Herceptin, health & politics

August 8, 2008

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.


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