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Press releases Saturday 25 November 2006

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(1) OTHER PATIENTS BEAR THE REAL COST OF HERCEPTIN

(2) USE FOLIC ACID TO CUT HEART DISEASE, SAY EXPERTS

(3) PROTECT PATIENTS FROM EXPLOITATION BY ALTERNATIVE MEDICINES INDUSTRY, SAYS EXPERT

(1) OTHER PATIENTS BEAR THE REAL COST OF HERCEPTIN

(How much will Herceptin really cost?)
http://bmj.com/cgi/content/full/333/7578/1118

The real cost of Herceptin is borne by other patients whose treatment has to be dropped to balance the books, say doctors in this week’s BMJ.

New guidance from the National Institute for health and Clinical Excellence (NICE) recommends trastuzumab (Herceptin) in early breast cancer, but it provides no extra funding and does not suggest what cuts should be made to release this extra money. This leaves medical staff with difficult decisions to make.

Doctors at the Norfolk and Norwich University Hospital NHS Trust and the University of East Anglia calculated that they will have to find £1.9m each year to make Herceptin available to the patients who may be eligible. This becomes £2.3m if the costs of testing and monitoring patients are added.

But the real cost lies in the services that will be cut to provide this money, they write.

To illustrate this, they audited drug costs in their hospital’s cancer centre and estimated how they could save £1.9m by cutting chemotherapy and palliative care treatments.

The sum of £1.9m would enable us to treat 75 patients with Herceptin, but at four times the cost of the adjuvant treatments, they say. These treatments have been proved to be clinically effective and their estimated cost effectiveness is far greater than that currently expected for Herceptin.

So they could fund Herceptin if they did not treat 355 patients receiving adjuvant treatment (16 of whom would be cured) or 208 patients receiving palliative chemotherapy, and if they found £500,000 from another source.

“These untreated patients will be people we know,” say the authors. “We will be the ones to tell them they are not getting treatment that has been proved to be effective and which costs relatively little, because it is not the treatment of the moment.”

These results are obviously not definitive, but illustrate the fundamental challenge facing the NHS – the tension between national priority setting and local implementation, they add.

This situation highlights our central argument, that as NICE guidance provides no extra funding or any suggestion of which services to cut, medical professionals ultimately have to make these decisions.

Political pressure, patient advocacy and media hyperbole should not be the determinant of who is treated and with what, they argue. In NICE we have an established system, but it is currently creating more problems than solutions.

They believe that NICE should be given responsibility to decide what should be cut to fund newly recommended technologies or the ability to allocate extra funds for implementation, or both.

Contacts:

Tom Roques, Consultant Clinical Oncologist, Department of Oncology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
Email: tom.roques@nnuh.nhs.uk

Professor Ann Barrett, Professor of Oncology & Deputy Head School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, UK
Email: ann.barrett@uea.ac.uk

(2) USE FOLIC ACID TO CUT HEART DISEASE, SAY EXPERTS

(The debate on folic acid, homocysteine and cardiovascular disease: examination of the evidence)
http://bmj.com/cgi/content/full/333/7578/1114

The scientific evidence is strong enough to justify using folic acid as a cheap and simple way of reducing heart disease and strokes, say researchers in this week’s BMJ.

Debate continues over whether raised homocysteine levels in the blood (an amino acid implicated in the development of arterial disease) causes heart disease and stroke, and whether folic acid, which lowers homocysteine, will help reduce the risk of these disorders.

So heart expert, Dr David Wald and colleagues set out to clarify the issue. They examined all the evidence from different studies to see whether raised homocysteine is a cause of cardiovascular disease.

Some studies looked at homocysteine and the occurrence of heart attacks and strokes in large numbers of people (cohort studies), some focused on people with a common genetic variant which increases homocysteine levels to a small extent (genetic studies), while others tested the effects of lowering homocysteine levels (randomised controlled trials).

The cohort studies and genetic studies yielded similar results, indicating a protective effect from lower homocysteine levels, even though they did not share the same sources of possible error. The randomised trials were too small to be conclusive although their results were consistent with the expected protective effects of folic acid.

The conclusion that homocysteine is a cause of cardiovascular disease explains the observations from all the different types of study, even if the results from one type of study are, on their own, insufficient to reach that conclusion, say the authors.

Since folic acid reduces homocysteine concentrations, it follows that increasing folic acid consumption will reduce the risk of heart attack and stroke.

They therefore take the view that the evidence is now sufficient to justify action on lowering homocysteine concentrations, although the position should be reviewed as evidence from ongoing clinical trials emerges.

Contact:

David Wald, Senior Lecturer and Consultant Cardiologist, Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary School of Medicine and Dentistry, London, UK
Email: d.s.wald@qmul.ac.uk

(3) PROTECT PATIENTS FROM EXPLOITATION BY ALTERNATIVE MEDICINES INDUSTRY, SAYS EXPERT

(Personal View: Shark cartilage in the water)
http://bmj.com/cgi/content/full/333/7578/1129

It is time to protect patients from “vile and cynical exploitation” by the alternative medicines industry, argues a cancer expert in this week’s BMJ.

It is estimated that up to 80% of all patients with cancer take a complementary treatment or follow a dietary programme to help treat their cancer, writes Jonathan Waxman, Professor of Oncology at Imperial College London.

Yet the rationale for the use of many of these approaches is obtuse – one might even be tempted to write misleading, he says.

Indeed the claims made by companies to support the sales of such products may be overtly and malignly incorrect and, in many cases, the products may be doctored by chemicals borrowed from the conventional pharmaceutical industry. The reason that these products are accessible to patients is that they are not subject to the testing of pharmaceuticals because they are classified as food supplements.

So why do patients take alternative medicines? Why is science disregarded? How can it be that treatments that don’t work are regarded as life saving?

Waxman believes that it is because the complementary therapists offer something that doctors cannot offer – hope. If you eat this, take that, avoid this, and really believe this then we can promise you sincerely that you will be cured.

And if the patient is not cured, it is the patient who has failed, not the alternative therapy. The patient has let down the alternative practitioner and disappointed his family who have encouraged his “treatment.”

As well as the complementary medicines they take, many patients will have changed their diets in order to cure their cancers, says the author. But although there is a strong dietary basis to the development of cancer, once cancer has been diagnosed no change in diet will lead to any improvement in cancer outcomes, he writes.

Why do patients change their diet? For some it is a way of taking back some control of a situation that is entirely out of their control, says Waxman. For others it is because of the pressure put on them by families, friends or vested interest groups to “go organic.”

“It’s time for legislation to focus on a particularly vulnerable section of our society and do something to limit the exploitation of our patients,” he says. Why not subject the alternative medicines industry to the level of scrutiny that defines pharmaceuticals?

“Reclassify these agents as drugs - for this is after all how they are marketed - and protect our patients from vile and cynical exploitation whose intellectual basis, at best, might be viewed as delusional. The current EU initiative to bring forward legislation on this matter is welcomed.”

Contact:

Jonathan Waxman, Professor of Oncology, Faculty of Medicine, Imperial College, London, UK

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs DivisionBMA HouseTavistock SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)

and from:

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