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Press releases Saturday 5 November 2005

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(1) SHOULD DOCTORS TELL PATIENTS ABOUT EXPENSIVE, UNFUNDED DRUGS?

(2) DOCTORS ADVISED TO PLAN THEIR RESPONSE TO FLU PANDEMIC

(3) HEADLINES ABOUT HERCEPTIN SHOW EQUALITY OF ACCESS TO COSTLY DRUGS MUST BE TACKLED

(4) ALSO IN THIS WEEK’S BMJ...

(1) SHOULD DOCTORS TELL PATIENTS ABOUT EXPENSIVE, UNFUNDED DRUGS?

(Medical paternalism and expensive unsubsidised drugs)
http://bmj.com/cgi/content/full/331/7524/1075

It is unethical and paternalistic for doctors to withhold information from patients about new drugs that are not yet publicly funded, say researchers in this week’s BMJ.

New drugs may be more effective than existing treatments, but many are very expensive and may not be available through publicly funded health schemes.

This raises several ethical dilemmas for doctors. Is it reasonable to ask a patient to finance the full cost of their treatment when it is not provided by government? Would it be unethical to raise the option of treatment with an unsubsidised drug?

Researchers surveyed 184 Australian cancer specialists about their opinions and practices regarding potentially useful but unsubsidised drugs.

A large proportion said they would not discuss an expensive drug with a patient if it were not subsidised because of potential psychological and emotional effects that these discussions might have on patients and their families. The survey also found that these discussions were stressful for clinicians.

But the authors argue that this practice fails to respect autonomy and may not be in the patient’s best interests. They believe that withholding information on the basis of what a patient would want is “a dangerous medical path to unjustified paternalism.”

A further ethical issue concerns the cost of publicly funding newer, expensive treatments, they write. This is an urgent question of distributing limited resources fairly that faces not just new drugs, but many forms of modern technological care. “The gap between what we can do and what we can afford will continue to grow, at a personal and community level.”

The issue of accessing new expensive drugs has no easy solution, they say. Nevertheless, it seems unreasonable to withhold information from a patient about any potentially beneficial treatment because of concerns about capacity to pay, even if these discussions cause distress for some patients.

Society at large should discuss whether new, high-cost drugs should be publicly funded, they conclude.

Contacts:

Julian Savulescu, Ethicist, Oxford Uehiro Centre for Practical Ethics, University of Oxford, UK
Email: julian.savulescu@philosophy.ox.ac.uk

Michael Jefford, Medical Oncologist, Division of Heamatology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
Email: michael.jefford@petermac.org

(2) DOCTORS ADVISED TO PLAN THEIR RESPONSE TO FLU PANDEMIC

(Influenza pandemics and avian flu)
http://bmj.com/cgi/content/full/331/7524/1066

Family doctors are advised to plan their response to managing a flu pandemic in this week’s BMJ.

The advice is based on a module that is freely available on BMJ Learning (www.bmjlearning.com) to help keep health professionals up to date with key issues.

It is important that general practitioners take the recent threat of a flu pandemic seriously, writes Dr Douglas Fleming, a general practitioner in Birmingham. If a pandemic does occur in the United Kingdom, general practice is likely to carry the major burden, and it is unrealistic to think that it will be contained in routine office hours.

Practice staff need to consider how to advise patients, target those at risk, cope with increased demand, and continue giving routine care, he says. He advises practices to train staff in triage methods and improve their capacity to manage illness by telephone.

He also warns practices not to be swayed by media hype, but to obtain and provide accurate information to a fearful and anxious population.

He points out that an appropriate vaccine cannot be developed until the pandemic virus is clearly identified and it will be some months before there are sufficient supplies for widespread use. Furthermore, it is not clear how useful antiviral drugs would be to treat a completely new virus, or how easy it would be to distribute them during the high-pressure conditions of a pandemic.

Supply shortages also bring ethical dilemmas between countries with manufacturing capacity and those without, and with respect to people in countries with inadequate resources to meet the cost of vaccines and drugs.

Should a pandemic emerge within 12 months, the availability of antiviral drugs will be limited, and people at high risk will need to be given priority. Healthcare workers and people operating essential services might be the most important groups to protect, he concludes.

Contact:

Dr Douglas Fleming, Director, Royal College of General Practitioners, Research Unit, Birmingham, UK
Email: dfleming@rcgpbhamresunit.nhs.uk

(3) HEADLINES ABOUT HERCEPTIN SHOW EQUALITY OF ACCESS TO COSTLY DRUGS MUST BE TACKLED

(Adjuvant trastuzumab for breast cancer: we need to ensure that equity exists for access to effective and expensive treatments)
http://bmj.com/cgi/content/full/331/7524/1035

The recent press coverage on the use of Herceptin (brand name for the drug trastuzumab) for treating breast cancer in its early stages shows that issues of equal access to costly but effective drugs must be confronted, says an editorial in this week's BMJ.

Trastuzumab was "rapidly adopted as the standard of care" in the US for treating breast cancer, but one of the barriers to its use in other countries is its high cost, say the authors. In Canada the treatment costs $C50,000 a year (£25,000) per patient, and despite its effectiveness was not approved for funding in Ontario until after a media backlash.

The drug represents the first of probably many new cancer treatments of this kind, say the authors. The new hope it gives to patients also highlights new cost issues - both for the drugs themselves and surrounding cost of treatment.

Equality of patient access must extend to these accompanying areas, for example in diagnosing suitability for the drugs. Recent UK figures, for instance, show that only half of women are currently tested for the cancer gene targeted by the new treatment.

Healthcare systems around the world must no longer be left scrambling when effective new treatments come on the market. Transparent, timely and appropriately funded processes must be in place if patients are to get equal access to the best new treatments, conclude the authors.

Contact:

Dr Mark Clemons Medical Oncologist, Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada
Email: mark.clemons@sw.ca

(4) ALSO IN THIS WEEK’S BMJ...

(Including older people in clinical research: benefits shown in trials in younger people may not apply to older people)
http://bmj.com/cgi/content/full/331/7524/1036

An editorial in this week’s BMJ argues that, although older people are the “core business of the NHS”, they are being excluded from clinical trials for new treatments.

The restrictive criteria often used when choosing trial participants mean that drugs tend to be tested on similar groups of patients, which might mean there are serious differences between patients in clinical trials and “patients in the real world.” This particularly disadvantages older people, argue the authors, “to whom the evidence does not apply.”

Contact:

Professor Marion McMurdo Ninewells Hospital, University of Dundee, Dundee, UK
Email: m.e.t.mcmurdo@dundee.ac.uk

FOR ACCREDITED JOURNALISTS

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(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)