ANTI-CANCER DRUGS DENIED – 20 December 2005
Dr Julian Lewis: Some jobs in politics require an optimistic temperament, and the Deputy Leader of the House is the occupant of one of those jobs today. For large parts of the debate, he has had just himself, with a solitary Whip for company, his party having run out of speakers on the Christmas Adjournment some three hours before its end. That seems a statement of the condition of the modern Labour Party, even considering that it won a General Election victory earlier this year.
My mind goes back to the happy, but false, dawn of 1997, when Labour swept in with all those new faces, all those bright and shiny people and all those wonderful ideas of modernisation. I remember speaking after perhaps three or four months to a new Labour MP, who is sadly no longer in the House, who had a particular interest in defence. I asked whether he would speak in that afternoon's defence debate.
"Oh no, Julian,"
"I can't do that as I would use up my speech allocation."
I asked what was his speech allocation, and he said it was four speeches a year. Those were the days, the Deputy Leader of the House must be thinking. Back then, the Whips had to ration their people to four speeches a year; now they are lucky if they can get anyone to keep a debate going.
Another person who is a born optimist is my right hon. – indeed, very gallant – Friend the Member for Penrith and The Border (David Maclean). One would have to have been an optimist to become Chief Whip of the Conservative Party in 2001, but he was equal to the task and did it very well. During his speech today, when he talked of his experience with his community hospitals, four of which are under threat, I was irresistibly reminded of what is happening in New Forest, East, in New Forest, West and in Romsey. Five community hospitals are under threat, and we, too, had a 2,000-strong demonstration, the first of its sort in many a long year in our part of the world. The Primary Care Trusts have indeed apparently retreated on their threat to close the hospitals. One, in my constituency, remains closed, but we have been promised that it will at least be considered for reopening in the next financial year. We shall watch like hawks to make sure that that happens.
One of the most frightening parts of that campaign was the way in which the figures bandied about were so suspect and the analysis on which they were based so shallow. We were told at one point that only 16 per cent. of people in beds in our five community hospitals needed to be there. We challenged the arithmetic, and straight away the figure shot up to 24 per cent. I am still awaiting further explanation of how a raft of other occupants in beds seem mysteriously to have dropped out of the calculations: they would probably take the 24 per cent. up to about 40 per cent. or 50 per cent. When the PCT finally gave way, it found – surprise, surprise – that, as my right hon. Friend the Member for Penrith and The Border observed in his case, lots of people would end up blocking beds in the general hospitals if the community hospitals closed. What a surprise that was. However could it not have guessed that, if it had given a little thought in advance?
The trouble with many health issues is that cases are put forward, for change or inaction or not doing that which should be done, on bogus grounds, and on rationalisations caused fundamentally by a shortage of funds. That leads me to the case of my constituent, Mr. Brian Jago, which I have briefly raised once before. He suffers from multiple myeloma, which hon. Members may know is a cancer of the blood. It is a cancer for which there is no cure. The conventional forms of radiotherapy and chemotherapy may work for a little while, but there will always be a relapse.
However, as I have recently discovered because of my acquaintance with this case, there have been some breakthroughs. In particular, there is a new drug, Velcade, which has been licensed in this country but not yet given its guidelines by NICE – the National Institute for Health and Clinical Excellence. When Mr. Jago came to see me, he explained that a bed had been booked by his consultant in the local major hospital in Southampton for him to start receiving Velcade, only for it to be decided by a body called the District Prescribing Committee that it was not prepared to prescribe the drug for him. I thought that that was a strange state of affairs, because the drug was not being denied to him purely on cost grounds, but because there was insufficient evidence of its efficacy.
Considering that Mr. Jago was being treated by top consultants in Southampton, who are among the world's leading experts on that particular medication, I wondered how a committee of people who are not world experts in such medication can effectively countermand the advice of the consultants. One would have thought that the consultants would be in the best position to know. So I wrote to the Chief Executive of the Southampton Hospitals Trust to request that if the issue was money, the committee should say so. Then, at least, Mr. Jago would have the opportunity to borrow the £15,000 that he needs and perhaps get it back, perhaps not in this financial year but in some future financial year when the guidelines have been issued and the treatment is available.
To my surprise, I received a reply that stated that
"there were concerns about the complexity of the trial's statistical data, the lack of quality of life data, the relatively small clinical advantage seen over dexamethasone" –
the more conventional chemotherapy –
"and the relatively high cost of the medication".
With a little help, I did some research on the issue. I shall not bore the House with too many details, but in June 2003, the conclusions of the specialist journals were that
the clinical name for Velcade –
"a member of a new class of anticancer drugs, is active in patients with relapsed multiple myeloma that is refractory to conventional chemotherapy".
By September 2004, the journals were reporting that
"bortezomib provides a cost-effective treatment option and the best value (in terms of cost/life-yr gained) among the currently available therapeutic options for relapsed, refractory myeloma".
By June this year, the results of a major study concluded:
"Bortezomib is superior to high-dose dexomethasone for the treatment of patients with multiple myeloma who have had a relapse after one to three previous therapies".
An editorial in the leading journal, The New England Journal of Medicine, stated that the take-home message of the trials was that
"bortezomib is an effective therapy against relapsed myeloma: a fact to which anyone who has used the drug can attest. It is a much-needed additional tool against this devastating disease".
Why is it then that a District Prescribing Committee in a regional health authority thinks that it knows better? I think that it has something to do with the fact that the Government have repeatedly stated that the absence of NICE guidelines for Velcade should not be taken as a sufficient reason not to prescribe it. Therefore, the committee has had to cobble together some pseudo-medical guff as an explanation for refusing to prescribe it. Once the guidance comes in, the committee will be in a very difficult position if it wishes to prescribe that drug.
There are a number of anomalies. If Brian Jago lived in Scotland or Wales he would be able to receive that treatment purely on the say-so of his consultant. There would be no question of a committee of that sort standing in his way. The advice I have had to give him is to live in another part of the country for a time, get himself registered with the NHS locally and try his luck to see whether that will save his life.
Another aspect of the contradictions in the situation is that the treatment that the consultant is being prevented from prescribing – on grounds of cost, I am sure – is less expensive than giving Mr. Jago another bone marrow transplant, which the consultant could do on his own authority and which would cost about £10,000 more than the £15,000 for Velcade.
Finally, although I do not want to cast aspersions on people or groups in the community who suffer from any disease, it is a fact that if someone were in the country illegally and were horribly stricken with AIDS, the medication that he would be given – given – by the same hospital trust would be more expensive than the medication that my constituent, who has paid into the NHS all his life, is being denied.
There is something terribly wrong with that situation. It may be put right in about six months' time when the guidance comes through, but that may be too late for Brian Jago. Although we are busy wishing ourselves a Merry Christmas, it will not be a very Merry Christmas for him and people in a similar situation.
[POSTSCRIPT: In January 2006, it was announced that the NHS would, after all, fund Mr. Jago's Velcade treatment.]