(My apologies to Russell Brown, as I’ve made this comment on Public Address System, where a debate worth reading is going on.)

On Herceptin, the Pharmac document (PDF) James Green linked to is worth reading.

PTAC considered that data for Herceptin in HER2 positive early breast cancer has been,
and continues to be, subject to unacceptable publication bias. Given this unacceptable
publication bias PTAC felt compelled to consider all relevant data sources regardless of
format or detail.

Pharmac then quotes Metcalf, from the Lancet

The effect of publication bias is outlined in the recent Lancet article (Metcalfe et al.
Lancet 2008;371:1646-8.) which expressed concerns about Herceptin publication bias.
‘Failing to publish inconclusive results can mean wide (and wasteful) use of
ineffective treatments, or even unnecessary illness and death if the reported risks
of harms are underestimated. Clearly adjuvant trastuzumab is effective but how
best to use it appears to have been hampered by some publication choices that
presently are unclear. There is a duty of care to trial participants, sponsors,
regulators, and the public good to promptly publish outcomes in all exposure
groups.’

There are some highly positive studies showing significant improvement in survival rates (~6/100 after 3 years), and no doubt this is what the breast cancer groups and the drug lobbyists have been highlighting. And with that kind of improvement, they might expect to be indignant or even outraged about its non-funding. But Pharmac has a duty to be rigorous and prudent* and has reason to be cautious about these results.

They then go on to state that

no new information had been
presented that has demonstrated any additional health benefit for 12 months treatment
(sequential or concurrent) over the currently funded concurrent 9 week regimen.

and that more evidence would be required that demonstrated such an improvement before funding a 12 month course should be considered.

To state that not funding Herceptin simply “means we are lagging” is to ignore the body of evidence that Pharmac considered.

It’s an indictment of the quality of this Government, that they’re going expressly against high quality advice this early. It should concern every thinking person in New Zealand.

*If only all Government departments had such a grounding in evidence based research.

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kahikatea

You have identified the questions. Now. What are your answers?

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There was a very interesting report on direct to consumer advertising of pharmaceuticals prepared in 2003 by Professor Les Toop, Dr Dee Richards, Professor Tony Dowell, Professor Murray Tilyard, Tony Fraser, and Assoc. Professor Bruce Arroll from the Departments of General Practice at Christchurch, Dunedin, Wellington and Auckland Schools of Medicine.

It recommended:

That the New Zealand government introduce regulations and /or legislation to prohibit the advertising of prescription medicines directly to the public, through print and broadcast media or any other means.

That the Government establishes an independent medicine and health information service free of commercial interest.

It is rather long, but I have blogged about some of its key findings and observations here.

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‘it would be willing to trade away Pharmac in an effort to secure a trade deal with the US. This is one of the key US demands.’
I don’t know why we need a trade deal with the US, that country is nearly finished economically. We should be looking at trade deals with other Asian countries like the China deal.
Anyway the last thing we want is US big pharma getting a bigger foothold over here, check out this book.
http://www.deathbymodernmedicine.com/
and this article
http://www.lef.org/magazine/mag2006/aug2006_report_death_01.htm
If we want a reasonable health care system we don’t need big pharma.

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Amazing that so many love the Pharmac model yet, try and suggest a return to the HFA and its centralised buying model and often the same people rail against it. Seems to me a great solution for standard items.

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Pharmac, its importance to our health system, is a story of power. Like so many other stories in economics.

Drug companies get 20 year monopolies on their products and utilise those monopolies to gain *huge* revenues.

Most of that money goes into marketing and dividends, about 10% goes into product development. Do not believe them when they say they need the profits to do research. They lie.

What Pharmac does is marshal all the economic power available in the NZ public health sector and concentrate it in one point of contact with pharmaceutical companies. This saves the NZ health system huge amounts of money. Money is a finite resource that is used to save lives. Pharmac saves NZ lives.

But to do this Pharmac has to make decisions that weigh benefits to one group against benefits to another. For instance Herceptin could treat H2 breast cancer, giving, maybe, a 20% chance of 2 years more life, maybe more (80% of people who take it have no improvement). The cost of funding Herceptin would fund (from memory) 300,000 courses of low dose aspirin. Saving thousands of lives. In a situation of limited funds, what do you do? A tough decision but made properly lives are saved and lives are sacrificed. Do we really want politicians making those decisions?

In the face of the enormous marketing and PR clout of the drug companies politicians have no chance. That is why we have bureaucrats!

I know that if I had H2 positive breast cancer I would be thinking differently, of course I would. That is the point, these are hard tough decisions but leaving them to politicians and/or pharmaceutical companies costs more lives than necessary.

Lastly: Lets give Pharmac more money to spend. Lets allow Pharmac to trade off money spent on therapies against money spent on drugs. Lets allow Pharmac to be much more holistic. But undermining Pharmac, as those economically illiterate fools in the National party want to do is bad bad bad!

peace
W

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“If there be time to expose through discussion the falsehood and fallacies, to avert the evil by the processes of education, the remedy to be applied is more speech, not enforced silence.”

Presumably we have free speech in order to spread power around. The problem with the above quote is that it takes no account of who has power. If the powerful (largely meaning the rich) are spreading falsehoods and fallacies in order to serve their own interests, what means can the rest of us use to keep them in control?

Personally, I’d say the solution is to deal with the inequality in power, not to restrict speech.

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frog – It is likely that you have never had anyone close to you at the mercy of receiving expensive treatment from the local health monopoly. Otherwise you would not have seen that article as a drug company ad. The thread of arguments about free speech is somewhat irrelevant.

I saw that article as a decent summary of some of the major health issues for New Zealanders and a fair comparison with the situation in Australia.

Pharmac does an excellent job with limited resources. They spend the money they receive wisely. It is up to the politicians to increase the amount of money available for drugs overall. The comparisons in the article with funding in Australia is the real price of falling behind in our economic position. I think the 40% funding for MS vs 10% in NZ is indicative and untenable. If Pharmac had more money it could fund and approve more drugs more quickly based on best European & Australian medical practice.

For National to have campaigned on getting Herceptin funded is simply to recognise that we have been lagging. Evidently Arts funding is a higher priority.

The most expensive drugs will always be leading edge. They are the ones that desperate people surfing the net for cures for themselves or the loved ones will focus on. A bit of advertising is neither here nor there. It has no clinical impact.

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Important point Sir Chip!
There is no obligation for big parma or GP’s to warn of negative side effects of Medicine – I have known two young men to die from improper Meds in the last few years – terminal ineptitude; a breach in the basic Duty of Care of Govt….the sort of thing Governments are paid to sort out.
Our Health system is simply not geared for 21st century medicine.
Somehow there’s a paradox where the patient comes last.
(if you are in that 25% of real carer’s; ily) mark

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Wat

You either accept limitations on advertisements and money spent on electioneering

OR

You ultimately accept that people who are wealthy own the country and can do whatever the fnck they please with the slaves who used to be citizens.

OR

You accept that the slaves will revolt and KILL the people who tried to become owners of all they survey.

Every democracy that has remained so (and the US is no longer a real democracy at this point), has restrictions on campaign finance. Many have restrictions on media usage or simply provide media access to the parties as part of the political process.

http://www.whofundswho.org.za/pubs/intl/duschinsky.pdf

The problem for democracy is real. You can’t hand over control of hours of media access to one party and a couple of minutes to the other, and expect a reasoned or accurate debate to occur. Money MATTERS, and its use in advertising matters. To say that in the election period the folks with piles of money can make all the advertisements they like, outspending both political parties and the rest of the citizenry altogether is a nonsense.

“Or perhaps we should add to your list by asking other people what restrictions on free speech they would like to see? Wouldn’t that be fair? I’m sure it would be quite a long list by the time we’re finished, and every entry would be justified with the same sanctimony you employ for yours.”

Sorry Wat… I don’t “pretend” to be good, I am the real thing.

What “list” was that again? There wasn’t one… so maybe you can come up with something more substantial when you clarify that paragraph. What restriction on FREE speech was that. Advertising isn’t free. It never has been. Ask any Newspaper for a price list.

I am telling you who I THINK should be allowed to ADVERTISE in the last 45 days… you seem to have a problem with that. Both understanding it and accepting. You lie at every opportunity. Tough…

All that means is that for 45 days the signal to noise ratio favors ALL PARTIES being able to make their policies clear so the voter’s are able to know something other than what big-money thinks. You want to argue about the length of time? Fine.

Now you are attacking the existence of all political parties. This is good. I like it when unreason finally hits the wall of reality. Political parties are a natural extension of the way humans self-organize. They have faults as you point out, but they have one significant advantage. They work better than the alternatives.

Propose an alternative construct that is not anarchy and which can be implemented by humans without resulting in tyranny. I am quite certain that you will fail. It will be amusing to observe your attempt.

You know all about ideology, but very little about human behavior.

BJ

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# Dave S Says:
November 30th, 2008 at 3:33 pm

> Two people arrive in the ER at the same time. One has collapsed and needs a 30 day series of a drug that costs $1,500 per dose and is not approved by pharmac to be cured, the other has been in a gun fight, been shot in the chest, and needs a $45,000 operation to save their life. Which one should the health system treat, and why?

for whatever amount of money Pharmac is given to work with, if there is no direct-to-consumer advertising, they won’t have to spend as much money on medicines that people are only on because they pestered their doctors for them after seeing the ad, and therefore be more likely to be able to afford to fund medicines like the one in your example.

Your example also brings up 2 questions that have nothing to do with the advertising of medicines – namely: (1) what proportion of funding should go to medicine vis-a-vis surgery? and (2) can and should we identify cases of people having medical problems caused by their own foolishness and avoid spending money on them?

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bjchip,

Priceless.

You people always become so angry when you believe others have misunderstood some minor technicality in your great schemes for restricting their freedoms.

These are your words: “Speech is not advertising. Advertising costs money…To equate paid for speech with free speech is a mistake.”

It’s very obvious you favour restrictions on people’s freedom to publish as they wish, on the entirely spurious grounds that they might have to pay some money to have their ideas disseminated.

You have no right to do any such thing. End of story.

Or perhaps we should add to your list by asking other people what restrictions on free speech they would like to see? Wouldn’t that be fair? I’m sure it would be quite a long list by the time we’re finished, and every entry would be justified with the same sanctimony you employ for yours. Would you favour that, or is just your own particular censorship you want to see imposed on everybody?

- “I said, not just now but on many occasions, that in a 45-50 day run-up to the election NOBODY who is not a political party or involved in the election or the media can buy advertising.”

So now you are telling me and the rest of the electorate who we shall be allowed to hear and who we shall not be allowed to hear. And all for our own good, naturally. Perhaps you’d like to confiscate our radios as well, in case we listen to unapproved broadcasts?

Political parties are the most insidious and corrupting influence in all politics. Virtually every decision made by the government is taken with a view to what is good for the party rather than what is good for the country. They are leeches on the political process; entirely self-serving groups that deserve no special privileges whatsoever. Yet, surprise surprise, here you are advocating thuggery to restrict the freedom of everyone except political parties.

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The only problem with letting big pharma have a free run is that they aren’t going to tell the whole truth.

On the whole I would prefer not to restrain them from advertising, but I would regulate that the claims be true and the costs be shown, and possibly a little statement like the warning on the cigarettes, that individual results can vary and the value of this treatment must be weighed against the benefits of spending limited health dollars on other treatments and other illnesses.

The issue is that their advertising plays directly against the intent of creating pharmac and prioritizing spending on pharmaceuticals and treatments. Rather than requiring Pharmac and the government to continually advertise to explain the ethical issue, forcing that message to be included in the advertisements should suffice.

respectfully
BJ

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For the record, here is the quotation in question.

. If there be time to expose through discussion the falsehood and fallacies, to avert the evil by the processes of education, the remedy to be applied is more speech, not enforced silence. – Justice Louis D. Brandeis, in Whitney v. California (1927)

IMHO the run-up to an election makes the time factor a problem. It is a unique problem in human affairs as arranging the methods elections tests the limits of democracy.

I may not expect the best from this government but I do hope for it.

Pax

BJ

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It’s an infomercial within an infomercial – the Sunday Star-Rag is one big ad.

Frog, I need to correct you on your apostrophe catastophe: “One could argue that New Zealand should fund it’s drugs…”

Back to varsity for you!
http://www.varsity.co.nz/content/view/499/142/

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BJ On a later point. You seem to have taken my desire for a country in which speech, including advertising by Large Pharma companies, is free and muddled it with the Electoral Finance Act and its restrictions on advertising in the year of an election. Sorry, it was not meant that way, perhaps I said something to misdirect you. I think my second para above expresses my main point, which is that I am opposed to speech restriction on ANY level at all.

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bj
Sorry if I mistook your quote. When all I had to go on was “The free market response to bad speech is more speech according to a former justice of the US Supreme Court.” I dealt with the statement as shown.

On the point of “Speech is not advertising” I can concur, because while advertising IS speech, it is not the only form, and so your statement is correct.

Happy daze

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Uh-Huh ; Well I would like to se us recycle or produce, much more stuff of our own, from pioneering electric cars, ethanol -a viable rail network – right thru the spectrum – we can feed and shelter 4,000,000 like real, real well BJ;
instead of taking cargo – bring factories.

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Mark52

Take it from the top. Slower. Complete sentences. I can’t be sure what you’re trying to say.

BJ

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Froggit: Readily concede that the new financial base will be in asia. No we cannot outprice beggars, what we can do is make sure the profiteers
Don’t make 300%, untaxed; its why I’m against ‘Three Strikes Tolerance ‘, Zero Tolerance’ It’s aimed at; hits the poor, whereby the wealthy crims stride by in sly pretended ingnorance – we are bound for REAL equality in this country.

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