Difficult cases

January 21st, 2014 at 11:00 am by David Farrar

Stuff reports:

Access to costly but life-saving treatment for rare diseases comes down to looking cute on TV or knowing a politician, sufferers say.

Allyson Lock is one of only eight Kiwis diagnosed with Pompe disease, an incurable degenerative disorder. Untreated, it can be fatal, but Mrs Lock of Masterton and other sufferers have been refused treatment because of its cost.

A medication called Myozyme is available, but it is expensive and gets no funding from government drug-buying agency . Costs vary according to a patient’s age, weight and severity of illness, but in Mrs Lock’s case have been estimated at $575,000 a year.

She said patients with similarly unusual illnesses had obtained funding for expensive treatment, which was unfair. “They say it’s too expensive, but there are other treatments that cost more. If your family can get you on TV, if you’re a little kid, if the public gets into an uproar, you get funded. That’s what it comes down to.”

It’s probably true that public sympathy plays a role in decisions. But regardless, these are difficult decisions. There is obviously a limit at which the Government can fund treatment, as every dollar spent on one treatment is a dollar not spent elsewhere. $575,000 a year is hugely expensive.  I’m not saying what the limit should be, as fortunately not my decision. And you can only have empathy for those with such conditions that need hugely expensive treatments.

New Zealand Organisation for Rare Disorders executive director John Forman raised the prospect of legal action against Pharmac’s funding refusal, and said it was unacceptable every other developed country was treating its Pompe patients, except New Zealand.

I’m not sure that is quite correct. In some countries I believe it is funded for juveniles only, which is a different variation of the disease.

It would be interesting to know what are the most expensive treatments that are funded by Pharmac. Is there a hard limit, or is it a combination of price and effectiveness?

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35 Responses to “Difficult cases”

  1. Right of way is Way of Right (1,129 comments) says:

    I have known Allyson’s husband, Steve, for nearly 28 years, since we joined the RNZN together in 1986. He’s definitely one of lifes good people, and I hope circumstances allow him and Allyson to have many more happy years together. As for you Allyson, keep up the pressure!

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  2. Gordon (6 comments) says:

    Pharmac is quite arbitary about lots of things. At a totally different level I suffer from hay-fever. The antihistamines which are subsidised don’t control it; the ones that do control it very effectively aren’t subsidised.

    So go Alison and family – no mercy to the man!

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  3. Adolf Fiinkensein (2,861 comments) says:

    David, the word you need is sympathy, not empathy.

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  4. iMP (2,349 comments) says:

    I hate public health by media and anecdote. Liked the idea when Sharon Crosbie was in charge of health and we discussed CORE HEALTH SERVICES. I prefer the idea we have a public accord on agreed health services/conditions taxpayers will supply; everything else goes to pvte and pvte health insurance. Alcoholic intoxication and drugs related health should be charged like search & rescue.

    Otherwise this is a burgeoning puffer fish that will explode in Gen Y’s face.

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  5. PaulL (6,013 comments) says:

    It’s very difficult. But when we have a publicly funded health system, then we cannot have a limitless expenditure – there has to be a limit. In fact, even in a privately funded health system, there has to be a limit as well – nobody has an infinite amount of money.

    Once we accept that there is a limit, then the questions become:
    – what is a reasonable limit? In a private system that is controlled by how much you’re prepared to pay for your insurance. In a public system it’s controlled by how much money taxpayers are prepared to spend on healthcare
    – is that limit being fairly applied? I believe Pharmac attempt to apply a risk adjusted life years analysis, which combines effectiveness and cost. I would imagine that a treatment that will be required annually for the rest of your life at half a million dollars a year is probably not going to rank very highly on that list

    I’m not clear whether the objection here is that the limit is too low, or that the limit is being unfairly applied. If the latter than I’d be very supportive – but we should acknowledge that one possible answer is that some of those photogenic or well connected people perhaps shouldn’t be receiving treatment, rather than non-photogenic people getting treatment as well.

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  6. Longknives (4,686 comments) says:

    “then we cannot have a limitless expenditure – there has to be a limit. In fact, even in a privately funded health system, there has to be a limit as well – nobody has an infinite amount of money.”

    The eternal Treaty of Waitangi gravy train kind of destroys this argument.
    I’d rather Ms Lock of Masterton gets my taxpayer dollar than greedy Maori tribes….

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  7. Camryn (552 comments) says:

    Agree with iMP – set firm and clear guidelines on what the public system does not and will never pay for. Then you can purchase private insurance against it (probably very cheaply since these conditions are rare). Of course, you can purchase such insurance now, but it’ll be more clear that you need to and what it should cost if it is targeted directly at a set of conditions the public system won’t deal with.

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  8. Cato (1,095 comments) says:

    There’s little we can do to keep costs down, whatever happens. Most new drugs are invented in the United States and despite our routine criticism of that country we piggyback on its investments.

    Unfortunately, the very lengthy FDA approval processes have driven developing costs (on an already risky enterprise) through the roof. To recover their costs – and despite much demonising their margins aren’t all that high – pharmacuetical companies have to up their prices during the time of their limited monopoly on their products.

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  9. Chris2 (770 comments) says:

    The drug manufacturer’s set the the price. If it weren’t for the money they put into researching and developing Myozyme then there would be no drug at all available for Mrs Lock. So we need to give thanks to the drug company

    On the flipside, perhaps there ought to be some discussion and participation by the drug manufacturer on how they set the price. because half a million dollars a year does seem rather expensive. It is tempting to have the usual knee jerk reaction that Pharmac ought to just pay it, but I think the drug company needs to justify the cost too. I don’t remember the drug companies ever participating in such a discussion.

    I understand that one of the sticking points for the USA in any NZ/US trade agreement is the cost of drugs and how Pharmac have done NZ proud, as the sole drug buyer for the country, in getting exceptionally good prices for drugs.

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  10. grumpyoldhori (2,416 comments) says:

    Longknives, I’m pretty sure Mrs Lock is part Maori.
    Therefore you would believe she should not be treated no doubt ?
    Cannot have her riding the gravy train can we ?

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  11. Wayne Mapp (65 comments) says:

    I agree that these cases are very difficult.

    As an MP I was quite involved in the Herceptin situation. As I recall, it was a $60,000 cost as a one off treatment. That was low enough to be pretty easy to decide, and became part of National’s commitments for the 2008 election. But Dr Paul Hutchinson and I did say there would be situations that would not be affordable, even though the consequence is that people would die prematurely.

    Is this current situation on the wrong side of that equation? In deciding that you should always assess how NZ stacks up with other advanced nations, though clearly the most wealthy of them can do more than we can (Norway, Sweden and for that matter Australia).

    Do you also ask the question how much can an induividual expect to get as live saving treatments, and to what extent is age a factor. For instance should an induividual be able to get say $10 million for treatments over a lifetime. But in truth any such calculation is hard to do. Someone might have a succession of very expensive, but unanticipated treatments, which might collectively go well above any agreed figure.

    A worthwhile discussion to have to get a better understood and accepted way of dealing with these issues.

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  12. metcalph (1,425 comments) says:

    On the flipside, perhaps there ought to be some discussion and participation by the drug manufacturer on how they set the price. because half a million dollars a year does seem rather expensive.

    Let’s see. Research and development isn’t cheap and the only way that one can recover the cost is through selling the medication. If the disease being treated were a common disease (like lung cancer), then there would be a high demand for the medicine and the Big Pharma can sell a large volume of pills and the cost of R&D per pill is small. But here we have a disease that affects 8 new Zealanders, which means the number of available patients world wide is something like 14,000 at the very best. The R&D cost per pill is going to be correspondingly massive.

    If the medicine was made generically then the R&D cost can be avoided by other companies. But that can only be done once the patent runs out which means the company only has a limited number of years to recover its R&D expenses. And if you rip off patents, that decreases the chance a big pharma is going to make new medicines in the first place.

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  13. slightlyrighty (2,505 comments) says:

    Metcalph.

    You make valid points, but you could argue that providing a medicine at a cost of $1000 a week to a person that would die without it does pose an interesting ethical dilemma. I understand the need for a return on investment, but if you have a product that costs $1000 a week, you will have a small pool of customers. That fact that people will die without it is a form of extortion.

    The ethical position for a company would be some form of product/profit mix. Now the parent company, Genzyme, has nearly 11 billion USD in assets, total revenues of 4.53 billion USD with 2012 profits totalling $422 million USD. They’re not badly off. Charging $800 USD per week for in this instance is ethically questionable. So is not developing the drug in the first place of course, but certainly a company so large would have other profit centers with higher volume products where a slight increase in charges could be used to better subsidise (as much as I hate that word) Myozyme for the small group of people who would die without it.

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  14. RRM (9,742 comments) says:

    Can’t help but feel slightly ashamed, to live in a country that

    :arrow: provides jails with under-floor heating so the scum of the earth don’t get too cold;

    :arrow: subsidises yacht races and rugby tournaments;

    :arrow: funds doctoral research in feminist studies;

    :arrow: pays Peter Dunne an extra $100,000 each year for being a “party leader”;

    But will not save the lives of a handful of good people, because the price of the drugs is too great.

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  15. dime (9,786 comments) says:

    “Charging $800 USD per week for in this instance is ethically questionable.” – no its not.

    Gotta feel for this lady. How many people in this country could afford to spend 500 stacks a year? about as many people that actually have the disease?

    knowing there is a cure out there and that you cant afford it would be worse than knowing there is no cure.

    Back to the “ethics” of it. Two choices – a drug company can spend the billion or so dollars developing a drug that they will charge shit tons for but will go onto save thousands and thousands eventually.. or no one bothers, the drug never ends up generic and see ya later

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  16. Fentex (912 comments) says:

    But when we have a publicly funded health system, then we cannot have a limitless expenditure – there has to be a limit.

    That there is a limit has nothing to do with a private or public health system, there is always a limit.

    Nations with private insurance schemes have no better record at providing for everyone’s health and everywhere those unlucky enough to find themselves at the margin are in danger.

    NZ does not forbid private health insurance, it is actually quite cheap in NZ (because in a nation with public health care it has to be to offer a viable service, thus we have mostly non-profit private health insurers). But not many people would, or could afford to, buy a policy that would offer half a million dollars a year in payouts.

    For NZ’s public health system to be a particular barrier to these people it would require it’s absence and redirection of an equivalent amount of their taxes into private health insurance to guarantee a policy capable of an indefinite period of half a million dollars in payouts per annum.

    I do not believe there exists any such policy, anywhere (remembering it has to be affordable to them).

    Arbitrary decisions are bad and a righteous issue to complain about, but confusing them with a general failure of the concept of public health providing cost effective solutions to our nation would be a mistake.

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  17. PaulL (6,013 comments) says:

    @slightlyrighty:
    If we think that the drug companies should develop drugs that they don’t make profit from, because they’re a public good, do we also think that the people who work in those companies should work for free or reduced salaries, for the same reason?

    If we identified someone at university who appeared to have the talent to be a great drug researcher, but they said “it doesn’t pay enough”, should we force them to go into that area anyway, because it’s a public good?

    If we identified someone at university who appeared to have the talent to be a great drug researcher, but they were doing a BA in Women’s Studies, should we force them to do a BSc in genomics instead, because it’s a public good?

    If we had problems identifying people who were good drug researchers, would it be reasonable to force everyone to do a BSc in genomics just in case, so we could find the ones who were good?

    /slipperyslope

    @RRM: I think you’re feeling ashamed of the wrong thing. The thing to be ashamed of is that we do any of those first 4 things when some children don’t have enough to eat and many people with significant mental health issues go untreated. There are far more things go on in the taxpayer funded bits of our economy that are reprehensible than just this funding gap.

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  18. PaulL (6,013 comments) says:

    @Fentex: correct, it’s not that it’s publicly funded that creates the limit, there’s always a limit. The trick is that when it’s privately funded you set the limit yourself – you buy an insurance policy that has exclusions, and you live with them. When it’s a publicly funded system you can lobby to get the exclusions changed because it’s not your money.

    In the US many policies for people under retirement age are actually incredibly generous, and not unreasonably expensive – the reason being that people under 65 don’t often get sick. The premiums are a combination of probability and expense – a disease like this wouldn’t be expensive to insure against given that it’s so rare. (Having said that, if it has a genetic component to it, then the time may come where you can’t insure against it because it can be tested for). Not saying we should move to that model though.

    In NZ, there’s no real incentive to get insurance, there’s little that isn’t covered by the govt. In some ways I think we’d be better to cut back on our public healthcare a bit, and thereby create a sensible market for top up insurance.

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  19. Fentex (912 comments) says:

    As to the arguments on the price of the drugs in question, well, as long as NZ doesn’t sign up to any binding international agreements forcing our hands we could try novel approaches to the idea.

    Here’s one off the top of my head – let’s suppose the drug in question cost $100 Million to research, test and prepare for manufacture. Once the plant to produce it is in place it probably doesn’t cost too much to actually produce, but that capital investment remains.

    Let’s further suppose someone, somewhere, can make it in a generic form whether or not the owner/designer agrees (in NZ or anywhere).

    How about NZ legislates the legality of generic copies on the payment of a one time fee to the patent holder – let’s say, for arguments sake, in NZ’s case $10 Million, and a small license thereafter proportional to the cost of manufacture.

    It would basically be an assertion that we believe in a right to recompense for investment but not recompense that becomes extortionate rent seeking after recompense is met in the field of life saving medication.

    At the end of the day the morality of such things comes back to the question of whether or not it is moral to steal bread when you are starving – the answer rests on whether or not your theft starves anyone else. And we can see that a few thefts from a well patronised bakery does not bankrupt it.

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  20. MH (696 comments) says:

    CTU paid $20mill over 10yrs for a negative result, Dalziel quits Parliament causing a by election-in essence to get a better paid job. Christchurch voters show respect to her and vote her in as mayor. She then employs a team to help her run a small town. Money is no object,there are no consequences just enquiries and commisions,but all involve costs. Every now and then an ACC case hits the headlines and we have to all rely on charity,above faith and hope.
    Hone et al goes on o/seas burial trip. No, there are no savings that can be made,no there is no shame in non attendance in Parliament and people will give us and chronic health patients the fingers and vote them back in. It does not occur to people that there are savings to be made and this person and others like them deserve money or are we to allow another Derek Quigly rationale to rule against basic humanity?

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  21. Fentex (912 comments) says:

    In NZ, there’s no real incentive to get insurance,

    This would be an argument against it then – for if there is no incentive NZ’s public health system must be flawless.

    That our health system is not flawless means there is incentive – all the things people argue against public health that are true (which is not all arguments against it) do show where incentives arise.

    And the presence of private health insurers in NZ attests to the many who act on the incentive, such as my parents who both worked for wages but knew they wanted more authority over their health than the safety net of public provision provided.

    In my fathers case this meant more comfortable and responsive care when he needed new knees.

    The point isn’t the pull and tug between private and public care in NZ in this instance but it’s irrelevancy in this specific case – these people would not have had a policy covering their needs whether they had bought one in NZ or elsewhere, their misfortune is outside the realm of either provision.

    Their best bet, and it’s not a good bet in NZ’s small population, if denied by Pharmic is to raise money by donation. It is not a situation to be wished on anyone.

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  22. dime (9,786 comments) says:

    Fentax – where to start.

    Drugs like list cost billions. not 100 million. Feel free to disprove that but whenever i research a pharmaceutical stock, the cost is over a billion. I know you used 100 mill as an example but a lower number helps your strange ass argument.

    “How about NZ legislates the legality of generic copies on the payment of a one time fee to the patent holder – let’s say, for arguments sake, in NZ’s case $10 Million, and a small license thereafter proportional to the cost of manufacture.”

    so, you want NZ, tiny little NZ, to shit all over the property rights of a company. a company who legally developed said rights. a company that spent the cash, took a fucking HUGE risk.

    HUGE risk meaning – how many other drugs did they spend a billion on that didnt end up going to market?

    “It would basically be an assertion that we believe in a right to recompense for investment but not recompense that becomes extortionate rent seeking after recompense is met in the field of life saving medication.”

    extortionate to the person? maybe. But the actual ROI? how many people are paying for this drug?

    according to wikipedia the avg cost is 300k US. so about 360k Kiwi. This lady is either large or has it bad. her dosage must be huge. According to wikipedia there is another drug made by the same peeps, the same cost that is meant for adults. apparently insurance companies werent keen on funding the one mentioned up top as it had negative side affects for adults.

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  23. tvb (4,307 comments) says:

    If it involves children the sky is the limit. A middle aged man despite being a taxpayer will be told to take a flying leap

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  24. dime (9,786 comments) says:

    “If it involves children the sky is the limit. A middle aged man despite being a taxpayer will be told to take a flying leap”

    true that. your only hope would be to start wearing a dress and call it a case of shemale discrimination! or marry a dude. anything to become a minority

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  25. Fentex (912 comments) says:

    so, you want NZ, tiny little NZ, to shit all over the property rights of a company. a company who legally developed said rights. a company that spent the cash, took a fucking HUGE risk.

    Every law restricting you may be denying you a right you would argue you have, I was floating an idea, not particularly different from many currently enacted, to improve our lot.

    Your disagreement seems agitated by the risk of developing pharmaceuticals that you think my suggestion would increase. I think you both over-estimate the risk (here’s an interesting discussion of the worthiness of current patent law) and under-estimate the contribution I suggested (many nations paying such fees would build up quickly).

    At the end of the day such issues rest on the danger of discouraging investment in beneficial research. I judge that risk minor and able to be mitigated.

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  26. Grendel (987 comments) says:

    Fentex, need to correct a few of your assertions:

    >>
    NZ does not forbid private health insurance, it is actually quite cheap in NZ (because in a nation with public health care it has to be to offer a viable service, thus we have mostly non-profit private health insurers). But not many people would, or could afford to, buy a policy that would offer half a million dollars a year in payouts.
    >

    Firstly, of the 8 major medical insurers in NZ, 3 are not for profit, the rest are for profit. in my experience the largest, Southern cross, is the most expensive for what you get, once you remove any employer subsidy (or even sometimes with), and rates much lower than the top rated for profit covers. The top covers are for profit and far outweigh anything you will get from Southern cross in terms of benefits.

    Most of the decent medical policies (not southern cross, which goes to about 100K) cover $300 000 per person per year on the policy, with 2 of them covering non pharmac drugs as well, and i suspect that if given the choice between funding a bit more in a year, so as to reduce how many years treatment is needed (and the ability for an insurer to negotiate costs), they might actually cover more than the 300K if it was seen as a good cost reduction in the long term.

    The issue is that NZers are cheap and expect the govt to bail them out for everything, so see medical cover as something they ‘dont need’.

    while i am sad for this lady, its not up to the rest of us to fund half a million a year for who knows how many years. she might state she had ‘paid her taxes’, but the chances of her paying enough taxes to cover 1 year of treatment (plus every other govt service she will have used) is very low.

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  27. MH (696 comments) says:

    it’s called belonging to a society,we pay for the armed services which we hope to not use. Derek Quiglites are alive but still not well.

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  28. slightlyrighty (2,505 comments) says:

    PaulL.

    I never said that drug companies shouldn’t make a profit. As I said, the company involved in this drug has had a 422 million dollar profit from as asset base of 11 billion and total revenues of 4.5 billion. They did not do this by putting all their money on one pharmaceutical product. Like any business each product fits into a category, be that a loss leader, a cash cow, a bread of butter product or a dog of a product with high costs and low volume requiring a high price to recover those costs.

    Now in pharmaceuticals the normal rules of supply and demand are somewhat distorted by the very medical conditions these drugs help with. If you have a rare and possibly fatal disease which can be controlled by medication you can expect the cure to be costly. If you have a more widespread illness that can also be controlled by medication you can expect economies of scale to make the cure more affordable at an individual level. What I find disquieting is that this company, which has billions of dollars in revenue, cannot adjust it’s product mix so that those who would die without Myozyme pay less for the privilege. A medicine that can’t be afforded could be seen to be worse than no medicine at all, if the cost of it prevents it’s use.

    There should be a way of managing the product portfolio so that all needs are met in a more balanced way.

    By the way, drugs such as this one can be classified as “Orphan Drugs”. These are drugs designed to treat orphan diseases which would otherwise not get treatment. This classification was put into place in the US in 1983 and grants the rights of the manufacturer to sell exclusively for 7 years as well as tax breaks for R&D in the development of these products in the clinical trial stage, as well as reduced federal taxes. This is also in place in the EU.

    These are good policies that allow drugs to be developed for diseases that otherwise would continue uncured, and I am sure that the cost will fall over time, but that is cold comfort to those affected in the here and now. The best result would be to find a common complaint that this med is also effective in treating, such as the drug Penicillamine which was developed to treat Wilson’s Disease, a rare hereditary disease that can lead to a fatal accumulation of copper in the body. This drug was later found to be effective in treating arthritis. Larger market, lower cost, win win.

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  29. Psycho Milt (2,401 comments) says:

    As an MP I was quite involved in the Herceptin situation. As I recall, it was a $60,000 cost as a one off treatment. That was low enough to be pretty easy to decide, and became part of National’s commitments for the 2008 election.

    Wayne, what you and your buddies actually did was demonstrate to people like Allyson Lock that the system can be gamed by people who make enough of a fuss. She’s now convinced that overturning Pharmac decisions is just a matter of getting enough media hype going, and you and your government are prime suspects for the people who convinced her. Job well done, mate.

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  30. ross69 (3,652 comments) says:

    As an MP I was quite involved in the Herceptin situation. As I recall, it was a $60,000 cost as a one off treatment. That was low enough to be pretty easy to decide, and became part of National’s commitments for the 2008 election

    Actually, Herceptin didn’t stack up on a cost-benefit basis but you thought it would win you a few votes. Too bad that taxpayers had to foot the bill.

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  31. RRM (9,742 comments) says:

    its not up to the rest of us to fund half a million a year for who knows how many years. she might state she had ‘paid her taxes’, but the chances of her paying enough taxes to cover 1 year of treatment (plus every other govt service she will have used) is very low.

    ^^^ That there is one of the main ideological disagreements I have with the right. Why should we help you? If you can’t afford to save your own life, you should die, it’s not my problem.

    The country doesn’t HAVE to have a public health service that looks after the sick… but I believe we SHOULD. Most primitive tribes and even many species of animals do whatever they can to help their sick, I think we’re failing when our civilised societies can’t or won’t do the same.

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  32. Grendel (987 comments) says:

    RRM calm down.

    no one is saying she has to die, what we are saying is:

    1. If we must have a public health system that pays for peoples care, there has to be a limit to what is spent.
    2. there needs to be a cost/benefit determination that helps the most people, and sadly 500K for one person for a years treatment, could be 5 breast cancer treatments, 12 angioplastys etc.

    Nothing is stopping them approaching rich people for assistance, or raising money or doing whatever that can, but if they force Pharmac to fund them, someone else will have to miss out.

    the only comment about tax is that often people demanding we pay for them will try and claim that becuase they pay their taxes then its just their money back. firstly thats not how it works, i know for a fact that the tons of tax i pay for me and my employees will never come back to me. and the reality is that she probably wont pay enough tax to cover it.

    now if she wants a donation, set up a page and if i want to, i will give her some money to help herself.

    Do you want to tell 10 kids every year they dont get cancer treatment becuase we have to pay for this ladys treatment.

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  33. metcalph (1,425 comments) says:

    They did not do this by putting all their money on one pharmaceutical product. Like any business each product fits into a category, be that a loss leader, a cash cow, a bread of butter product or a dog of a product with high costs and low volume requiring a high price to recover those costs.

    So let me see if I get this straight. You are arguing that a Big Pharma company should use some of its profits from highly profitable products to pay for the cost of this particular drug? That’s not going to happen and any company that did this would be onto a right shitkicking by its shareholders. There’s no such thing as a loss leader in the pharmaceutical business – they are not a supermarket.

    You talk of big profits by Big Pharma. Big Pharma needs those profits. They need the money in order to develop new drugs (that billion dollar cost to develop has to be paid up front) and for every drug that gets onto the market, there are at least several that don’t. The costs of the failed trials also have to be paid for out of those very same massive profits.

    There’s a number of ways out of this none of them good.

    1) State subsidies. Morally defensible but as politically acceptable as giving state subsidies to Big Oil. Not going to happen. Even if it did happen, the governments will be most likely to subsidize treatments for diseases that have a large number of victims. Any government that put its money into funding medication that will save eight kiwis a year will be voted out at the next election for not having its priorities straight.

    2) Rip off patents. Aside from the fact that we don’t have an industry capable of making all the medicines required, the real problem is that they can legitimately retaliate against us in ways that are not pretty. The US government could decide that Weta’s patents are null and void and screw Wellington.

    3) A large part of the development cost I understand it is human trials. If we introduced a law removing the restrictions on medical trials making it cheaper for big pharma to develop their drugs, then the cost of drugs go down and everybody benefits. Except those that turn into vegetables by trialling drugs that didn’t work.

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  34. Fentex (912 comments) says:

    Firstly, of the 8 major medical insurers in NZ, 3 are not for profit, the rest are for profit. in my experience the largest, Southern cross, is the most expensive for what you get, once you remove any employer subsidy

    This is the first time I’ve heard of employer subsidised health care in NZ, though on reflection it does make for a sensible condition of employment in dangerous industries and/or a potentially attractive distinction between employers.

    I was just thinking myself about how many for profit health insurers there may be in NZ because, the topic having been brought up, I realised I’ve been seeing more advertisements than I ever recall for health insurance and from companies I’ve never heard of before and it did occur to me this would be unlikely behaviour by non-for profits.

    Though I suspect from what numbers I can find the not for profits remain the far larger portion of private health insurers in NZ.

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  35. Fentex (912 comments) says:

    2) Rip off patents

    You don’t have to ‘rip them off’, and a government never would anyway – patents being an invention of governments they can function however governments please them to- even to not existing if they choose (though we all know that’s unlikely).

    A lot of people are sympathetic to the argument that pharmaceutical companies face a lot of expense in developing products and much of it in proving it’s efficacy and safety to regulated standards, but that’s not an argument that they should be guaranteed large profits (arguing patents are an inherent property right is such an argument though).

    It is on it’s own an argument they be protected from loss due to regulations and there’s no reason patent law protecting their exploitation couldn’t change or lapse when the cost to meet regulations has been recovered.

    Unless one is arguing patents are property that exists regardless of statute (as Libertarians often do as a innate property right created by the invention of value) patents remain an invention of society to serve a use and as such they can be bent to whatever shape best pleases us.

    Demanding compromises by seekers of profit is little different from demanding helpful action from bystanders as many places good Samaritan laws do. We often insist in law people put themselves out to enable us to live together, in this matter (unless you wish to take the position there is no such thing as society) it’s a debate on whether or not we will do it some more.

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