Cancer Treatment

[19thagain]

On Five Live, Professor Karl Secosy(excuse the spelling) a leading Oncologist, stated that cancer treatment should be ageist with older people being denied drugs on the grounds of cost.

Now this opens up for me a can of worms with many questions having to be answered, such as .......

Does the person who has paid in over all their lifetime working, have to suffer when a young person having paid in very little, benefits from the treatment resulting from those payments?

Does a forty year old, beer swilling, overweight, fag devouring person come front in the queue when I, being older and never having used the NHS, is refused treatment due to my age?

Does a younger 30 handicapper come before an older scratch player.

The list goes on BUT the bottom line is ...... should I now amend my will to the benefit of my dog and cat home at the expense of Cancer Research and tell the collector on flag day to piddle off and attack the young with their collection boxes?

In fact, on the final point, does the drug companies, being funded by said collections/will funds, plus Uni grants and input of expertise, be allowed to make indecent profits, which dictate the overpriced drugs which cause the problem in the first place?

It would appear that we are literally being allowed to die for higher profit to shareholders.

 

[Ethan]

It was probably Karol Sikora. Five Live is the aural equivalent of the Daily Mail, so everything you hear should be taken with a large pinch of salt.

The first issue is this idea of having paid in all your life. You may think the NHS is funded by National Insurance. It really isn't. It is mostly funded from general taxation. Would you also say that those who have paid more tax deserve more and better treatment. Same logic.

Cancer Research is a fine charity and I would certainly encourage supporting it, but they are not a major funder of drug development. Nor are Unis, wills or the national lottery. Drug companies and new medicines are normally funded through company money or venture capital (i.e. private investors). You may read a splash in the Daily Wail when Pfizer make a big (or indecent, as you would have it) profit, but you probably hear nothing when 10 or 20 small biotech companies who have invested millions in development go bust. That happens all the time and is part of the food chain in the pharma business.

I spent 6 years working for a small company which had a very interesting line of development products for hard to treat cancers. Over 13 years the company tried to bring the drugs to market but ultimately the funding ran out because of pressure on the sources of private funding from other factors in the poor economy. So the company collapses. No write up in the papers or people calling Five Live to whinge about lack of support for small British biotech's doing important work. The assets of the company will probably be bought up cheaply by a foreign company and disappear out of the country.

Companies bear the financial risk of drug development and bring new medicines to market to hear people who don't know what they are talking about complain about indecent profits. Those indecent profits pay a lot of British wages and fund a great deal of drug development. Think on that next time someone you know has a serious illness.

As for discriminating against old people, NICE does this as a matter of policy. I can explain how if anyone is so interested - it is a bit technical. Anyway, the appropriate decision making method is to determine a risk-benefit for the patient. If a patient has a condition from which they have low potential to benefit, and/or is less likely to tolerate treatment or be more susceptible to harm because of infirmity or prior illness, then it is worth thinking twice. If the patient is likely to benefit and tolerate well, they should be offered the treatment.

Note: I am a medical doctor and certified pharmaceutical physician working in the pharma industry, about to move from a small company which ran out of money, to a big one which has some money.

 

[Hacker Khan]

Blimey, I'm not used to a reasoned argument by someone who has experience of the subject and knows what they are talking about on this board.

I have kind of given up with the reporting of a lot of subjects in the media (especially most debates where they always pit people with extreme and diametrically opposed views against each other), just because when they do in in the area that I happen to know a lot about or my wife does, the arguments are so trite and often vastly over simplified that they are pointless. So I imagine they are doing this for most subjects, as it seems they were here.

 

[Doon frae Troon]

Thank you Ethan that last para was enlightening.

I used to help my wife raise funds for Breakthrough and I used to question their 'marketing' figures.

In my wee world 88 year old women dieing of breast cancer should not be used to bulk up scare statistics.

I know that the breast cancer recovery figures are steadily improving thanks to better drugs and treatment.
The supporters raise vast amounts of money and it seems to be well spent.

 

[Foxholer]

Blimey, I'm not used to a reasoned argument by someone who has experience of the subject and knows what they are talking about on this board.

I have kind of given up with the reporting of a lot of subjects in the media (especially most debates where they always pit people with extreme and diametrically opposed views against each other), just because when they do in in the area that I happen to know a lot about or my wife does, the arguments are so trite and often vastly over simplified that they are pointless. So I imagine they are doing this for most subjects, as it seems they were here.

Newspapers - and other 'News' media - are rapidly degrading into headline grabbing.

It's scary about how wrong/biased/<whatever> they can be just for the sake of a headline.

My experience is the same as yours/your wife's - in the areas where I know quite a lot, it's frightening how wrong the media can be, either accidentally or deliberately! And if that's the case in areas where we have some expertise, it's almost certainly just as bad in equivalent areas where we rely on the media to keep us informed!

And, much as I castigate the medical profession for some of its narrow-minded views and occasional weird inadequacies, I would not want to be responsible for deciding which treatments to dole out to whom, knowing that some peoples lives are going to be shortened because of my decisions!

 

[HomerJSimpson]

Lost both parents to cancer. Both in their early 70's and were given an initial chemo course. In my dads case, little else could be done and it bought a bit more time. Similarly with my mum but on a slight tangent, they local authority provided a decent care package including drugs and carers/home helps. I would have been far from happy if the oncologist had told either they had the insidious disease but because they hit an age barrier there was nothing else to do. Channel 5 is a sensationalist channel at best and so I would take any "information" with a large pinch of salt and always do my own research on whatever topic it related to

 

[Ethan]

One other thing. The NHS has received plenty of money in recent years, partly as a result of an unplanned promise made by Blair on TV. The problem is that a lot of it has been wasted on bone headed initiatives from Government, targets, money for management consultants to come up with either stupid or bleeding obvious template ideas, subsidies for private surgical centres and the like, the apparatus and structures of Foundation Trust status and most of all, PFI payments. These PFI contracts were negotiated by idiots who had rings run around them by the companies. The companies were then able to sell on the contracts for a large profit almost immediately. They result in exorbitant charges for maintenance and repairs and the total value of the contract shoots up.A lot of recent spending is to streamline parts of the service for slicing off and sale to the private healthcare companies that have been schmoozing ministers and civil servants for years.

There is plenty of spending on the NHS. Unfortunately less and less of that spend is going on healthcare.

 

[c1973]

One other thing. The NHS has received plenty of money in recent years, partly as a result of an unplanned promise made by Blair on TV. The problem is that a lot of it has been wasted on bone headed initiatives from Government, targets, money for management consultants to come up with either stupid or bleeding obvious template ideas, subsidies for private surgical centres and the like, the apparatus and structures of Foundation Trust status and most of all, PFI payments. These PFI contracts were negotiated by idiots who had rings run around them by the companies. The companies were then able to sell on the contracts for a large profit almost immediately. They result in exorbitant charges for maintenance and repairs and the total value of the contract shoots up.A lot of recent spending is to streamline parts of the service for slicing off and sale to the private healthcare companies that have been schmoozing ministers and civil servants for years.

There is plenty of spending on the NHS. Unfortunately less and less of that spend is going on healthcare.

I'm no expert, but I would hazard those last two sentences pretty much sum up what is wrong with the NHS.

 

[19thagain]

Ethan, what is the chances of someone with hands on knowledge being on here and that person providing such a comprehensive reply!!

I am not a five live regular listener so was not aware of their political leanings and accepted the info at face value.

I however, always thought profits was the amount of money made by an organisation after they have paid the workers wages and yes, to the lay person they do appear indecent, with people dying due to the high cost charged by said companies. Lower profits = reduced cost to the NHS = patient now receiving treatment and perhaps living longer.

Silly me!

 

[Ethan]

Ethan, what is the chances of someone with hands on knowledge being on here and that person providing such a comprehensive reply!!

I am not a five live regular listener so was not aware of their political leanings and accepted the info at face value.

I however, always thought profits was the amount of money made by an organisation after they have paid the workers wages and yes, to the lay person they do appear indecent, with people dying due to the high cost charged by said companies. Lower profits = reduced cost to the NHS = patient now receiving treatment and perhaps living longer.

Silly me!

Well, firstly, the profits are also the investment fund for new development programmes, as well as provider shareholder returns which go into your pension, ISA, the Govt's tax coffers.

Secondly, the UK has a scheme which balances a pharma company's total "take" relative to its investment in the UK. That deal, known as the PPRS, is supplemented by quite a lot of deals to the NHS that are not reflected in list price. The problem is that some countries have pricing controls which are structured differently to the UK and use what is known as reference pricing, simply put they restrict the price allowed to the average of that in a certain number of other specific countries. So a list price reduction in the UK affects the price in a whole load of other countries too.

So lower cost could = fewer new development programmes, fewer new drugs and patients not receiving new treatments for much longer.

Silly you .

 

[Foxholer]

Health Services are where i believe the (pure) Capitalist system has a real problem.

Unfortunately, the alternative Socialist system has the same problems, but doesn't incentivise the developments required to promote solutions!

Somewhere in between is the unhappy median, but that's at the cost of funds going 'out of the system' and/or potentially fruitful directions being chopped because of (lack of) funding issues.

And, of course, the NHS (and health in general) is just a giant bottomless pit for money. Even if every pound of tax was thrown at it, it would still, quite reasonably, demand more!

 

[Ethan]

Health Services are where i believe the (pure) Capitalist system has a real problem.

Unfortunately, the alternative Socialist system has the same problems, but doesn't incentivise the developments required to promote solutions!

Somewhere in between is the unhappy median, but that's at the cost of funds going 'out of the system' and/or potentially fruitful directions being chopped because of (lack of) funding issues.

And, of course, the NHS (and health in general) is just a giant bottomless pit for money. Even if every pound of tax was thrown at it, it would still, quite reasonably, demand more!

It is a bigger problem in a pure capitalist model. The socialist/socialised model works pretty well and there are various models in operation in different European countries. All sound a lot less in GDP terms than the US system which is famously inefficient and patchy. The need for entrepreneurship is exaggerated in the NHS by management consultants who sell solutions to problems which are political in nature.

This notion that the NHS is a bottomless pit really isn't true. Demand can be managed if GPs are given real power to do so, but the current agenda is exactly the opposite. The NHS was in surplus last year and returned money to The Treasury.

If all the money wasted on running Foundation Trusts and servicing extortionate PFI contracts was directed to healthcare, there would be even more dough available.

 

[19thagain]

I see you have omitted my personal investment portfolio being a beneficiary as well as, of course, the many other personal portfolio holders who all enjoy what I refer to as indecent returns, when to help fellow human beings, we would settle for decent returns only, in my opinion.

I also during my research found that Executive Pay, Profits and Spending by Drug Companies on marketing, advertising, and administration is twice as high as the spend on research and development; that drug company profits, which are higher than all other industries’, exceed research and development expenditures; and that drug companies provide lavish compensation packages for their top executives.

Now being silly, as you correctly state, maybe I read all the incorrect reports to extract the above which is historical.

However they have, so far, provided substantial returns but, as I stated, at a deadly price, in my opinion.

 

[Foxholer]

This notion that the NHS is a bottomless pit really isn't true. Demand can be managed if GPs are given real power to do so, but the current agenda is exactly the opposite. The NHS was in surplus last year and returned money to The Treasury.

If all the money wasted on running Foundation Trusts and servicing extortionate PFI contracts was directed to healthcare, there would be even more dough available.

You slightly misinterpreted my 'bottomless pit' expression, possibly because I didn't explain it well.

It's not so much that Health systems/models - and NHS is simply one of them - simply gobble money, though they certainly can do so. It's that, even with the most efficient use, however much is spent, there will be the opportunity to spend more and improve the service and health of 'users'. The classic example is the likes of MRI scanners. By increasing the availability of these all sorts of benefits arise from resulting the earlier diagnoses - earlier return to work, more successful treatments etc. But the demand for such (expensive) improvements never goes away - until instant access is expected!

So it's not so much a huge whirlpool demanding ever increasing resources, though there's certainly potential for that, but a true bottomless pit that can never be filled!

The 'wastage' from the way different areas are set up is not something that can ever be agreed either. There will always be examples of disasters and triumphs, unfortunately meaning shortened/restricted lives for the disasters but with 'new' ones for some of the triumphs. I know/have known folk in both those categories.

My view is that whatever structure there is needs to be managed by professional managers, so that the health care professionals can concentrate on doing what they are good at.

I am rather ambivalent about Drug companies. On the one hand they have made the greatest advances in certain areas of health, yet so much of it has been done either directly for ,or by harnessing, that much reviled feature of mankind - Greed!

Btw. To return to the topic in the OP, One of those I knew did his own 'assessment' of the value of expenditure on his Cancer, deciding it was not worthwhile providing an extension to his quite reduced quality of life. So it's not completely 'Big Brother' making the decisions. His 'point of no return' was actually when he could no longer play Golf!