Cancer drug funding debacle

It is difficult to have sympathy for the National Party over the flak it is receiving for its decision not to follow through with its cancer drug promise this Budget.

It is a political nightmare, making the government look at best inept, and at worst uncaring and cynical.

The delay has also provoked another round of criticism about the government’s priorities.

The campaign promise, to fund 13 named cancer drugs, was flawed from the outset. The medicines, already funded in Australia, were chosen on the basis the Cancer Control Agency said they would provide "substantial clinical benefit".

That $280 million over four years, or $70m a year, would come from bringing back the $5 prescription charge for most people, a move many saw as an unfair trade-off.

While, as oncologist Prof Chris Jackson pointed out, barely any of the named drugs would cure patients, they would help people live better and live longer.

However, since the list was drawn up, he says some of them have been superseded by better drugs.

It has not been spelled out whether current short-staffing in medical oncology might affect the logistics of administering some of the named drugs.

Cancer patients and their loved ones, hanging out for promised treatments they hope might extend lives, will not be moved by various government ministers banging on about fiscal cliffs, the complexities of the situation, and the suggestion the promise cannot be funded until money rolls in from the reinstatement of prescription charges.

They understandably expected the government to have its act together on this, appreciate their time was precious, and get on with it promptly.

Breast Cancer sufferers and supporters of the breast cancer drug Herceptin, gathered in Aotea...
Breast Cancer sufferers and supporters of the breast cancer drug Herceptin, gathered in Aotea Square, Auckland, in 2006 to remember women who have died from the disease and lobby for Pharmac to begin funding for the drug, PHOTO: NZPA
However this mess is eventually resolved, questions remain around the wisdom of politicians getting involved in picking medicine winners in the first place.

In 2008, after years of controversy over the issue, National promised to fund 12 months of Herceptin treatment for women with early stage HER2-positive breast cancers, contrary to the decision of Pharmac to fund nine weeks.

The nine-week decision was based on available evidence suggesting the benefits of that were similar to the 12-month treatment but with fewer serious side effects.

Before the election, Pharmac made it clear that even if it had been given the estimated $20m to fund the longer course of the drug, that would not have been its priority.

The new government could not direct Pharmac to approve the longer treatment so it had to fund it through the Ministry of Health.

It is baffling to see why National chose to go down this path again.

Tony Ryall, who was health minister in 2008, always regarded the Herceptin decision as a triumph, but his successor general practitioner Jonathan Coleman said history had shown it was not the right call.

Interfering with the Pharmac model would turn it into a political football, he said in 2015 amid clamour to fund melanoma drug Keytruda.

Is it fair to allocate funding on whoever can capture the ear of politicians?

Apart from anything else drug companies, knowing the government has decreed certain drugs must be bought, undermines Pharmac’s negotiating power.

Pharmac is not perfect. It cannot please everybody in a world where funding does not keep up with the demand for medications and it has to consider whether funding for some people’s conditions will mean more people miss out somewhere else.

Members of the public, with the help of "Big Pharma", may be persuaded every new drug funded elsewhere is a magic bullet when the evidence of efficacy might be scant.

Pharmac cannot be so laissez faire.

In a detailed analysis of the Herceptin controversy in 2011, health law academic Prof Joanna Manning suggested the way to freedom from political interference and to enhance Pharmac’s legitimacy as a decision-maker was to increase consumer participation in funding decisions and the prioritisation process.

We still have a long way to go.