NHS drugs cheaper but much less effective

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves. One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy. The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care. Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Last week The Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors. John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about 2,200 pounds a month compared with about 800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control. A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan. Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added. Erbitux, costing about 3,000 pounds a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

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South Australian hospital crisis

Penny-pinching socialist government needs to fire some of their precious bureaucracy and put the money into medical pay

DOCTORS in retirement and on holidays could be called back to work under contingency measures to combat SA's growing public hospital crisis. Health Minister John Hill said yesterday the Government was developing a plan to try and keep the hospitals functioning if as many as 115 emergency doctors and anaesthetists follow through on resignations by the end of next week. Mr Hill said other possible measures included recruiting doctors from interstate, nurses taking on additional duties and GPs being drafted into public hospital emergency wards.

Doctors are seeking a pay rise of up to $111,000 a year while the State Government said it was offering to incease the current annual package for emergency department consultants from about $313,000 to about $356,000. The State Government's packages include on-call allowances, leave loading and salary sacrifice benefits. Mr Hill revealed the measures under consideration yesterday as:

DOCTORS warned more will quit as part of a rolling campaign.

EMERGENCY doctors gave emotional accounts of overcrowded and under-staffed hospitals.

DOCTORS revealed they were starting rescue funds to help those planning to quit pay mortgages and bills.

QUEENSLAND said it would welcome disaffected SA clinicians, who are also being targeted by agencies recruiting for other states.

Mr Hill said the Government was considering a range of options to plug holes left by the resignations in the public health system. He said patients would face "very long waits". Some emergency wards could close, with less serious cases diverted to GP services. "We have to take them seriously and we are working through contingency plans now," Mr Hill said. "We are looking at how you'd bulk up the services; in the city we'd need to keep the spine hospitals - the Royal Adelaide Hospital, Lyell McEwin and Flinders - functioning.

"I am very worried about the circumstances if they do resign. "It might be that GPs come in to the emergency department; some nurses could come in and do the minor things; people who have retired, they might want to come back to work; doctors on leave might come back early . . . or those working part-time might do more work. "Those are the kinds of options we have to look at."

The doctor resignations have been prompted by an impasse in a bitter eight-month long pay and conditions dispute and are effective two weeks from lodgement. Doctors say they want pay parity with their interstate counterparts to attract more doctors as well as equality in a system where groups of doctors in the past have negotiated separate loadings.

SA Salaried Medical Officers Association senior industrial officer Andrew Murray baulked at the Government's contingency suggestions - and accused the Government of not having a plan. "If people who deal with the most seriously sick people that go to EDs suddenly aren't there, what's the contingency for that?" he said. "Does he really expect an old, retired doctor who hasn't practised medicine in five to 10 years to deal with a major road trauma? "As a first fallback, probably the most closely related specialists in dealing with people in trauma are intensive care doctors and anaesthetists . . . hang on, didn't someone tell me the anaesthetists are quitting tomorrow? They don't have a plan."

Mr Murray said the emergency doctors who had quit represented about 75 per cent of those available in the state, not 50 per cent as reported this week. RAH emergency consultant Dr Tony Eliseo said it would be "impossible" for the Government to replace their level of expertise at short notice. Yesterday, more doctors said they would quit over the industrial dispute - including the Women's and Children's Hospital's head of general medicine, Dr Christopher Pearson.

Dr Pearson, who started at the WCH in 1971, said his resignation was "for the future of health in SA". "Without a sufficient package, it will not be possible to attract the bright young minds who will become the senior consultants of the future," he said.

Dr Jane Edwards and Dr Terry Donald, forensic pediatricans in child protection at the WCH, also said they would hand in their resignations tomorrow. Dr Edwards said the pay inequality across specialties in SA was leaving doctors disenchanted. "By giving deals to small groups of doctors, the Government has introduced a cancer to the whole of the health system," she said. "It's festering and pitting doctors against each other; people become jealous and feel they are not worthy." Dr. Edwards also said the hospital was struggling to fill two positions in child protection because they could not compete with other states.

Another 70 anaesthetists also planned to resign tomorrow, but Mr. Hill said a child-protection expert earning a salary package between $198,000-$215,000 would go up to $324,000 under the Government's offer. He also said there were no vacancies in general medicine. Mr Hill said doctors needed to be consistent in their claims, as "the problem we are having is different pockets of people with different goals". "They say they need extra money to recruit and retain doctors; the offer we made would help us with that," he said. "Then they say they want extra money to put them (in line) with `intensivists'. "We had to put extra money into intensivists, that's what the market dictated. It's a different market in other areas."

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