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This came out on Wednesday from Pharmac:

PHARMAC statement on Herceptin 12 month funding

Press Release by PHARMAC at 10:57 am, 10 Dec 2008

PHARMAC has played its part in the decision to fund 12 months Herceptin and will continue to assist the government as required.

PHARMAC’s role has included providing information as necessary, and assisting the Ministry of Health with its contract negotiations with Roche, the supplier of Herceptin.

PHARMAC fully respects the democratic process that has led to the Government’s decision to fund 12 month treatment with Herceptin.

The nine-week treatment course will continue to be fully funded through the Pharmaceutical Schedule.

ENDS

Yeah right! I believe that the truly democratic process came up with the 9 week fully funded treatment plan. It was election pandering and political interference by this National led government in the processes of a supposedly arms length entity that has resulted in the 12 month treatment course being fully funded.

While I don’t begrudge the 400 or so that will benefit from this funding change, you have got to wonder how many others are going to miss out on different treatments as a result. The independent authority obviously thought that we got better value for our tax dollars elsewhere.To state that this was a democratic process is laughable.

It sets a dangerous precedent for political interference, as I said in my previous post on this topic.

Mike Moreu

Cartoon added later after comments. By Mike Moreu, from Stuff

45 Comments Posted

  1. So all the other western countries who have funded Herceptin for 12 months having read the same advertising as Pharmac have reached the wrong conclusion and only Pharmac is right!!

    Trevor.

  2. So all the other western countries who have funded Herceptin for 12 months having read the sasme reports as Pharmac have reached the wrong conclusion and only Pharmac is right!!
    Perhaps Pharmac should simply have told the truth – we didn’t have the cash.

  3. What’s up with people suggesting that it was somehow a choice between Herceptin funding and bicycle lanes? Do you not understand how budgets work? Money for those comes from completely different budgets.

  4. When the state runs the health system you end up with politically skewed rationing.

    How could anyone be surprised at this?

    It’s one of the good reasons why the state shouldn’t be providing healthcare.

  5. A cynic is a man who knows the price of everything but the value of nothing.
    Oscar Wilde

    price
    5.the cost, as in life, labor, sacrifice, etc., of obtaining some benefit or advantage

    value
    5.that quality of a thing according to which it is thought of as being more or less desirable, useful, estimable, important, etc.; worth or the degree of worth
    6.that which is desirable or worthy of esteem for its own sake; thing or quality having intrinsic worth
    7.the social principles, goals, or standards held or accepted by an individual, class, society, etc.

  6. hey Frog

    Let’s agree it was a bribe. Cynical – well, I need a political definition of cynical before I can agree to that!!

    Happy weekend all.

  7. Right. So National get at least nine years of free passes on these matters, just to break even.

    Then, if we have a LabGreen government again in ten years time, they can set a new standard, for all who come after, to follow 🙂

    ‘Aint precedents wonderful….

  8. Frog repeats the myth that this decision “sets a dangerous precedent for political interference.” It doesn’t set a new precedent, it reinfocres one set by Labour. What happened to Transfund can just as easily happen to Pharmac, a point that was no doubt whispered in the ears of the board of Pharmac before this press release was released.

  9. kahikatea claims that “when drug companies sell expensive drugs, they make a big profit which covers the cost of lobbying the government to fund the drug. When surgeons do expensive surgery, they do not make a big profit that can be used to lobby the government to fund the surgery.”

    Yes they do and their lobby group is called the Association of Salaried Medical Professionals.

  10. I posted, and was logged in, but every single post was going into quarantine.

    As you can see from this reply, my password remains remembered….

  11. I’m sure it was the password forgotten. Early stages alzheimers. I checked whether he was blocked when I first read the claim. He wasn’t. Just as well. IceBaby was going to get purged with the summer clean out as the email address is not valid….

  12. BluePeter’s been posting as IceBaby saying “they blocked me”, though they happily let him carry on posting with his new nym.

    Probably just forgot his password.

  13. Frog,

    Hard cutting through the smoke to even get to the mirrors. Costing out one aspect of policy, whilst leaving the rest uncosted. Ref: tinyurl.com/6pbkju

    >>12 month herceptin was a cynical election bribe

    Sure it is, but I can think of worse things to spend it on.

    Are you claiming to be above all that? For example, a universal student allowance, at the level of the unemployment benefit, for all full-time students, isn’t a bribe? Or is it just “good policy” when the Greens propose it?

  14. Oh, and then Pharmac go on to state quite explicitly that the evidence available a 12 months continuous course is the least effective use of the drug.

    So National go ahead and fund a 12 months continuous course.

  15. DaveS – I agree, the things you mentioned are definiteluy election bribes too.

    Icebaby – Again with the lies. Our public transport policy was costed and was cheaper than the roading alternative, so would actually have saved the taxpayer money up front and for years going forward. And it was a policy, not a bribe. Unless you consider the LabNats’ roading policies a bribe too. No, the 12 month herceptin was a cynical election bribe, nothing less.

  16. (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.

  17. BB
    Don’t be a dreamer. Have you looked at the cartoon yet? Please don’t try and paint me as someone who wished to with hold medical aid from anyone. You want me to change my opinion… The only opinion I expressed is that you don’t understand the issue. Even Vanilla Ice (baby)admits it was a bribe.
    And it was a very evil bribe, pulling on the heart strings…
    However it was an extremely effective bribe as it directly effects half the popultation and the other half can easily imagine it could effect someone close to them… So really a very cheap way to buy votes….. But OH SO EVIL

  18. I should’ve qualified my comment: they won’t take money away from the stuff you mentioned for a few years, seeing as they campaigned on doing a bunch of other stuff, which are presumably the priorities.

    You’re probably right about plans, but then again i’m sure political parties *always* have plans.

  19. I would not be so sure Stephen, I have a feeling that the Nat’s have plans for the DPB and the Dole.

    It would not surprise me to see time limits put on them both, that would be a great start.

  20. fin

    Don’t be an idiot, would you change your opinion if one of your family was diagnosed with her2 breast cancer?

    Of course you would, and being a socialist you would be screaming for public funding.

    I have NO problem paying for herceptain, they can take the money from DPB bludgers, racist treaty settlements, the family commission, or any other PC agency or programme.

  21. From the NZ Herald editorial:

    Other pharmaceutical companies, and other groups dedicated to the sufferers of any illness, will be encouraged that they, too, through special pleading, can garner some of the $180 million that the Government plans to spend on pharmaceuticals over the next three years. The path to the Health Minister’s door will be well-trodden. Ironically, a National government established Pharmac in part to prevent just this lobbying.

  22. BB said “To deny anybody the drug that might help save their life is unbelievably cruel”
    So you are advocating free medical care for all… That sounds wonderful. Have you costed this… What about those naughty people that had too many kids that they couldn’t afford? Surely the govt shouldn’t take your hard earned money and give it to them…
    Have a look at the cartoon linked to above. It may help you grasp the issue

  23. dB

    Never seen a killer breast, so am happy to bow to your superior knowledge. as regards the actuarial tables, they only predict when a proportion of the population that share a particular trait will die, so don’t worry if the humour wasn’t to your math.

    Happy daze

  24. Dave S: “To a man, a woman’s breast is a sacred thing to be preserved at all cost.”

    Trust me, speaking as a bloke, when they turn into killers you want them gone.

    And I just dont get your last post in reply to michaela…

  25. Michaela

    The actuarial tables would probably have pointed out that the party that offered to treat breast cancer more comprehensively than the others would win the female vote – especially the ones of high-risk age.

    This was a political decision, made by (of all people) politicians. If you don’t like it, squawk all you like, just as we who disagree with the political decision regarding appropriate methods of child discipline had to do.

    If you don’t like politics, go play another game, it will be second best but perhaps less stressful for you when you lose.

  26. The herceptin issue is a particular example of the Clinical-Actuarial controversy. This has been ongoing in the literature dealing with decision making under uncertainy since 1956 (Meehl.P. 1956). For the whole of the past 50years the actuaries have out predicted the clinicians on 2 out of 3 ocasions and equalled them on almost all other occasions. It wasn’t until the ’90s that any comparisons gave the clinicians a win, and even there it was very marginal and could well have been a statistical blip. The latest figures available to me, from 106 comparisons show that the actauaries won on 63 occasions, the clinicians on 3 with the remainder tied. These comparisons apply across all situations where the data is uncertain, from medical diagnosis to horse racing to weather forcasting.

    Despite the garbled media reporting, my understanding is that Pharmac make actuarial decisions while the herceptin issue is driven by clinical judgement; in this case I’ll put my money on Pharmac any day.

    Futhermore pharmac have to make decisions on behalf of the institution (in this case all of us), not individual circumstances which is what the National Party has done. Their interference sets a worrisome precedent. Political oversight should be limited to deciding on the relative weightings to be given to funding differing medical conditions; ie cancer v arthritis v heart disease v childbirth etc.

  27. >>there is only a certain amount of money available to spend on health care.

    Right. You see, I acknowledge this is an election bribe…

    HOWEVER

    It is no less a bribe than a lot of Green policy is. A lot of it is expensive and has negligible, if any gain. It keeps a small self, interested, vocal group happy at the expense of others. In my example, cyclists.

    >>Even less if you cut taxes.

    Incorrect. Tax cuts can lead to economic stimulation, which grows the pie.
    Increase taxes and you likely reduce the size of the pie. Try increasing them to 100%. See how much you’lll collect…..

  28. IceBaby :- I would like to see you stand up in front of a group of breast cancer sufferers and tell them why they can’t have a long course of Herceptain, but tell them why they do need to fund some tax cuts – for New Zealand’s richest citizens.

    I’m sorry to quote one of our local ACT candidates. Money doesn’t grow on trees. While you might content it is made of paper and therefore kinda does they reality is there is only a certain amount of money available to spend on health care. Even less if you cut taxes. The decision to weigh up treatment of breast cancer with funding for hip replacements and funding for pre and post natal care is a lose lose situation. There are always going to be people left out. The fact of the manner is that some people are going to die because the amount of money require to fund all possible health care measures is beyond our means.

  29. When surgeons do expensive surgery, they do not make a big profit that can be used to lobby the government to fund the surgery.

    Find me a consultant surgeon earning less than my brother in law (ENT = $1 million per year) and I’ll agree with you! Ha.

  30. There are clearly too many women on the Pharmac decision making chain. To a man, a woman’s breast is a sacred thing to be preserved at all cost. I know which of a breast to caress or a bike path to ride down I would prefer!

  31. Once again the Greens tell it like it is.

    The commitment to Herceptin funding was a political kneejerk by John Key. Faced with a group of hysterical women focussed solely on themselves John Key once again showed that he stands for nothing beyond getting elected. The lack of any coherent philosophy behind the National leader and his party is showing already in hourly flip flops on policy. Not having any coherent world view he was unable to see what Pharmac were doing and why and so he gave in to pressure.

    The clinical evidence weighed by Pharmac showed no benefit for extended funding. Herceptin treats a very specific and rare type of breast cancer. Just because other countries don’t have a Pharmac type agency prepared to make the tough calls is not a basis for thinking we are out of step with the rest of the world. With a limited budget Pharmac has to make tough calls all the time. NZ doesn’t have an unlimited health budget to give everyone drugs that might but probably won’t save their lives.

    It’s not a trade off between drugs and bicycle lanes. It’s a trade off between an ineffective drug for breast cancer and really effective drugs for other conditions that are not funded and probably now won’t be because of John Key’s dumb decision.

  32. big bro Says:
    December 12th, 2008 at 10:19 am

    > To deny anybody the drug that might help save their life is unbelievably cruel,

    what about denying someone the surgery that might save their lives? because this is going to be funded out of Ministry of Health funds, and surgery is what the money is most likely to be taken away from.

    when drug companies sell expensive drugs, they make a big profit which covers the cost of lobbying the government to fund the drug. When surgeons do expensive surgery, they do not make a big profit that can be used to lobby the government to fund the surgery.

  33. Or saying you’ll fund all sorts of public transport initiatives, that haven’t been costed, and even if they were, there would be no money to pay for them?

  34. Breast cancer is a frightening diagnosis and I can only imagine how I would feel if it was me or one of my family who was affected. That said Roche has run a campaign which has to some extent misrepresented the statistics, Read http://www.guardian.co.uk/lifeandstyle/2006/jun/01/healthandwellbeing.health4 to get the real figures. Pharmac is not some wicked witch, doctors and pharmacologists struggle to come up with the best use of our inevitably limited funds to help as many people as possible. Political interference in difficult decisions is the start of a slippery slope.

  35. election pandering

    is that like taking the interest off student loans, or giving a tax reduction before the election (and taking it back after winning)?

  36. I’d like to see Russ stand up in front of a group of breast cancer sufferers and tell them why they can’t have Herceptain, but tell them why they do need to fund some bicycle lanes instead.

  37. Frog

    That post is a new low for you and the Greens, while I understand it is the job of the opposition parties to question the government there are some issues where those in power just have to do what is right and what is humane.

    For you to suggest that this is simply political point scoring on behalf of the Nat’s is pathetic and says a lot about how low you are the Greens are prepared to go.

    To deny anybody the drug that might help save their life is unbelievably cruel, you are happy to waste our tax dollars on PC crap and the rehabilitation of low life criminal scum yet you are against Herceptain, perhaps you should spend more time with real people instead of inside the insulated world of Bowen House.

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