Why can’t we have this drug? Anger as cancer medication that saves thousands remains banned in UK
Cancer sufferers are to be denied a ‘miracle’ drug on the NHS which is used routinely in almost every country in the Western world. Avastin can extend the lives of bowel cancer sufferers by at least two years and often much longer.
However, the Government rationing body NICE ruled yesterday that it must stay banned because it is too expensive. The result is that thousands of sufferers with the advanced form of the disease will not get the drug on the NHS – despite the fact that those living in France, Germany, Italy, Scandinavia, Australia and Canada are all prescribed it for free.
The veto could mean that Avastin is one of the first treatments to be paid for by the Government’s new emergency cancer drugs’ fund, which it has pledged to launch in October. Ministers have promised to make £200million available to meet the cost of any medicine recommended by a hospital doctor – even if it has been banned by NICE.
Around 35,000 Britons are diagnosed with bowel cancer every year and it claims 16,000 lives. But Avastin could be used on at least 6,500 of those with the most advanced form of the cancer, granting them more time to spend with loved ones.
NICE initially banned the drug last November under preliminary guidance, prompting an outcry from patient groups and campaigners. Since then manufacturers Roche have come up with cheaper ways of prescribing Avastin – but the watchdog still believes it is too expensive, under new guidance issued today.
The controversial decision has been made despite damning criticism from the Coalition Government that Britain has a much lower uptake of new cancer drugs than other countries.
Avastin costs £20,800 for a ten-month course and is taken intravenously. In some cases the drug, usually in combination with other chemotherapy medication, can shrink even advanced tumours so much that they can easily be removed by surgery, allowing patients to lead normal lives again.
But the complex formula used by the National Institute of Health and Clinical Excellence when deciding whether to approve drugs has ruled that it is not ‘cost effective’.
This is despite the fact that the price of the treatment is the same as most other countries where it is prescribed for free. NICE’s decision means Britain is in the same category as poorer European countries such as Poland, Albania and Latvia who do not fund the drug.
Last night campaigners and patient groups voiced their dismay at the decision. Rob Glynne Jones, chief medical adviser at Bowel Cancer UK, said: ‘I know that NICE has to be rigorous in its appraisal of treatments and that it looks in detail at individual drug trials to assess cost-effectiveness.
‘However, as a practising oncologist, if we simply look at survival in the UK, I can see that in even the most up-to-date national drug trials patients with advanced bowel cancer have an average 19 months survival. This compares to up to 27 months survival for patients in countries that use Bevacizumab (Avastin), such as in mainland Europe and the United States.
‘I can’t argue with NICE’s decision, but I am disappointed. These statistics tell their own story and imply that we are likely to fall even further behind in world-wide league tables.’
Kate Spall, founder of the Pamela Northcott fund, which assists cancer patients denied new therapies, said: ‘If the oncologist believes that the drug works it should be used. It should not be down to NICE to make the decision. ‘This is further evidence that the system isn’t working but sadly I am not at all surprised at this most recent decision.’
Dozens of trials have shown Avastin is safe and effective in advanced bowel cancer, where the illness has spread to other parts of the body. Four out of five patients experience a shrinking, or disappearance, of tumours that have spread to the liver, research has shown.
One sufferer who owes her life to Avastin is 54-year-old Barbara Moss, who was given months to live when she was diagnosed with bowel cancer in November 2006. She paid for the drug from money donated by her 86-year-old mother and the treatment shrank the tumour that had spread to the liver, enabling it to be removed. Mrs Moss is now in remission and is convinced Avastin kept her alive.
NICE’s draft guidance on Avastin follows a preliminary decision made last November.
In the three months since the election, the watchdog has turned down ten other life prolonging drugs for various cancers, including mifamurtide for a type of bone cancer which affects children.
NICE has also come under attack for spending £1million more on spin than on approving treatments. The organisation was accused of ‘squandering’ funds after it emerged that it had spent £4.5million on ‘communications’, compared with £3.4million assessing new medicines.
Meanwhile Sir Andrew Dillon, the chief executive, has seen his salary increase 44 per cent in the last five years and he now takes home more than £180,000.
A Department of Health spokesman said: ‘We have already announced an additional £50million of funding to be available from October, ahead of the 2011 Cancer Drugs Fund, which will help thousands of patients access cancer drugs recommended by their doctors.
‘We respect the expert independence of NICE and their role is vitally important to the NHS and the Government. As set out in the White Paper, NICE remains at the heart of our plans for liberating the NHS, including significant expansion of its role on quality standards.’
Avastin has been licensed to treat breast, renal and lung cancer. Studies have also shown it can be effective in treating ovarian, liver, pancreatic and several other cancers.
Final High School exam results: Yet again, the education system has failed Britain’s teenagers
Soggy-minded adults are responsible for an educational culture that flinches from all forms of grading or selection
Year after year, we fail the test. And it’s a test not only of intellect and memory, but of nerve, of honesty, and of will. As the A-level results are published and the nation’s teenagers rejoice, their elders lower their eyes in the shameful knowledge that, once again, they have let down the young.
Make no mistake: the annual controversy about grade inflation is about the failure of adults, not of pupils. Which is why Michael Gove’s declared determination to do something about this debauched educational currency is – potentially – one of the best reasons to support the Coalition.
This year’s debacle has two aspects, intimately related. The first is that more than 8 per cent of candidates received the new A* grade: to achieve this, they had to get more than 90 per cent in their final year examination. This means that already, in its launch year, the proportion of candidates gaining the new elite grade is the same as those awarded an A – the previous highest grade – in 1965.
In other words, A* is the new A. If the system is left to itself, the new super-grade’s value will diminish steadily in the years to come, compelling the introduction of an A**, an A***, an A****… well, you get the picture.
Second, there is a grievous mismatch between the demand for university places and the supply of teenagers looking for them. More than 180,000 were scrambling for last-minute places this weekend, many considering the option of pursuing higher education abroad. A measure of disappointment, of course, is intrinsic to the system. Competition for places at university is just that: a competition. And, by definition, not everybody will succeed.
More worrying is the impact that grade inflation is having on the fairness of the selective process. When 27 per cent of all A-level candidates gain an A or A* and the overall pass rate rises for the 28th year, how are universities supposed to distinguish between applicants?
The case of Ben Scheffer, the Brighton College schoolboy who could not find a university place in spite of A* grades in maths, economics and physics, and As in further maths, chemistry and German, is an extreme example of a common phenomenon. So many applicants to university have the highest grades that it becomes impossible for institutions to distinguish between them.
Like citizens of the Weimar Republic pushing wheelbarrows full of marks to buy a loaf of bread, today’s school-leavers are forced to sit ever greater numbers of A‑levels to distinguish themselves from the crowd – and even then have no guarantee of securing a university place.
I disagree profoundly with those who say that teenagers today have it easy. When I was a sixth former, we were only expected to take three A-levels, and that struck me as plenty. A quarter-century later, it is perfectly common for 18-year-olds to take seven or even more: a monstrous amount of work with which to fill your sixth-form days, with no certainty of a college place at the end of it.
Teenagers know perfectly well (or at least intuit) that the A-level “gold standard” disappeared long ago and make the best of a wrecked system to distinguish themselves by any means necessary. The Baby Boomers and Generation X don’t know how lucky they are. This generation is infinitely more resourceful and stoical than its immediate predecessors.
To give Mr Gove due credit, he has been urging root-and-branch reform of A-levels (and classroom assessments in general) since becoming Shadow Schools Secretary in July 2007. In Opposition, he appointed Sir Richard Sykes, the former rector of Imperial College, to investigate our system of tests and qualifications – an inquiry which concluded in March that “the usefulness of the system has been eroded by the politicisation of assessment outcomes” and “universities’ loss of confidence in A-levels as a certificate of readiness for university study”.
Now, in office, Mr Gove is conducting his own review, much influenced by the best sections of Sir Richard’s report: AS-levels (the first half of A-levels) are set to be abolished, as are the infantile “modular” courses that have afflicted Western civilisation for far too long. Universities will be closely involved in the overhaul of A-levels, and – one hopes – will play a much greater part in their future administration and the maintenance of this particular academic currency.
As the Sykes Report argued, behind the debasement of the A-level “gold standard” lies politicisation – not only in the direct sense that politicians always want to announce good news and increased tractor production, but in the subtler respect that political culture pollutes all systems of calibration and measurement. In the case of A-levels, an insidious “group-think’’ intervened and tore the currency to shreds.
Part of the contamination was caused by New Labour’s obsession with targets and central control – an obsession that led to the A-level scandal of 2002, in which the then Education Secretary, Estelle Morris, clashed in public with Sir William Stubbs, the chairman of the Qualifications and Curriculum Authority, over a grading fiasco (the resulting Tomlinson Report was all but ignored by the Blair administration).
Deeper still is the horror of academic selection that is enshrined in the comprehensive school system, but leaks into the nation’s education at every tier. Tony Crosland’s war on the grammar schools did not just destroy the principal engine of social mobility in this country’s history. It encouraged a fear of educational competition generally, and an unstated belief that all must have prizes.
The 11‑plus [exam taken at age 11 to assess eligibility for selective schooling] is spoken of like polio, a scourge upon the young that has been wiped out by the march of progress. We inhabit a culture in which it is apparently acceptable for children’s educational future to be determined by catchment area, but not by academic criteria. Infantile as it is, there is still a collective flinch from all forms of grading or selection. How much easier for soggy-minded adults for all children to get As at A-level – or, in due course, A*s.
As in so many aspects of its programme, the Coalition’s task here is cultural before it is administrative. It has to introduce afresh the idea that if all have prizes, none do. And that if ever-increasing numbers of candidates get the highest A-level grades, the university application process will become nothing more than a lottery, an arbitrary process of selection between candidates with straight As for a limited number of places. This may be a bitter pill, but it is not teenagers who are reluctant to swallow it. The pupils are not the problem. It is time for the adults to start acting like grown-ups.
British police are at the beck and call of animal rights activists
Norris Atthey is a retired military policeman who for some years has been trying to defend one of the last pockets of red squirrels left in England , around Morpeth in Northumberland (see his website, Morpeth Red Squirrels). He does so by destroying the grey squirrels which across most of the country have seen off their red cousins, not least by infecting them with a fatal disease, squirrel pox. There used to be a bounty on them and it is still an offence to release them into the wild, since they are officially vermin. After trapping them, Mr Atthey has quite legally shot hundreds with an air pistol, very much more humane than hitting them over the head in a sack, as Natural England and other wildlife bodies prefer.
Mr Atthey was outraged when a Burton window cleaner was recently given a criminal record and lost £1,547 in costs after being prosecuted by the RSPCA for drowning a grey squirrel. He publicly challenged the charity by announcing that he had drowned one too. The ever-zealous RSPCA rose to the bait, knocking on his door to demand an interview. He responded that he had no more to say, beyond his published statement. Next morning, the RSPCA official returned, summoning two policemen to arrest Mr Atthey for “causing unnecessary suffering to an animal”. He was handcuffed and taken to the police station at Bedlington, some miles away, where he was held for nine hours in the cells. Eventually he was interrogated for an hour by an RSPCA official, with a policeman standing mutely by, before being released.
Why was Mr Atthey arrested on the orders of the RSPCA? Why was he handcuffed, and imprisoned for nine hours? When I put this to Northumbria police, they replied that “the RSPCA is leading this investigation” and that “the arrested man remained with police until suitable arrangements were in place for an interview to take place”.
This provokes much wider questions, also raised by other cases reported in this column, such as that of Alan Brough, who was held by Carlisle police for six hours while the RSPCA took away his 90 fell ponies, and who immediately went and hanged himself. [There was no evidence that the ponies were abused or were suffering in any way]
The RSPCA, that once-admirable charity, now often seems to pursue animal-lovers through the courts simply to win the publicity that keeps its £115 million a year in donations rolling in. And why do the police now regard themselves as the charity’s enforcement wing? What an admission from Northumbria police that they seek to justify holding a 66-year old man of impeccable character for nine hours by saying “the RSPCA is leading this investigation”. When did Parliament empower RSPCA officials (all ordinary members of the public) to order our police around like this?
Scrap the minimum wage: “It’s time to abolish the minimum wage. Yes, I want to see pay and conditions improve for the lowest-paid workers just as much as anyone else. But it is now obvious that the minimum wage is keeping out of work those — like younger people, unskilled workers, women and ethnic minorities — who need job opportunities the most. Of course, there is an economic downturn going on, so jobs are harder to get and unemployment is higher. But where is it highest? Yes, precisely among these groups.”