I woke up this morning to read an article by Karol Sikora, a Dean at the University of Buckingham Medical School, about high cancer drug prices.* This quote caught my eye.
quote: “So cancer drug rationing is inevitable in all health economies – rich and poor alike. My solution is to have age limits for expensive therapies. Oncologists have been doing this covertly for the last two decades – it’s now time to be explicit.”
This is a morally repugnant statement, because, like many others, the author accepts the denial of access, as though there are no alternatives.
We propose another solution, i.e. delinking the patient prices for cost of life saving medicines from R&D costs. Many of those who say delinkage strategies are not possible are far too comfortable recommending early death and unnecessary suffering of cancer patients.
Delinkage, in the context of cancer drugs, means permitting access to inexpensive generic versions of products, while funding innovation through grants and innovation prizes. We already know how to manage grants for cancer research, and could use the cost saving to increase the budgets for grants. Innovation prizes would be the new incentive mechanisms, replacing the grant of expensive and deadly drug monopolies. Among other things, innovation prizes can target incentives on the most useful treatments, and reward sharing of knowledge for upstream research.
Recently NICE, the UK agency that evaluates drug prices, made the “rational” decision to oppose patient access to the new cancer drug T-DM1 for women like me (Stage 4 breast cancer) because of the high cost. NICE justified its decision by the fact that the new drug “only” extends lives by 6 months. Who among you would “give up” the last 6 months of your life? I have been busy and hopefully sometimes am as “useful” as most.
As cancer drug prices escalate, there are too few calls for a change in pricing of the life saving drugs, but many who defend rationing of access.
There are many cancer patients who are excluded from access. In high income countries reimbursement entities are rationing access to new drugs. In lower income countries, patients have almost no access to new cancer drugs. This is not inevitable. It is not the only option. And because it is not the only option, it is morally indefensible.
Instead of settling for policies that make investors in cancer treatments comfortable, start with policies that make patients more secure. We can have innovation and access. We can have innovation and affordability. We can have innovation and fairness. We just have to reject ways of paying for innovation that deny access, or are unfair, or create terrible financial burdens on health systems and cancer patients and their families.
The current policy failures are killing people and threatening a generation with unnecessary death and suffering. The time to change is now.
Manon Ress. /manon
*Professor Karol Sikora, Cancer medicine: a scientific dream turns into an economic nightmare, pharmaphorum.com, June 2, 2014. http://www.pharmaphorum.com/articles/cancer-medicine-a-scientific-dream-turns-into-an-economic-nightmare