Macdoctor blog of week

The print edition of the Herald on Sunday has given its blog of the week to Macdoctor for his post on the government’s decision to fund 12 months of herceptin.

The blog is always good reading and the award is well deserved.

McDonalds standard for health

Macdoctor starts by noting the international reaction to how we do things in our health system, including not funding 12 month courses of herceptin, is “are you crazy”.

He concludes with:

You may notice from the above list that the only thing our hospitals excel at is quality assurance. I point out that one of the finest quality assurance programs in the world is run by Macdonalds. They make sure that the quality of their burgers is the same the world over. Universally horrible.

At least our excellent QA systems help us to ensure that the quality of our health system is consistently crap. International standards indeed.

The bits in between make interesting reading too, you’ll find it all here.

[Update: Macdoctor left a comment clarifying, for anyone who doesn’t follow the link and read his whole post, that: ” the first sentence of the quote is made in the context of international standards. I am not suggesting that hospitals do not practice good medicine, given our under-resourced system!”

Pharmac boss backs Herceptin decision

Pharmac chief Matthew Brougham explains the reasoning behind the decision to not fund 12 month courses of Herceptin.

He says that if one of his family had breast cancer he would recommend she take the nine week course which is publicly funded and that the jury is still out on the benefits of the year-long course.

The Herald editorial supports the decision and says that even if Pharmac had more money it would probably not spend it on longer courses of Herceptin.

And Kerre Woodham agrees that there is not enough evidence for Phramac to have reversed its decision to fund only nine weeks of the drug.

Update: Macdoctor responds to the Herald.

Herceptin, health & politics

Was Pharmac’s decision to not fund 12 month courses of herceptin based on clinical evidence or financial necessity?

Women’s Health Action Trust director Jo Fitzpatrick accepts it was clinical: 

[she] “reluctantly” spoke out yesterday in support of the decision, “because of concern at the high level of public misunderstanding about the drug and its effects”.

“Herceptin is promoted as the magic bullet for early breast cancer treatment,” she said. “People used to think – and many still do – that Her-2 positive breast cancer can and will be cured by Herceptin.

“We wish that was true but the evidence just isn’t there and people need to know that. At its best, 87 women in every 100 taking Herceptin get no benefit from the drug at all and may be harmed by it.”

And:

District health boards’ spokesman Murray Georgel said the lack of convincing evidence for 12-month treatments meant the decision was one “DHBs can understand”.

“In that context, and given the ability of DHBs to improve health through other interventions, it would have been concerning if Pharmac had come to DHBs and asked that the 12-month treatment be funded.”

But:

Other groups were scathing of the decision. Breast Cancer Aotearoa Coalition chairwoman Libby Burgess called it “a cruel blow for women and their families”.

She said the drug was “life-saving”, and Pharmac’s decision was “shameful” and “simply inhumane”.

Comments on my previous post  on the issue are also divided with Ed Snack saying it is important to judge the issue on science not emotion and he points to this link as a starting point. However Macdoctor  evaluates clinical trials and concludes Pharmac’s decision was a budget one.

But then NZ Conservative and several comments at No Minister  back Pharmac.

I am not qualified to argue about the science so I’ll move to the politics and this from TVNZ:

Diane Edwards from Herceptin Heroines says “there’s not a woman in this country that can afford to vote for this government after today’s decision”.

However over at the Hand Mirror Stargazer points out:

… national are saying they will fund the full 12 month course but legally would not be allowed to do so. unless, of course, they change the law to allow political interference in medical decisions.

She is right, Pharmac is independent and there are good reasons why neither the the Minsiter of Health nor the government can intervene. But that will be lost on most people because emotion beats facts in politics. Pharmac is regarded as an arm of government so unpopular decisions from the former will rebound on the latter.

Furthermore, Keeping Stock  points out the only other OECD countries not to fund 12 month courses of the drug are Turkey and Mexico.

As any parent will tell you “nearly everyone else does it” is not a convincing argument. But if most other OECD countries fund the treatment because they can afford to, even if the science is not settled; and we don’t because we can’t afford to then regardless of Pharmac’s independence we are justified in holding the government to account.

Why can’t we afford Herceptin?

Pharmac’s announcement it won’t fund 12 month courses of Herceptin for women with aggressive Her-2 breast cancer has been labelled a cruel blow by Breast Cancer Aotearoa Coalition chair, Libby Burgess.

Ms Burgess said it was “unbelieveable and shameful” that New Zealand women were denied the standard of care offered elsewhere.

“It’s a bad outcome, but we’re not terribly surprised by it. But we are of course extremely disappointed.

“This is a cruel blow for women and their families. Phamac’s continuing refusal to fund the treatments New Zealanders need is simply inhumane.”
 
Ms Burgess said that, to access the 12 month treatment their doctors were recommending, women had to fundraise the tens of thousands of dollars needed. 

“This adds huge stress and suffering for women when they most need support and comfort … I am amazed Government hasn’t stepped in to end this inhumane treatment of our women.

“Increased funding for medicines including Herceptin will surely become an election issue. That will give voters the opportunity to decide.

Pharmac chief executive Matthew Brougham said the cost wasn’t the reason the drug won’t be funded.

“I want to be absolutely clear; this decision is not about the cost of Herceptin. This decision rests solely on the science and our assessment, our confidence, around whether or not funding 12 months treatment with Herceptin would produce additional health benefits.”

But he also said:

[Pharmac]  had to consider all illnesses and treatments, not just cancer, and had to make a decision with limited funds about what would bring the greatest benefits.

“It’s not about who can scream the loudest and make the most noise.”