnosed with dementia has been rightly met with outrage by many doctors. They question the ethics of the decision as well as how effective tests are at confirming the condition in a limited consultation time. Now, a poll has found that half of GPs will refuse to take the money.

I’m delighted that GPs are standing up to this nonsense – but alarmed that half of them say they will accept the payment. This should be the perfect opportunity for GPs to stand shoulder to shoulder with their patients and show the Department of Health what they think of it.

A visit to the GP is now increasingly about delivering tests, asking certain questions and ticking boxes so that the GP can get paid for delivering favoured services. It is less about the actual problem that brought you to the surgery in the first place. Doctors don’t want this sort of consultation, and neither do their patients.

Vivienne Westwood is right about the poor
I do love Dame Vivienne. Not only does she make wonderful clothes, but she refuses to settle quietly into old age, still causing controversy and consternation on a regular basis. Last week she was at it again, this time suggesting that people who couldn’t afford to eat organic should ''eat less’’ instead. Immediately, she was pounced upon and accused of being unsympathetic towards the poor and hungry.

This response shows a basic misunderstanding of the state of the nation. I have worked in sink estates in some of the poorest parts of London, and rates of obesity are terrifying. Nutrition is poor, but the calorie intake is high. You only have to walk around the streets to see why this is – cheap takeaways on every corner, no fresh fruit or vegetables in the shops and a desperate lack of will or knowledge about how to prepare and cook fresh food. In one project where I worked, nurses resorted to holding cookery classes, as no one knew how to prepare or cook vegetables.

Dame Vivienne is correct – the short answer is that buying less food but of better quality would do these people the world of good.

Story Source: The above story is based on materials provided by THETELEGRAPH
Note: Materials may be edited for content and length


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