“DEPARTMENT OF HEALTH HATES WOMEN”

I recently came across the following news article, from the excellent and reputable Daily Mirror
NICE condemn breast cancer women to death while fatties jump the queue for gastric bands

This is columnist Carole Malone’s response to the news that the NHS will not fund the new anti-cancer drug Kadycla due to its cost. She attacks the organisation responsible for recommending treatments for NHS funding (NICE), who cleverly hide their misogynistic evil behind a seemingly friendly but inaccurate acronym – the letters actually stand for “National Institute for Health and Care Excellence”, so NIfHaCE, the liars.

Since the UK has infinite resources the NHS is never ever strained, and so any and all treatments can easily be purchased and provided to patients. It is therefore clear that NICE exists only to arbitrarily deny access to treatments and thereby condemn certain groups of patients to death – chiefly women.

To be clear, I don’t actually think any of this. My thoughts are, as they always are, complicated and confused and difficult to summarise but I will at least commit to disclosing that I think Carole Malone is a moron.  Cancer, and the commonest is breast cancer, is clearly an extremely an important and emotive topic and so newspapers should especially careful to avoid publishing such irresponsible and misleading columns.

NICE is actually a pretty good idea. Clearly any decision, and particularly those involving healthcare, should first consider the balance of costs and benefits before the best option is chosen. NICE is organisation that exists to do just that: they review all the available data before publishing guidance on the best practice on managing specific conditions, and the cost-effectiveness of various new or existing medicines and treatments.

Kadcyla (or trastuzumab emtansine) is a clever new drug that targets HER2 positive breast cancer cells, using the existing drug herceptin to deliver emtansine a (cytotoxic chemotherapy) directly to diseased cells. It’s used for aggressive, metastatic HER2+ve disease and can extend a patient’s survival for a few months, in some cases. A few months may not be much but of course it’s literally a world of difference when compared with the alternative.

Unfortunately drug development is extremely expensive. Companies must recoup their costs and make some profit before the patent protection expires – usually 20yrs in the UK. This must of course be collected (usually indirectly) from those patients who would qualify for treatment and use the drug – so rarer diseases are more expensive per patient. The Swiss manufacturer, Roche, has set the price at £6,000 per month and so £90,000 for 15 months treatment. This corresponds to approximately £165,000 per year of life obtained, and far in excess of NICE limitations, where the normal cut off is £20,000-30,000 per year, but sometimes up to £50,000 for exceptional cases and end-of-life treatments. In addition, it is hard to assess the quality of the life that is extended but blighted with the effects of the disease and the side effects of the treatment.

Crucially, the money that is not spent on kadcyla is spent on treatments that meets NICE requirements and will have a (much) larger benefit to other patients elsewhere. This is obviously pretty bleak for the patients with horrendous, rare, difficult to treat, end stage disease, and it’s absolutely not my intention to belittle or diminish their situation, but surely there’s no sense in diverting funding from areas where more can be done?

Or maybe, like NICE, I just really, really, hate women with cancer.