Thursday, August 7, 2008

ZenTiger Perception on Herceptin

I see Pharmac have made the brave decision to decline Roche's application to fund Women's Breast Cancer drug Herceptin for a full 12 months. They will continue to fund a 9 week treatment of the drug. They've relied on cold hard scientific evidence, and spent a lot of time and effort coming to what seems to me to be a reasonable decision.

Now they just have to combat the public, who usually have a lot less information at their fingertips and don't want to read it anyway, but will be very worried, because more is always good and less is always bad.

Perhaps more importantly, women undergoing treatment for breast cancer may have seen this drug as the gold plated weapon in their battle against a very scary disease. In such battles, attitude and hope can make a big difference to the outcome.

Those women and their families will have to take heart that they still have a range of treatment available, and combined with the 9 week herceptin course, have good chances to have good outcomes.

I also recall another health campaign where "more is good" was not the case at all. Pumped with fear over the deadly Meningococcal disease, many parents were cowed into demanding vaccinations to protect their young ones from certain death. It's not surprising - it's a fate not wished on anyone.

However, even back in 2005, there were legitimate questions being raised about the risks, the effectiveness, the costs and the side effects. Numbers of people contracting the disease from the time the outbreak peaked a few years earlier showed it in steady decline before even the first shot was fired. Those stats continued to drop throughout the programme, even though children needed "the whole set" to gain protection - this was the excuse used when vaccinated children caught the disease.

Now, in 2008 more information has come to light that continues to question the "more must be better" logic that pushed that particular decision. It was logic supported not by facts, but by the Health Department's search for hope.

It was, in effect, the reverse of the Pharmac decision, which seeks to provide the most optimal health care based on the available evidence, and leaves the supply of attitude and hope in the hands of the patient and their family.

I think that's all we can ask for.




A review of the government's $200 million meningococcal vaccination programme has found that the vaccine's effectiveness often wore off within just months of the injection.
Related Link: You are safe - for a month or two

Related Link: Pharmac Stands on Current Evidence

If you wanted a second opinion, Macdoctor dispenses alternate advice: The Price of Life

Women's groups split on Herceptin

6 comment(s):

fugley said...

Yes, the MenzB vaccination doesn't seem to be long lasting, but it also seems to have provided a circuit breaker for the disease as reported cases are now well down on 3 years ago.

fugley said...

I agree that pharmac seems to have made the best, evidence based decision, but that's not good enough for National - they see the value in pissing away millions more just to gain a few more votes.

National - the anti-Science Party.

ZenTiger said...

Yes Fugley, it was a great vaccination. First one in history that started working, showing dramatic results even before they had injected the first person.

As for National. No doubt, you'd be noticing something called "politics". It's the same game Labour have played for the last nine years. There's no vaccination that can protect voters from its ravages.

macdoctor said...

I won't link-whore here, but I have posted on both the MeNZB vaccine debacle and the latest Herceptin decision on my blog (macdoctor.co.nz).
There is clear evidence that the epidemic was on its way out at least two years before the vaccine program started.
As for Herceptin, Pharmac is basing its judgement on a single low-numbered trial. There is a vast amount of evidence that a one year course works and a single piddly trial suggests that nine-week may be as effective. If you think that represents good, or brave, judgement on Pharmac's part, then I suggest you vote for the Mcgillycuddy serious party in the election!
Herceptin is extremely expensive. This is the reason why Pharmac is so interested in over-interpreting a single trial. I have yet to meet a single oncologist who thinks that given Herceptin for nine weeks is anything but morally repugnant.

ZenTiger said...

Thanks for your comment macdoctor.

I confess, I know nothing of significance about the drug efficiency other than what I've read in the papers and a couple of articles.

This recent decision will no doubt be challenged, and we'll surely see more information come to light.

Barnsley Bill said...

All the measured and informed comments are great. But largely worthless in the eyes of the public. "West Coast snails are more valuable than our mummies' will be the headline. I also note the governments determination to stick needles in prepubescent girls at the cost of tens of millions to save a dozen or so lives a year.
Clark will find the money for this if the media play it up.

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