No full Herceptin treatment
Despite being ordered by a court to review their decision, the Government has decided not to fund Herceptin for the full 12 months – as is the norm in most countries. It will be made avilable for a nine week course only.
If I recall correctly the cost of full funding of Herceptin was slightly less than the cost of moving the snails on the West Coast.
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Tags: herceptin
August 8th, 2008 at 6:45 am
I realise this is a popular reason to attack Labour (a worthy goal), however I’m not sure Pharmac’s decision is wrong in this case. The clinical studies so far have generally shown that there is no statistically significant difference in survival rates between the 9 week course and the 12 month course. In my view, this is simply a case of the pharmaceutical company trying to use public opinion to force Pharmac to buy more drugs.
August 8th, 2008 at 7:09 am
Well the UK’s National Institute for Clinical Excellence (NICE) certainly disagree – in fact I note today that there is controversy over there that Suten (a kidney cancer drug) is now not to be funded and Herceptin is being held up as an example of a drug that gives much better value for money…
August 8th, 2008 at 7:12 am
David, or the cost of gummint dept website development.
August 8th, 2008 at 7:21 am
Rakaia, I am not saying that Herceptin is ineffective. I’m saying that the difference in life expectancy between the 9 week concurrent course and the 12 month subsequent course if uncertain and, according to current studies, small or not statistically significant. If you compare not using Herceptin to either the 9 week or the 12 month course, you will see a difference, if you compare the two together, you won’t.
August 8th, 2008 at 7:29 am
I don’t think this post is worthy of you DPF. It is very clear that the issue was around marginal effectiveness of the drug after 9 weeks, not money, and a glib reference to snails doesn’t really serve debate.
[DPF: Why then do all those other countries fund it? Countries don't tend to fund drugs with marginal effectiveness. ]
August 8th, 2008 at 7:32 am
I also note that it was only necessary to move the snails once.
Herceptin costs will be incurred every year from now until an even more expensive drug takes its place.
I have little knowledge of the merits of the Herceptin case (and frankly, nor do most of the people making noise about it), but the cost comparison with snails is clearly inappropriate.
August 8th, 2008 at 7:36 am
arkhad – its about priorities.
Labour has been run by focus groups and polls to the extent that they’ll toss aside (in cash expenditure terms) the well being of the people they claim to represent in favour of a possible green/conservation popularity fillip. And yes, labour do direct SOE’s, the ones spying on activists, or sending plants into party conferences….
August 8th, 2008 at 7:39 am
Michaelt – I’ll take your word, not having looked at the data. I was just pointing out the the UK’s Pharmac equivalent had come down in favour of the full 12-month course.
August 8th, 2008 at 7:48 am
the Government has decided not to fund Herceptin
“The Government” has decided? Please outline for us how changing to a National govt would alter this situation, DPF:
1. Perhaps they’d alter the law to provide for political interference in medical decisionmaking?
2. Remove from Pharmac the obligation to consider the cost effectiveness of its subsidies and fund it to allow for the resulting massive wastage?
3. Alter Pharmac’s terms of reference to make it rank public opinion and the effectiveness of lobbying by interest groups and drug companies alongside cost-effectiveness when considering subsidies?
Are you seriously recommending any of these, or just taking an opportunity for a cheap shot at Labour?
[DPF: National's policy is to provide for full funding of Herceptin, so presumably they will simply make a Cabinet decision to fund it. Pharmac only has to decide on drugs out of the contestable budget]
August 8th, 2008 at 7:52 am
>>Despite being ordered by a court to review their decision, the Government has decided not to fund Herceptin for the full 12 months – as is the norm in most countries. It will be made avilable for a nine week course only.
The government ‘governs’ government departments Milt. Simple stuff aye bud.
August 8th, 2008 at 7:54 am
Does Hulun still have 100% control of the SIS?
Do they do covert surveilance?
Tape conversations?
August 8th, 2008 at 8:17 am
What arkhad, bobux and psycho said.
Apples and oranges DPF
this post is an embarassment to your usual high standard
August 8th, 2008 at 8:17 am
I would like to have seen the lovely Dr. who fronted up with the announcement asked the following question:
“If you had invasive breast cancer, would you prefer 9 weeks or a full year treatment?”
August 8th, 2008 at 8:31 am
Spineless, gutless and heartless wankers!
Good on the Nat’s for doing the right thing, they will pick up a lot of votes over this.
I wonder how long it would take for the government to fully fund herceptain if one of the Labour “wimin” developed breast cancer, (I wish one of them would develop it) words cannot describe the hatred I feel toward this fucking corrupt and evil government.
[DPF: Wishing cancer on someone - way way offensive. 30 demerits]
August 8th, 2008 at 8:43 am
I asked a Cancer specialist about this last night and they said Pharmac’s views did not reflect the science but was cost based.
Frankly that Pharmac was telling porkies.
Their Department had lobbied Pharmac both through the advisory council and direct as had specialists all over the country to no avail, they were disappointed in their own man who had been weak in his defense of the science and the patients. Some feel uncharitably because he has been suborned by his access to the system and it’s high office and is not looking at patients needs first but the MOH.
August 8th, 2008 at 8:48 am
“I wonder how long it would take for the government to fully fund herceptain if one of the Labour “wimin” developed breast cancer, (I wish one of them would develop it) words cannot describe the hatred I feel toward this fucking corrupt and evil government.”
no no, those words describe your hatred very well.
they also may show mental instability
August 8th, 2008 at 8:57 am
What a pathetic performance by David Cunny-Lips on National Radio this morning.
Is this the same Health Minister who stood up in the house crowing “I’m running this show now” only a few short months ago? His weasel-word defence of being hamstrung by the rules in limiting this funding sounds very hollow when compared with Labour’s ability to retrospectively amend legislation to pardon their own corrupt actions during the last election – no problem then! He can also be slippery enough to manoeuvre past the rules to protect his Labour mates after they completely ignored the rulebook with their dodgy dealings at Hawkes Bay DHB – no problem there either.
However, when it comes to the treatment of women cancer sufferers throughout New Zealand, it all gets a bit too difficult for him – yeah right.
National’s Dr Jackie Blue will be an infinitely superior Health Minister, and she is obviously more concerned with the health of NZ women than the “sheriff” – all he can be counted on to produce is more cronyism, and lies and posturing to protect his corrupt Labour Party mates.
August 8th, 2008 at 9:07 am
DPF: National’s policy is to provide for full funding of Herceptin, so presumably they will simply make a Cabinet decision to fund it. Pharmac only has to decide on drugs out of the contestable budget
So, under National we can expect govt depts to continue to do the necessary work to figure out the cost-effectiveness of a particular course of action and make decisions for or against based on that cost-effectiveness; and after that the Cabinet will decide whether to second-guess those decisions, based on the public relations effectiveness of the relevant lobbyists, and will cheerfully dip into our pockets to fund that second-guessing. We’re meant to vote for this, are we?
August 8th, 2008 at 9:13 am
In December 2006 the Women’s Health Action Trust published an article called Happily Ever After with Herceptin. It is available on their web site. It is most interesting and explains why this group – which is clearly pro women’s health – supported the (then) Pharmac decision. There is a strong lobby group for 12 months treatment, but still there seems to be a split in the scientific community.
Personally, I look very critically at any well organised lobby group like the Herceptin one, with a clear self interest and little or no regard for other needs in a limited budget environment. Especially if their lobbying is significantly based on anecdotes and poster ‘children’. The article mentioned above includes info on the profile of the average breast cancer patient, as follows:
“We think that most breast cancer patients are young because it is young women who get the media attention. In fact the majority are older women. In 2002, the latest year for which figures are available, only 16% of newly diagnosed women in New Zealand were under 40 and most (60%) were over 50. Around one in four were between 40 and 50. An ideal breast cancer patient for media stardom is young and balding a clear sign of a heroic battle weary warrior.”
While I am sympathetic to the women who are ill, we don’t have an unalienable right to a fairy tale ending.
August 8th, 2008 at 9:15 am
DPF I don’t know a great deal about the marginal effectiveness of this drug between 9 weeks and 12 months. However if it is low then why fund it? And if it is high and this is Pharmac bullshit covering a cost concern (Pharmac was telling porkies, as someone suggested) then let’s pull that apart. What I found disappointing about this post is that it lacks any of your usual rigour. Because other countries do fund it, because it’s national policy ……????? Please!
August 8th, 2008 at 9:15 am
Short Shriveled and Slightly to the Left (288) +0 Says:
August 8th, 2008 at 8:48 am
“I wonder how long it would take for the government to fully fund herceptain if one of the Labour “wimin” developed breast cancer, (I wish one of them would develop it) words cannot describe the hatred I feel toward this fucking corrupt and evil government.”
no no, those words describe your hatred very well.
they also may show mental instability
Ahh yes, the arrogant words of a Labour lick spittle who obviously does not know anybody fighting breast cancer.
You would be the same type of low life who expects the govt to bail you out of every problem you ever have in life yet you are happy to let woman and mothers die when Hercepatin might give them a chance.
And please, if you had a fucking brain you would know the difference between anger and mental instability, given that you are a socialist then it would be a fairly safe bet to assume that you have no brain at all.
August 8th, 2008 at 9:19 am
is it really a big surprise? we know the far left doesnt care about human life..
why is it wrong to point out the govt spent so much money moving snails?
the standard certainly would if national was in office.
i like how people talk about – “there is no statistically significant difference in survival rates between the 9 week course and the 12 month course”
so what youre saying is, having the drug available only saves a few more lives than the 9 weeks course…
well
those few lives are peoples mothers!!!!!!!!!!!! FFS!
i dunno about you whackjobs on the left, but anything that saves the lives of mums/sisters/wives is all good in my eyes! spend the cash!
August 8th, 2008 at 9:31 am
At $25 million a year the cost of funding a full treatment of hereceptin seems tiny compared to some of the government’s recent spend ups
$50 million to be spent on upgrading government house (number of lives saved 0)
$150 million to be spent on the highly questionable gardacil vaccine (which has incidentally killed 12 girls in the States)
2 Billion dollars to be paid out over 8 years in foreign aid to the Pacific (thanks to wiley Winston)
I do not know if this treatment is effective, but it seems to me that if other countries fund it then so should we.
OR IS THIS WHAT NZ HAS BECOME UNDER LABOUR A THIRD WORLD COUNTRY INCAPABLE OF LOOKING AFTER
ITS PEOPLE
In the house yesterday Tony Ryall pointed out that the government has employed an additional two bureaucrats for every medical person in the health system.
August 8th, 2008 at 9:34 am
Your post is very disappointing, David.
All of us know, regardless of any political persuasion, that if this decision was made by an election strategist, there would only be one possible result: fund, fund, fund. Any government, any party. Take on cancer patients, just before an election? Nothing could look worse.
But the decision wasn’t made by a cynical election strategist, it was made by Pharmac. Now, the decision is of course debatable, on the best international evidence – and it should rightly be debated. By the health community, by patients, by all of us – but not decided by pollsters.
August 8th, 2008 at 9:36 am
Despite what the decidedly uncomfortable-looking Pharmac folks told us, this is all about money. With a finite budget any decision to spend more in one area compromises the care available to others. So it becomes a case of where can most lives be saved with the resources available. I’m sure that can never be a comfortable decision process.
The fact that 30 other countries fund the 12 month course probably reflects higher overall spending on font-line health, while our Labour government has overseen a bloating of management / admin / consulting people in our health system. I’d support axing a bunch of health ‘managers’ (eg so that they no longer outnumber beds at Wellington hospital!) and spend the liberated budget where it will actually make a difference for many lives. Herceptin may be a candidate.
edit: democracymum – completely agree.
August 8th, 2008 at 9:38 am
we are talking about a cancer drug here…
even if the effect is “low” after 9 weeks, it could still mean life and death difference.
labour government fund what, 120 million a year on legal aid for the “poor criminals”? the samuri guy along cost taxpayers over half a mil, or think about the RSA murder case, and that money doesn’t even save 1 life, victims of the crime had to fight with ACC for mere compensation. it’s so wrong… 3 of my colleagues are leaving for UK in the last 6 months.
August 8th, 2008 at 9:40 am
Here is the link to the OTHER part of the Herceptin story.
http://www.stuff.co.nz/4549817a27346.html
Yes, it is funded in the UK, but ONLY after pressure was applied by a special interest group after some INCOMPLETE initial successes. As the article points out, when the more complete trials are examined, it is more a matter of a pharmaceutical company overhyping their product. Yet we don’t see anyone arguing THAT point!
But yes, the announcement has been poorly handled, I will grant you that.
August 8th, 2008 at 9:55 am
i sat in on a discussion with one of the big ups form Pharmac last year and it was just after the herceptin thing had started up.
his comments were the same then, there is marginal difference between teh 9week and 12month course, and it costs a ton of money, money they have to take from somewhere else if they fund it.
as he said then, what about the next drug on the scene that might do something, how do you then fund that? there is a limit to what can be funded.
yes its about someones mother, yet i see it as odd that some of the same people who are arguing that any cost is ok to save someones mother were outraged by the overspending in the meningitis campaign that would save only a couple of children. wheres the perspective.
personally, this is an area where you should be self covered, if you are concerned about breat cancer and herceptin, get a health insurance policy that covers non pharmac drugs, or take out trauma cover so that it will give you a lump sum you can use to pay for the treatment.
the government cannot and should not pay for everything, and if it has limited resources to pay for things, then it needs to be very careful what it does fund. i am not a fan of labour by any stretch but in this case i think pharmac have it right, from my readings of what the drug actually does and from the information i have seen from pharmac.
none of this means i don;t feel for the people who have cancer and cannot get the treatment, but i feel awfully bad for the people who miss out on other (potentially more effective) drugs if it is fully funded. of course we don;t see them on TV.
AL
August 8th, 2008 at 9:55 am
I support Pharmac on this one. There is an assumption here that 12 months of this drug is more effective than 9 weeks, because “more is better”. Unfortunately, “more” of this drug generates side effects like heart failure. Would we be railing against the government if we insisted all women have “more chemo” in shorter intervals – because lots more chemo works, right?
The Perception on Herceptin
August 8th, 2008 at 10:14 am
DPF
No argument with the demerits as I see that as a fairly cheap price to pay for stating my views, it does however (and I can already see the extra demerits coming) highlight the problem with some people who are far to close to what happens in Parliament and the power games that go on in Wellington.
For many of you politics is a game, it is all about one set of very good chaps having a battle with another set of very good chaps (even if their politics are wrong) and there are a set of very antiquated rules that must be followed, you are all fairly well paid (nothing wrong with that) and you develop a lot of contacts over the years that enable you to do very well in business (nothing wrong with that either)
However (and as a former Wellingtonian I have some knowledge of this) almost all of you are insulated from what happens in the real world, one only needs look at the parliamentarians most of who are bloody useless, they only need worry about their jobs every three years (most don’t even have that worry) and despite the fact that so many could or would not make it in the real world there is an unbroken rule that you do not expose the inadequacies of the “other chaps” as long as they keep their heads down and do not cause any problems for “your chaps”.
What happens is that you end up looking at the whole thing as a kind of sporting spectacle, yes question time might be a bit rough but hey, you can always go and have a beer with the opposition at the end of play and after all they are fairly “decent chaps” who just happen to play for the other team.
You become so insulated that you do have no idea what life is like in the real world, if you did then you would realise that issues such as herceptain are things that many are passionate about, as democracy mum said in her excellent post we are spending 50 million on doing up the Governor Generals residence and I would assume that you agree that is money well spent when many of us think that money should be spent on funding this drug.
No doubt you also develop a rather cynical attitude toward people who become passionate about issues such as this, it is not that you do not care it is more to do with the fact that you are so insulated and have no idea that the whole “game” of politics is something far more serious to the rest of us who are out here in the real world.
There you go, perhaps you will take offense at this and if so then I am sorry, it is not meant as an insult David more of an observation of those who are closely involved in the power games that go on in our nations capital.
August 8th, 2008 at 10:17 am
“i dunno about you whackjobs on the left, but anything that saves the lives of mums/sisters/wives is all good in my eyes! spend the cash!”
Dime, how much is it worth spending to save the lives of Husband/sons/brothers? The present government opposes PSA testing for prostate cancer. Does National care about men or just votes?
August 8th, 2008 at 10:18 am
I’ve supported Pharmac based on what I’ve read so far. However, I could be wrong. Macdoctor provides a second opinion.
I’m not interested in being right here, I’m interested in the evidence. Can anyone shed light on Macdoctor’s interesting comments?
August 8th, 2008 at 10:20 am
Chuck
We can fund Herceptain and PSA testing easily, there is HUGE waste in the social welfare area that would more than cover this expense.
The Nat’s should promise to fund both.
August 8th, 2008 at 10:30 am
chuck – i think in a post yesterday i said.. “strange decision, usually they just cut funding for mens issues”. pisses me off!
the fact they dont spend money on guys, doesnt detract from this issue though.
August 8th, 2008 at 10:37 am
I am a pharmacist although soon not to be, in no small part due to the decisions foisted upon pharmacists by pharmac. Nearly every day of every week I have to explain to an irate customer that pharmac have changed the rules, usually to the detriment of the customer’s wallet.
David, you’ve copped some criticism about your comparison of herceptin to snails. I will give your critics some food for thought. Methadone maintenance is costing the taxpayer in methadone alone $3000 per annum. Taking into account the cost of thier invalids and sickness benefits (in my experience very few of them work), and the cost of the pointless and useless AOD services, I think the bill for herceptin would pale into comparison. I have been dishing out methadone to some junkies for 20 years, they were useless 20 years ago, and they still are today.
August 8th, 2008 at 10:38 am
That should be $3000 per patient per annum.
August 8th, 2008 at 10:39 am
As I said earlier, as more complete evidence mounts, the more it looks like Herceptin was oversold at the start. There have been SO many “wonder drugs” over the years (anyone remember interferon?), that ultimately are shown to be useful, but NOT the “silver bullet” initially thought. Again, have a look at the link I provided, and then go online and check out the issues. As the _science_ evidence mounts, we need to take care not to be overwhelmed by the emotion.
P.S. Oh, and I lost a partner/lover/friend to breast cancer side-effects a few years ago. We took care to look at the whole body and the drug side-effects, balanced by the benefits. That’s what Pharmac appear to have tried to do, to their credit. What they haven’t done well is front-up with a clearer statement of that.
August 8th, 2008 at 11:17 am
I agree with the comments that this is a most unworthy post. The fears of sick people are used to score a cheap political point in an area that is at the very least debatable as has been covered in the comments.
The second point about the giant snails is just absurd. The comparison comes from John Ansell’s Kiwi/Iwi style of proposed advertising for the Act party.
The money spent on snails was not spent by the Government at all. It was spent by SOE Solid Energy when it was obliged to delay mining at Happy Valley so it could relocate what was thought to be an endangered species. The snails were more numerous than first thought but that is an issue of scientific sampling methods of very small creatures rather than anything political. Solid Energy resisted doing anything about this issue when they had the option to deal with it in the first instance so they made a decision which in the end didn’t work for them. The legal procedures that caused the delay were initiated by conservation groups on the West Coast and the Green Party, not the Government.
The $25 million figure that is touted as the cost of relocating the snails includes the income that didn’t occur because of the delay. So it is an opportunity cost, not real money spent. The coal is still there waiting to be mined. Solid Energy has said their actual expenses were $10 million. And as stated above if Solid Energy had made a different decision at the beginning there would have been no delay (or cost). This, as others have pointed out, was a one off cost compared with an ongoing annual cost for herceptin.
The connection between these two issues is non-existent.
August 8th, 2008 at 11:40 am
Funny, everybody jumps up and down hen a WINZ worker tells someone in need to ‘Fuck Off’, but when the Labour government does it to the female population…..
August 8th, 2008 at 11:58 am
DPF, don’t take any notice of those weasels who object to you using the “cost of moving the snails” comparison. That point needs to be hammered, and hammered, and hammered. There is hardly anything that better illustrates the warped values scale that is metastizing through our society like a cancer today. What would Horowitz say? Labour CARES MORE ABOUT SNAILS than about the sick and elderly!!!!!!!!!!!!
August 8th, 2008 at 12:45 pm
I don’t necessarily think that just because other countries do something, we should follow suit. I mean, what is the rate of growth, the standard of living, etc in these other countries? These other countries can presumably afford to fund Herceptin, but that does not mean we can afford to. If we increase funding of Herceptin, will funding of other health initiatives suffer? In simple terms, will spending more on breast cancer drugs save a few lives at the expense of more deaths in other areas of the health sector due to reduced spending?
However, I note that the government spent more than $200 million on the meningococcal B vaccine which may not have saved any lives. I suspect that Pharmac would never have gone with such a bizarre decision.
August 8th, 2008 at 2:15 pm
DPF asked why then do all the other countries fund Herception. This was asked on Evening Report yesterday and the answer was that the Governments of other countries have control over the decisions made by their drug buying departments, whereas in NZ, Pharmac’s purchasing decisions can not be dictated to by the Government.
August 8th, 2008 at 2:21 pm
Chris2- that’s a lot of nonsense. Governments can get around that sort of thing very easily. If it was important to HC she would have made it happen.
They will go down in a screaming heap for this poor judgement.
August 8th, 2008 at 3:44 pm
first time caller – The Green Party has released an interesting statement on this issue, supporting Pharmac’s independence:
http://www.scoop.co.nz/stories/PA0808/S00149.htm
August 8th, 2008 at 4:31 pm
Any Government has to show discipline about how they spend the taxpayers money … and discipline is just a short way of saying “sometimes you have to say no to people who ask you to spend money on them”.
Herceptin seems to be a pretty useful anti-cancer drug, albeit not quite as miraculous as Roche first touted it to be. But where is the sense in spending something like 10%-20% of the annual cancer drug bill on one class of breast cancer patients? Where is the “discipline” in that? I realise it’s a personal tragedy for the individuals affected, and I feel for them. But Government sometimes has to make hard decisions about rationing the taxpayers limited resources … and this Herceptin debate strikes me as being a textbook example of those hard rationing decisions.
Personally I’m really disappointed that National has gone all populist on this and committed to fully funding it. It might be good politics with an election a few months away. But it’s bad policy … politicians shouldn’t be making those decisions, clinicians should. And it’s massively hypocritical for a supposedly right-wing party that campaigns on being better stewards of the public purse than the socialists.
August 8th, 2008 at 5:08 pm
What are the drugs and the related conditions that will need to have funding stopped to to allow Herceptin funding for 12 months?
How many people are expected to die from these conditions without funding for the drugs?
How many people will live with due to Herceptin funding?
August 8th, 2008 at 6:39 pm
Another important review has gone to Cunliffe today in order for him to make a decision on the implant of pig cells to help diabetics.
Pigs from the Auckland Islands are free of all diseases because of their isolation and tests in Russia have shown massive improvements in diabetics. They tested the pigs in Russia because Annette King banned the research in NZ.
LCT has applied to start clinic trials in NZ on eight patients with a view to establishing a biotech facility in Invercargill.
If Cunliffe turns this down I pray him and his whole family get diabetes to show them what a horrible disease this is.
August 8th, 2008 at 6:41 pm
The Herceptin decision is all about money and Labour having screwed up priorities eg $17m on the Tane Umaga TV ads.
We are also one of only two first world countries that doesn’t fund or subsidise insulin pumps.
August 8th, 2008 at 7:21 pm
Chris2: first time caller – The Green Party has released an interesting statement on this issue, supporting Pharmac’s independence: http://www.scoop.co.nz/stories/PA0808/S00149.htm
Oh thats rich. This is the same Sue Kedgley who gets upset when the NZ Food Safety Authority and their independent experts reach conclusions on the safety of aspartame etc different from hers. Government intervention on drugs bad, but on food good.
August 8th, 2008 at 7:32 pm
They fully fund a cerival cancer vaccine instead of actually educating young girls that having any sex let alone unprotected sex at 12 is probably not the best life choice.
Yet people who have made no bad choices and have life threatening illinesses can’t get any assistance.
August 8th, 2008 at 8:20 pm
Chris2
Jacki Blue is a breast physician…far more qualified and better educated than Sue Kedgley to be commenting on this or any health matter.(Remember hydrogen dioxide????)
According to the newspapaers, a 12 month course is supported by even Pharmac’s cancer advisors!
I’m cynically wondering if this decision has been made so Clark can charge in on her pink horse to the rescue…
August 8th, 2008 at 8:50 pm
So, four different points that DPF is mingling (and therefore leaving himself open to attack).
1. The health pharmaceutical budget is and always will be limited. Within the limits set, Pharmac seem to do a pretty good job in deciding where the most benefit is for the dollar spent. I think they are probably right in this decision to fund 9 weeks but not 12 months. But I am not a doctor. I wouldn’t be complaining about how Pharmac have handled themselves here.
2. The health budget as a whole is and always will be limited, particularly in a public system that uses rationing and waiting lists as the only way of managing demand. I think there is plenty of room for criticism of the way this current government has managed the overall health budget, and the outcomes they have achieved. Savings elsewhere in the health system could pay for additional Pharmac budget, and the sector could be managed differently so as to achieve much better health outcomes for the same total spend of taxpayer dollars.
3. The health budget competes with other functions of government for funding. In the same way we have to choose between drugs like Herceptin and other drugs, we also have to choose between more funding for the Ministry of Women’s Affairs and more funding for health. Whilst some might objectively argue that ‘the Ministry of Women’s Affairs is a good thing’, they should also have to have argued for the last four years that the Ministry of Women’s Affairs is a better spend of money on women than Herceptin is. And Solid Energy is an SOE, so the profits forgone in moving the snails could otherwise have been spent on Herceptin, so this is a valid comparison. Of course, it would be tighter if DPF had said “could have funded 1 year of Herceptin treatment, and next year we’ll shut down some hip hop courses instead”, but I think the overall point is valid.
4. The government budget as a whole competes with the private sector. We can choose to tax the people more, spending more from government. This necessarily crowds out private innovation, quality of life, and individual choice. Or we can choose to spend less on government, this will imply some functions that government might otherwise have carried out being instead left to private individuals. Of course, some of those functions we might argue didn’t need to be carried out at all, but that is really an argument within point 3.
I think DPF and the National Party’s argument is that,
– in point 1, Pharmac are making reasonable choices,
– in point 2 there could and should be more efficiency in the health sector, freeing up more money for useful things like Pharmac and doctors,
– in point 3 there are ample opportunities to redirect spending to areas that are actually useful to citizens, thereby allowing a lot more service to be delivered from the same budget, and
– in point 4 the government is taking more money than it needs, and giving us a “govt rich, people poor” country, we need to rebalance back the other way a bit, leaving more money in the average Joe’s pocket.
August 8th, 2008 at 9:55 pm
I would make the point that Pharmac is a drug buying agency set-up to ration available funds.
If you want to evaluate the efficacy of a drug then set-up an independent committee using global experts to assess the efficacy. If you have a penny pinching elephant leaning on everyone in the room while this process is going on you are not making a decision on the science but on cost.
The decision by Pharmac to offer NZ$3.2million toward another clinical trial to compare 9 weeks v 52weeks is bus change if you actually want to run a proper study with strict entry criteria (in terms of narrowing prior/concurrent treatments) and 100+ patients per arm. I suspect Pharmac knows this but at least it ‘gives the appearance of action’.
Incidentally look how many international studies are looking for patients …
http://clinicaltrials.gov/ct2/results?intr=TRASTUZUMAB&show_flds=Y
The best option would be to fund for 12 months at doctors recommendation until such time as some of the studies (above) can conclusively demonstrate more efficacious options.
August 9th, 2008 at 8:47 am
Further to my previous post in this thread about the 2006 article on Herceptin from the Women’s Health Action Trust, the Trust has confirmed its 2006 position (Herald 7 August).
“Women’s Health Action Trust director Jo Fitzpatrick “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.”
The article is here:
http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10525897
August 9th, 2008 at 10:02 am
Typical Labour dribble from PaulL.
If Health is anything like education the problem lies squarely with Labour. In Education the budget for the Ministry has increased exponentially compared to the funding of schools in the last 8 years. Better to pay a punch of complete twats in Wellington to think about things than actually have money for actual.
There is no funding issue in Health it is purely application of that funding and ideological bullshit from Labour. Waiting lists could be slashed and money saved for other activities by using private clinics for elective surgery.
August 9th, 2008 at 10:11 am
first time caller,err, that would be Nationals Jacqui Dean.
August 9th, 2008 at 11:54 am
Southern Raider, I think you missed the point of my comment. Maybe it was too long for you and you didn’t read it properly? I think I said that our current government has misapplied funding in health and could do much better.
August 9th, 2008 at 8:50 pm
ERRR CHA. That would be National’s Dr Jackie Blue actually.
August 10th, 2008 at 10:22 am
Jacqui Dean, actually.
http://www.stuff.co.nz/4200797a6160.html
In September 2007, the Social Tonics Association of New Zealand (STANZ) called for Jacqui Dean to step down from speaking on drug issues after she demonstrated – “a lack of credibility in calling for the ban of dihydrogen monoxide (water.)” STANZ Chairman Matt Bowden said – “The DHMO hoax played on the member this week is not a joke, it highlights a serious issue at the heart of drug policy making. Ms Dean demonstrated a ‘ban anything moderately harmful’ reflex. This approach is just downright dangerous.” – “Jacqui Dean has clearly demonstrated a lack of credibility in her requests to the Minister to consider banning water; She has also seriously embarrassed her National Party colleagues who can no longer have confidence in her petitions to ban BZP or anything else.”
http://en.wikipedia.org/wiki/Jacqui_Dean