Drugs dilemma that simply won’t go away
It is now seven years since the North-east campaigner Tina McGeever ignited a moral dilemma in Scotland’s NHS which has proved a source of controversy ever since.
Ms McGeever campaigned relentlessly for the cancer drug Cetuximab to be made widely available in Scotland, insisting it helped ease her husband Michael’s suffering in the final months of his life. But he had to pay thousands of pounds for the drug which was formally licenced, but not approved for routine use by the Scottish Medicines Consortium (SMC). This is the body which must decide whether each new, and often expensive, drug developed by pharmaceutical firms is value for money for the hard-pressed health service and should be widely available. Ms McGeever eventually won her battle to have Cetuximab formally endorsed by the SMC earlier this year, but the controversies over which drugs get the thumbs up continue to vex.
The latest drug which has failed to make the SMC grade is Afinitor. It is available in England and campaigners see it as an innovative treatment for secondary breast cancer after it has spread to other parts of the body.
Its rejection marks the fourth time a breast cancer treatment has been knocked back this year by the SMC and prompted an understandably emotive response from campaigners about the “shattering blow” for the women affected.
But the SMC members are faced with a truly gut-wrenching dilemma. They comprise a group of health professionals from NHS Boards across Scotland, as well patient representatives, NHS managers, economists, pharmacists and members of the Association of the British Pharmaceutical Industry (ABPI). Their decisions are based on evidence about how well the drug works, as well as its cost effectiveness. But it’s hard to see how they can win. Someone is always going to be disappointed.
Of course, a recommendation by the SMC is not a definitive ruling. Arrangements exist which allow health boards to provide drugs for individual patients in certain circumstances if they are deemed appropriate for their needs even without SMC approval. But this process has been another source of consternation among patients who say it lacks transparency.
The NHS in Scotland already spends about £1.3 billion on drugs – about 15 per cent of the total budget. There is only so much money to go around.
Just last week, it emerged that NHS Tayside required a Government bailout for the third year in a row as the service struggles to meet the demands of patient care. That’s aside from the chronic pressure on GPs and ever-longer working hours faced by junior doctors.
At a time of shrinking budgets across Scotland’s public sector, the painful truth is that the NHS can’t escape from the belt-tightening, The SNP Government has pledged to protect NHS budgets, but it doesn’t address soaring patient demand, especially with an ageing population.
Sadly, the Afinitor campaigners are unlikely to be the last who are left disappointed by the availability of new drugs on Scotland’s NHS.
Nobel success should be celebrated
Scottish economist Angus Deaton’s elevation to the ranks of Nobel laureate should be a cause for celebration. The Edinburgh-born academic joins the pantheon of luminaries which includes Friedrich Hayek, Joseph Stiglitz and Milton Friedman. But his award caught many in his native Scotland by surprise yesterday.
The soul searching over Scotland’s constitutional future in recent years saw a seeming conveyor belt of economists line up to give their views on independence and the impact on the nation’s finances.
Prof Deaton’s input – or lack of it – now seems oddly notable by its absence. Perhaps more so given that his thoughts on inequality, and the importance of human welfare, are something which appear so close to First Minister Nicola Sturgeon’s heart.
He did speak out against independence, but this seemed more grounded in nostalgic reasons than any hard economic analysis.
The First Minister was quick to offer her congratulations on Prof Deaton’s achievements on social media yesterday.
And rightly so. The academic’s work is widely acknowledged to have transformed modern microeconomics. His observations about inequality and how best to measure real progress gets at the core of contemporary economic and political thinking. Is it about money in our pockets and GDP growth? Or does it feed into deeper questions about happiness of people and issues like health and life expectancy?
It is now to be hoped that the academic’s works gets a wider audience among Scotland’s political classes and some formal recognition of his achievements is now surely something for the Scottish Government to consider.