Tuesday 19th of November 2019

How should Cancer care be funded?

The big ticket items in Western healthcare include Cancer, Arthritis, Diabetes, Asthma, Stroke, Cardiovascular and Hypertension. Each of them is integated with the pharmaceutical industry (pharma). Alan Ramsey, senior journalist for Sydney Morning Herald, wrote about cancer services in Country health care a poor cousin

How much do we need to pay, as a community, for comprehensive and equitable care for people with any of the many different cancers, regardless of their choices and geographical location? How much is being spent, taking all into consideration, on cancer treatments? There are different places to start, in order to come to an answer. For example, we could ask our army of health economists and policy wonks to make an estimate of the breakdown in the next $1billion that Australians spend on their health.

One thing is for certain, pharma is dedicated to making us pay more for medicines, in order for shareholders to get bigger profits from their investments in pharma. And herein lies a deep problem, as explained in this short article on the dynamics of pharma profits. Simply put, a big global company must keep risking more and more on "blockbuster" drugs, in order to maintain its prime position as a profit maker. Right now, as a result of the problems with
the Cox-2 inhibitors, there is speculation about further consolidation in the industry, as in Should Pfizer Buy Merck? at Forbes.

The pharma-prescriber helix is a vertically integrated industry, with each strand reliant on the other to maintain expectations of future income. The intertwined relationships can be better explored when they are laid out in the horizontal plane. We can do this by looking at the actual floor-plan of a large metropolitan health service. This is a large block of suburban real estate, though its ownership is a mystery. Along the northern boundary are two multi-storey privatised research buildings, and soon
another will be added to the complex. They are connected to a building that houses the research schools of the university's faculty of medicine, and the administration of the public healthcare agency. One can walk from there into the main public hospital building. This also houses a private hospital wing, and the clinics where the hospital's specialists can rent rooms for their private activities. Along the southern border, but still within 100 metres, are separate, private day hospitals for surgery and other procedures. The chief executive of the
public agency
is also director of one of the main research
companies on this block, and director of the company that shelters the in-house private hospital.

From one point of view, none of this has anything to do with pharma. Until we get back to the questions of how much is spent, and should be spent, on a big-ticket item like Cancer. A clue to pharma's expectations is found at a website where some of the clinical trials are registered. It is very important to note that this is not provided as information that the community should know, but to facilitate the business of recruitment for the trials. It is only in recent months that the ethical pressure on pharma and medical specialists has resulted in actions requiring drug trials to be registered in Europe and UK. But, there is no comprehensive and centralised registration of trials in Australia or the US. However, a glimpse is revealed by searching on 'cancer australia' at clinicaltrials.gov. This lists 162 entries, for example Suppression of Ovarian Function Plus Either Tamoxifen or Exemestane Compared With Tamoxifen Alone in Treating Premenopausal Women With Hormone-Responsive Breast Cancer.

There are only 226 entries for 'australia', so it may be fair to say the majority of drug company money coming to Australia is for cancer drug research. It's also true that no details will be provided unless the public puts specific pressures onto the medical specialists. That is, the answers to the questions about funding for cancer services, or for diabetes, arthritis, etc., will remain locked up in the mysterious world of pharma sponsorship.

Winners and losers in the war on cancer

The world of medicine, ministering to people with diseases, is pretty sombre. The mood isn't lifted, just pushed sideways, because of the perceived need to urge people to modify their
lifestyles, in order to prevent or delay onset of degenerative conditions. The business of disease creation seems to be more upbeat, if the recent report (The Influence of the Pharmaceutical Industry) from the UK is accurate. Perhaps that's because disease-mongering attracts the jovial, entrepreneurial types.

If you don't like to make things worse than they really are, then some slight pleasure can be obtained from the pursuit of new knowledge. The weekly trip to the hospital library, to scan the journals on display, is nearly always fruitful.

A letter in Health Services Journal (UK) of Mar 17th, from the chair of the Independent Advisory Group for Sexual Health and HIV, sits at one end of the consumer spectrum. Baroness Gould writes that a number of "non-conventional settings" are successful at reaching people whose sexual bahaviour put them at risk for STIs and pregnancy. She implies that the traditional "consultant-led structure" will have to be complemented by empowerment, training and resources for lesser levels in the healthcare hierarchy, such as nurses and other support staff. The sexual health initiatives being explored in the UK include easier access to testing for chlamydial infections, by using community pharmacies as contact points. These innovations directed at preventiion of STIs threaten a power structure building up around the treatment of STIs and their consequences.

But what conflicts of interests do the people on the IAGSHH have? Have they been declared? Yes, in the Annual Report, easily accessible at the website. One of the medical researchers on this board is the principal investigator for a GSK vaccine. Other members are shareholders in pharmaceutical companies.

Another publication is one of many that represent the super-specialties within the broad practice of medicine. The journal
Cancer is the fortnightly organ of the American Cancer Society. The issue of March 15th is probably typical in content. I do not pretend this journal is accessible to the general public, but the tone can be examined with simple tools. The editorial board of 26 cancer specialists, the 44 MDs on the advisory board, and the dozens of specialists contributing to the 26 articles, do not declare any pecuniary interests, except for one of the articles. This one, about the drug bortezomib for multiple myeloma, lists the pharma connections of the 12 authors. For example, "Dr. Nix is employed by Millenium Pharmaceuticals, Inc. and owns stock in the company" and "Dr. Berenson has received research grants; is a member of the Speakers' Bureau, and has received honoria and consultant fees from Millenium Pharmaceuticals, Inc."

It's highly likely that many of the other authors' employing bodies and laboratories are supported by pharma. For example, the only paper from Australia attributes support for their research from the Bluey Day Cancer Fund, Cancer in Kids Association and the Murdoch Children's Research Institute. It may be possible to find out from these autonomous bodies if they have relationships with pharma. The journal, Cancer, has no advertisements for drugs. But it does advertise the Sister Study, which is "a national study to learn about environmental and genetic causes of breast cancer. In the next 3 years, 50,000 women who live in the US and who have had at least one sister with breast cancer and do not have breast cancer themselves will be asked to join the study." It is being conducted by US National Institutes of Health, US Department of Health and Human Services and US National Institute of Environmental Health Sciences, but "Organizations that are in partnership with the Sister Study include the American Cancer Society, Sisters Network, Inc., the Susan G. Komen Breast Cancer Foundation, and the Y-ME National Breast Cancer Organization, as well as countless local community breast cancer support and advocacy groups." It isn't clear who the immediate beneficaries of this study will be, and the role of the national bodies is not clear, beyond collecting the data. The subsequent testing of specimens, including genetic analysis, may be contracted out to private agencies.

The American Cancer Society publishes numerous books and guides, including American Cancer Society Consumer Guide to Cancer Drugs, Second Edition which has 'The latest patient information on over 200 medicines used to treat cancer'. Each and every one of those medicines needs to sold on, at the highest margin possible.

The battle to gain market share starts very early in the development cycle. Like any warfare, the 'War on Cancer' has victors and losers. Its always good to be on the winning side, especially if you can cite truckloads of empathy with the victims.

Clinical Trials

At Biotechnology Industry Organization's annual trade festival, 64 Australian biotech entities were on show. Australian governments were adequately represented. Wouldn't it be nice to peek inside the showbags of our politicians, as they struggle back into the office, after a gruelling circuit of the watering holes?


The BIO 2005 Sponsors include big names from the pharmaceutical industry, and the major consulting firms.


In Drug Makers' trade group makes the industry's priorities U.S. trade policy -

In addition to PhRMA [Pharmaceutical Research and Manufacturers of America], the Biotechnology Industry Organization, another industry trade group representing biomedicine firms, reported lobbying USTR [the Office of the U.S. Trade Representative] on 35 separate documents — ranking it seventh. Pfizer Inc., the world's largest drug company, disclosed lobbying the agency 32 times; Bristol-Myers Squibb Co., the ninth largest, lobbied the agency 27 times.


Despite Vow, Drug Makers Still Withhold Clinical Information But Merck, Pfizer and GlaxoSmithKline, three of the six largest drug companies, have met the letter but not the spirit of that agreement, Dr. Zarin said.

--

This editorial, The Australian Clinical Trial Registry, refers to ... the pharmaceutical industry’s longstanding unethical practice of “silent

Profits before cure

From the Guardian

Drugs firm blocks cheap blindness cure

Company will only seek licence for medicine that costs 100 times more

Sarah Boseley, health editor
Saturday June 17, 2006
The Guardian

A major drug company is blocking access to a medicine that is cheaply and effectively saving thousands of people from going blind because it wants to launch a more expensive product on the market.
Ophthalmologists around the world, on their own initiative, are injecting tiny quantities of a colon cancer drug called Avastin into the eyes of patients with wet macular degeneration, a common condition of older age that can lead to severely impaired eyesight and blindness. They report remarkable success at very low cost because one phial can be split and used for dozens of patients.

But Genentech, the company that invented Avastin, does not want it used in this way. Instead it is applying to license a fragment of Avastin, called Lucentis, which is packaged in the tiny quantities suitable for eyes at a higher cost. Speculation in the US suggests it could cost £1,000 per dose instead of less than £10. The company says Lucentis is specifically designed for eyes, with modifications over Avastin, and has been through 10 years of testing to prove it is safe.
Unless Avastin is approved in the UK by the National Institute for Clinical Excellence (Nice) it will not be universally available within the NHS. But because Genentech declines to apply for a licence for this use of Avastin, Nice cannot consider it. In spite of the growing drugs bill of the NHS, it will appraise, and probably approve, Lucentis next year.

read more at the Guardian....
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Gus: !@#$%^&*()#@W$$%%E$T!!!!

Crumbs from the table

From World health: A lethal dose of US politics:

... Lee's unexpected death has already engendered some serious soul-searching inside the WHO. Lee was widely lauded after his death, but his final legacy to the organization he served for 23 years is very much in doubt.

US President George W Bush said, "Lee provided tremendous leadership to the international community as it confronted the challenges of the 21st century." UN Secretary General Kofi Annan, Microsoft founder Bill Gates and former US president Jimmy Carter all made similar eulogies to Lee's long commitment to improving global public-health standards.

Lee frequently denied allegations that US political pressure influenced his decision-making, most notably perhaps during a recent television interview with the British Broadcasting Corp. However, it is just as likely that Lee will be remembered for the many times he caved to US pressure on crucial public-health issues, frequently in areas where WHO positions and commitments required that he take a stronger stand, some WHO officials contend.

Moreover, the secretive way that Lee sometimes conducted WHO business, apparently in some instances at the United States' behest, already has some officials inside the UN agency talking about the need for greater transparency and accountability under the next director general. "It will be very rough waters ahead for the new [director general]," said a Geneva-based WHO official, speaking on condition of anonymity.  ...

 

From The Message, Eugene Peterson:

Then the woman came back to Jesus, went to her knees, and begged. "Master, help me."
He said, "It's not right to take bread out of children's mouths and throw it to dogs."
She was quick: "You're right, Master, but beggar dogs do get scraps from the master's table."

In a world crying out for Justice, we get the Rule of the Market. 

Here is my servant, whom I uphold, my chosen, in whom my soul delights;
I have put my spirit upon him; he will bring forth justice to the nations.
He will not cry or lift up his voice, or make it heard in the street;
a bruised reed he will not break, and a dimly burning wick he will not quench;
he will faithfully bring forth justice.
He will not grow faint or be crushed until he has established justice in the earth;

Too early, even in 20 years' time

Howard says too early to leave Iraq
The Prime Minister, John Howard, has warned that an early withdrawal of Australian troops from Iraq could undermine what has been achieved so far.

Iraq's Deputy Prime Minister has said Iraqi forces could soon take over security responsibilities in the south of the country, where Australian soldiers are based.

Labor has seized on the comments to renew its call for Australian forces to leave Iraq.

But Mr Howard has told Channel Nine that Australians troops would still be needed as a back-up.

"To jump from primary responsibility to no responsibility would be to risk a smooth transition to what we all want, and that is a position where the Iraqis can look after themselves," he said.

Meanwhile Japan's Foreign Minister, Taro Aso, says the country's Prime Minister is considering announcing an end to Japan's military mission in southern Iraq.

__________________________

Gus: another 20 years and the Aussie troops MIGHT leave unless they are kicked out before... or unless the Yanks also leave before without the situation they created still in chaos...

business as usual .....

Sadly Gus, there is no way that the US & its war criminal acolytes will leave Iraq before a suitable "replacement" for Saddam has been fully installed .... & even then they might still maintain their occupation .... calling the shots & oppressing her people just like they have for nearly a century.

Tragically, only the death of an Australian serviceman or woman in action is likely to rouse the passions of our apathetic populace, sufficient to demand the return home of our forces ..... or a real crisis closer to home.

the real meaning of withdrawal .....

‘Britain intends to retain a military
presence in the first province of Iraq to be handed over to local control, the
government has revealed.
 

The Iraqi deputy prime minister Salam Zikam Ali
al-Zubaie yesterday claimed that British, Australian and Japanese troops will
transfer security responsibilities in the southern province of al-Muthanna to
Iraqi authorities next week and would soon withdraw from the area.  

But the Ministry of Defence said that there
were no plans to withdraw the 150 British troops in the province, which is one
of the most trouble-free regions of Iraq.
 

A defence spokesman said that even if some
troops were eventually pulled out of al-Muthanna, Britain intended to keep a
rapid reaction force in the province to respond to any future outbreaks of
violence.  

The Iraqi announcement initially fuelled
speculation that a full-scale withdrawal of British forces from southern Iraq
might be imminent. But Britain moved quickly to pour cold water on the claims.’
 

Britain To Keep
Troops In Locally Controlled Area Of Iraq

Too few Pharma fora

The above reference ends:

... The Bush administration's tactics, often cloaked as reform measures, in reality aim to bring UN agencies like the WHO more in line with US commercial and political interests. At the WHO, at least, that process has come at the expense of the UN agency's stated mission, commitments and, perhaps most significant, its global credibility as an impartial and apolitical actor.



A predominant interest of the US is the well-being of its corporations, especially those in the pharmaceutial industry. A measure of that well-being is reflected in the value of companies to ordinary shareholders. This note, at Forbes.com - Novacea Looks Like A Bargain - uses typical language:

...  "Despite these attributes, shares of Novacea are trading at a significant discount versus its peers in terms of market capitalization and enterprise value," the Cowen analyst said.  "We recommend that investors purchase Novacea shares as we believe growing investor understanding of and confidence in Novacea's pipeline will remedy this valuation gap."


Pharma has shifted a lot of resources into the cancer sector. People are fearful of cancer, as expressed at Mother chooses to undergo major surgery over years-long limbo. This fear of the unknown is a powerful lever, and will be exploited to sustain Pharma's profits.

Here's the text of a letter sent to two major newspapers, by Yours Truly -

The retail price for the new papillomavirus vaccine is $483 for the three injections. Will politicians push for a much lower price, at the risk of angering CSL's shareholders in middle Australia?
Since the vaccine prevents cervical cancer, will health authorities ask for free vaccination for those most at risk of infections with the virus? Indigenous girls have a high incidence of sexually acquired infections. Also, indigenous people who get any form of cancer are more likely to die of it, compared to the rest of us. It seems to make sense to vaccinate all girls with the highest rates of sexual activity, as soon as it becomes available, and regardless of their ability to pay for it.


I thought it made a couple of good points, but it failed to make the cut. Perhaps it does not do to hint at the value of an Australian Of The Year to an Australian company's prospects.

That feeble, solo attempt to nudge the national conscience brings up two more issues. One is the supreme importance of effective and timely communication. In a technical sector, scientific publications and conferences are major drivers of knowledge. But they suffer from the disadvantages of time and distance. The life cycle of traditional publication is far too long for today's opinion-seekers. And the traditional national, or international, annual conferences are great for travel to popular venues (Gold Coast, Florida, etc), but, again, seem to be a fixed part of a timetable that is at odds with the need for rapid turn-around of response to current issues.

The mass media generate a lot of talking points, and those on health will be more often initiated by vested interests.

Governments operate in the adversial world of politics, and want to be able to commission their own research on a subject, so they can have exclusive ownership of that particular opinion.

New Matilda, a subscription service with a broad range of contributions from the social democratic sphere, runs a discussion forum. For whatever reason, this forum requires a separate log-in and password, and that in itself is an irritation. There are other aspects of the NM discussion forum that cripple it as a venue for reasonable discourse. Web fora need to be pretty lively to sustain a critical mass of both moderators and participants.

There is a challenge for those who want to present to the public an engaging discussion on health, away from the primary interests of Pharma and governments. Solo views do not count for much, so the difficulty becomes one of getting enough credible people together, to talk over an issue, and make the discussion freely available, and timely.

A terrific example of the capability of the internet has been started by Bloggingheads.tv. Here, the protagonists link up via web conference, and make the content available in streaming format.

So, in case a forum like that does come together to discuss Pharma, I'd like to propose the first topic:

"Is it possible for pharmaceutical companies to buy data from cancer registries, on the familial linkage of cancer types?
Is it possible for Pharma to buy blood samples from commercial pathology companies?
It is possible, then, to use data-matching tools to 'add value' to some of the samples, by attributing them to people known to have specific cancers?"

Still planning for yesterday....

From the ABC

Govt 'moving swiftly' to boost dentist numbers
Federal Health Minister Tony Abbott says the Federal Government is moving as quickly as it can to address a shortage of dentists.

New South Wales Health Minister John Hatzistergos has called on the Federal Government to provide more university places for dentists to help address the shortage.

But Mr Abbott says the Government has already increased the number of university places by 80 per year.

"I accept that there is a shortage of dentists, just as there is a shortage of doctors and nurses," he said.

"But I also ask my distinguished state colleague to accept that the Government is moving as swiftly as it can to address this issue."

Mr Hatzistergos says NSW is on the brink of a serious shortage of dentists.

--------------------

Gus: What a sorry sight: Mr Abbott, begging his distinguished colleagues to forgive his government total lack of planning in health — and everything else, except doing little wars with buddy Dubya — while his master is fudging the state of the economy with bananas... All we need now is Peter Costello to tell us to do a little more banging...

Er... Hang on?

cancer fight stalls amid push for profits...

Progress against cancer is stalling, with the latest targeted cancer drugs failing to live up to expectations and priced so high that treatment is becoming unaffordable even in rich countries, according to experts at a meeting of nearly 100 eminent cancer specialists from around the world.

At the two-day meeting in Lugano, Switzerland, the doctors agreed a 10-point declaration, to be published early next year, which will chart the way forward for cancer care around the globe. Much needs to be done, they believe, to improve treatment, care and prevention both in the developed world and in poor countries, where cancer rates are rising even faster. They agreed to embark on an ambitious plan to get essential cancer care to those who are dying early in developing countries, in the same way that Aids doctors took on the fight to get HIV treatment into hard-hit Africa.

The meeting of the World Oncology Forum, organised by the European School of Oncology and attended by experts such as epidemiologists Sir Richard Peto and Prof Michel Coleman as well as the government's national cancer director, Sir Mike Richards, agreed urgent action was needed on many fronts.

Only a few years ago, many cancer experts thought the arrival of targeted medicines, designed to attack the genetic makeup of the tumour, would make dramatic inroads into cancer deaths. That has not happened. Instead, these therapies have only bought a few extra months of life. If the question was whether the world was winning the war on cancer, said Douglas Hanahan of the Swiss Institute for Experimental Cancer Research, who outlined the latest state of drug research, "in general, for most forms of human cancer, the answer is clearly no".

The excitement generated by targeted drugs, which interfere with specific molecules involved in tumour growth and suppression, has been short-lived.

Doctors reported apparently miraculous results from the use of the BRAF-inhibitor vemurafenib in advanced malignant melanoma, a usually fatal form of skin cancer. Within two weeks, the tumours had melted away.

"But six months later, [the cancer] is back with a vengeance," he said

http://www.guardian.co.uk/society/2012/oct/28/targeted-cancer-drugs-expectations-experts

bleed the monkey's wallets to pay for active ingredients...

 

Without clear and enforceable intellectual property protections in the TPP, we risk losing billions of dollars in investment for life-saving medical research. Although Australia's biotech success has come quickly, it has by no means come easily and the path to future success is not assured.

The average drug takes more than a decade and $1 billion to produce. According to a recent analysis by Forbes, that cost can be as high as $5.5 billion for large pharmaceutical companies working simultaneously to develop many drugs. Companies and investors are only prepared to take on these substantial risks if they can earn a return on their investments, backed by strong and predictable intellectual property protections.

Indeed, the Trade Commission further states that, "Leading Australian biotech companies have developed and brought many drugs to market often in collaboration with international investors and multinationals." If we make it easier for our trading partners and other governments to undermine intellectual property protections, limiting opportunities for reward, you can bet that investors will quickly lose their zeal for Australia's biotech sector.

That would be a great shame. The University College London has just published a report arguing that if current scientific momentum is maintained, disease-related deaths among the under-70s could be nearly eliminated by 2050. The authors cautioned, however, that the greatest threat to this progress is a global trend toward weaker intellectual property rights. When it comes to the TPP negotiations, Australia should not make itself a part of the problem when it is poised to play a key role in the solution.

Alex Butterworth is an intellectual property and technology lawyer at top-ten global law firm Squire Sanders in Sydney. View his full profile here.

http://www.abc.net.au/news/2014-02-21/butterworth-intellectual-property-drives-biotech-innovation/5275716

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One person named Gus could be cynical here. One needs diseases to occur before the "need" for drugs... The big Pharma's drugs are often the most unnatural way to fight diseases. Don't get me wrong, some drugs work a treat. But often there is a creation of drugs that are doubtful in their efficiency or have "side-effects" and some drugs are not worth the result of research. Even the humble aspirin has side-effects; used for too long, it can damage the kidneys... 

Most "active" ingredients in pharmaceutical drugs are actually extracted from nature and are used in trials to see if they have an effect on lab-rats, then pigs (or guinea pigs), then humans should the earlier results be "promising" when seeing a sick rat rumba-ing like a celebrity in "Dancing with the Stars" (the rat might die soon after but this is part of the research: how to stop the rat from croaking after his magic performance)...

Often you hear in the media about a miracle cure coming your way — in "about" five years time... This rings alarms bells: the early tests are extremely promising but the firm needs at least five more years of funding to find that the wonder drug A) is not as good as taking an afternoon nap B) can kill you with a nasty side-effect C) will cost heaps to administer, especially if it's patented and on the register of medical benefits... while making you live for another six months of managed pain.

Cynical me... Though most of the active ingredients are natural, the fact of extracting them may actually reduce their ability to be  "active". But one cannot patent say a clove of wild garlic... but one can patent an active ingredient in garlic by some slight modification of bizoid. And if one includes the cost of law suits for drugs that were near lethal instead of curing patients (such as Vioxx [rofecoxib]) one can look at a $25 billion single drug development in the face, by 2025. 

Disease-related death in the under 70 to be eliminated by 2050? This is more crystal ball gazing than predicting something, even with a 50/50 chance of happening... One of the main problems here is that nature often fights back on its own term. Virus become resistant to this or that... New strains of diseases like malaria are stubborn. poisons need to be stronger till a time when they kill us as well.

We need to invest money in research for better "drugs" but this has to be done by governments, not by bio-tech whose primary interest often is to bleed the monkey's wallets to pay for "active ingredients"... 

In the end we die anyway.

And the older we die, the more chance we won't know the time of day... I'm sure there is a drug somewhere to cure this: healthy diet, brain exercises and a magic pill called happy... 

Unfortunately for the big pharmas this attitude cannot be patented... but I'm sure they will try to extract bits and sell it back to us for big bucks. Some gyms and fat farms already do it on a small scale...