Elderly to be denied new drug treatments

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I find it interesting that big pharma's advertising bill is billions more than its research bill.

I think with the arrival of GP commissioning boards there could be a much bigger postcode lottery in future than we have ever had in the past.
I suppose part of the issue with making these difficult decisions is not "can this treatment cure this cancer" but to take into account all the other medical conditions that a person has and how they will be affected by possible treatments.
Governments and charities play their part by funding the fundamental research that provides the platform for new treatments. Sometimes discoveries get taken up by small biotech companies but often they do not have the financial backing to get their products to market (10 years isn) without any income - so big pharma plays a part in funding this long and very expensive process.

It's a pity that it is so often seen as NHS versus private, when the two systems could complement each other and sometimes do.
I have a friend who worked for many years as an NHS hospital manager, got out because of the politics and went to work for BUPA.
His BUPA hospital took referrals from the local NHS and charged the NHS less than what it cost the NHS to provide the surgery in-house. So the local NHS patients benefited from shorter waiting times than if the referral to the private sector hadn't been made.

I agree Jane that external factors come in between the doctor/patient relationship. I suppose I see NIHCE guidelines as an equalizer because without them I think there would be even more of a 'postcode' lottery than people appear to experience on the NHS.

The other moral maze question is the one about NHS vs pivate..does it release resources , limit them etc and is it morally right that patient A can have treatment because they have insurance or are rich over a more critical patient who is NHS or poor.

You are right penstemmon that it is a moral maze, and for all we are grateful for the NHS, it certainly produces ethical dilemma for doctors.
A doctor's primary relationship is with his or her patient and the over-riding duty of the doctor is to act in the patient's best interest.
But with the involvement of a third party ( the Government in the case of the NHS, insurance companies in the USA and increasingly here too) come all sorts of constraints. The interests of an individual patient who needsan expensive drug may be at odds with a general policy to restrict the use of that drug for financial reasons.
Wallygrom said that her doctor was unwilling to prescribe a particular drug, but it may well have been the PCT dictating policy, and in turn being dictated to by the Department of Health.

I am going to try and get to a local talk about stem cell research..it's a local science group.

At the moment they are tending to use stem cell transplants with younger myeloma patients. They prefer you you be under 70 or even 65. Mainly I think because it is a very debilitating process and paradoxically you need to be pretty fit to undergo it. It is also not a cure, it only slows the progress of the disease, so the jury is still out on whether it is worth doing at all. There is some very exciting stem cell research out there though and it may not be many years before we have a cure. In that case, although the treatment might be very expensive it will probably be cheaper than keeping some one alive for years on chemo.

So many 'moral maze' issues with health/medicines/drug companies/doctors/NHS vs private etc etc.

If there is £10 to spend on medicine and 10 children can have protection against malaria or one adult (no dependents) can have treatment that might extend life by a year what choice would you make??

If the decision not to provide treatment/drugs to someone is clinically based, then that seems perfectly reasonable. Someone with multiple serious conditions would probably not benefit from an expensive (or not expensive) treatment of a new condition, for example, regardless of age. If the refusal to treat a condition were to be a blanket ban on everyone over, say, 80, that would be unethical and completely wrong. If the latter were the case, it would be laughable hypocrisy coming from the powers that be who so oppose voluntary euthanasia.

it seems your case is not what I had in mind as your husband had remission after chemo. Some people don't and go on and on.
The research with stem cells is the way forward. Whether it will be for people my age I don't know.

If it all comes down to economics, politics and pharmaceutical profits whether older people receive treatment, I assume that mentally and physically disabled will also be included? And who decides the boundaries?

Pharmaceutical companies research only those drugs that can be expected to turn a profit. It means there is very little research into the illnesses of poverty or uncommon medical conditions.

So lots of research into heart disease and diabetes, little into Water blindness and cholera.

Ooh that's a can of worms Penstemmon, maybe we shouldn't go there!
Who pays for R&D into new drugs? The drug companies, mostly.
I don't have a problem with them making a profit, particularly if this can then be used to support more research.
What is worse is not sharing information from trials, but thanks to Dr Ben Goldacre's All Trials Campaign, things are slowly changing for the better.

Wallygrom Re your Gp, that is dreadful!

The argument is not just about NIHCE's recommendations to the medical profession about the match between efficacy of drugs and cost effectiveness but the bigger moral argument about drug companies holding patents on life saving drugs.

So, all the grans who look after their grandchildren so their parents can work are NOT useful to society?

anno your statement
* Evidently the members of NIHCE who make these decisions have not had to avail themselves of the help freely given by so many grandparents.*

is not the case. My DD1 took maternity leave from her senior post in NIHCE and I looked after my DGS1!

I listened to Andrew Dillon on R4 and he was clear that there was no specific age criteria.

From experience (and I am not retired, am working full time, grandmother to 4) and I work with older people on a daily basis as what used to known as a 'warden' in a sheltered housing scheme.....many older people are denied treatment due to cost alone.

Personally I have had to fight with my GP to get a controlled drug which prevents me from getting infections as my body is unable to produce adequate white blood cells which do the job naturally. I am only 55. I know other people with the same condition across the UK and have researched how they managed to come by the drug which is life saving as without the ability to fight certain infections sepsis could set in. It certainly seems to be a postcode lottery. My own GP said she wasnt prepared to pay for the drug as its expensive and therefore will not write me out a prescription - I bypass this by going to my local hospital and they have agreed to continue to treat me for the rest of my life but are not amused with my GP's attitude. Her reason for her decision? I am too costly and for the cost of my treatment she can treat 10 other people! I must emphasis that prior to taking this medication I had 11 lots of antibiotics in 5 months to help fight infection - since the new drug, I have had none! I think this is self explanatory really - better quality of life and reduction of visits to GP and less cost in the long term to the NHS!

"The quality of life decreases with age". That is a very broad statement. At 92 my father was still driving considerable distances, on the committee of three local organisations and living alone and independently. Yes, his joints were a bit stiff and he had angina, which was controlled by medication so his quality of life to that extent had decreased but when his angina suddenly worsened the specialist referred him immediately for experimental key hole surgery to replace his aortic valve because, he said, my father was in such good health otherwise, both physically and mentally, that the operation could give him another 5 years of active life. He didn't have operation because he picked up an infection and by the time that cleared his condition had deteriorated too far.

On the other hand when asked to draw up an end of life statement for an elderly relative in his 80s with dementia, after consultation around the family, we decided that we did not want him receiving invasive treatment for any illnesses because we felt it would cause too much distress and to little purpose to someone whose health was deteriorating on several fronts. This decision undoubtedly shortened his life as he developed a potentially treatable cancer.

Of course we all have to die sooner or later but quality of life is a qualitative judgement and affects different people in different ways and if a medical treatment will give someone an extension of life that they and their families can enjoy I think they should receive it.

What a gruelling regime that sounds, Deeda. You and your DH have my sympathy, although it's good that your GP is so positive!

It rather depends on the cancer MargaretX My DH has Multiple Myeloma, which is basically incurable. The protocol is therefore to gain remission through chemotherapy, changing the drugs used as they become ineffective. Over the last three and a half years he has had 4 month's chemo followed by a stem cell transplant and after two and a half year's remission he has relapsed and started on a different drug combination. The new drug he is taking is frighteningly expensive, but the consultant had no hesitation in requesting it because he considered it to be the most suitable. The treatment for myeloma is to have as many courses of chemo as it takes to keep it under control. Some people have survived for many years with combinations of different drugs and transplants. There is certainly no set limit for the amount of chemo you should have and so far no one has quibbled about DH being over 65.
Our GP has a simple rule when prescribing. He says "There is an expensive drug or a cheap alternative that isn't as good - which one do you think the Prime Minister would have?"

Courses of treatment with gaps in between I believe ana though this is not first hand. Certainly went on a long time.
And this guideline is only for new fancy drugs like the Lucentis. Monoclonal antibodies are very clever specific targeted antibodies, each one the result of many years of careful research. Typical of the new wave of drug treatments.
Probably the money should be going to look for new antibiotics because antibiotic resistant bacteria are going to start killing off significant numbers of people one of these decades. If alternatives are not found we may see life expectancy rises go into reverse.

MargaretX makes a good point about the quality, rather than just the quantity of life any of us can hope for. I also agree with Flick and Nellie about liver transplants in relation to age, general health and alcohol dependence

courses of treatment say over 8 - 12 weeks. Chemo is to prevent the cancer from spreading or that the cancer goes inot remission, and most doctors would admit that if two courses of treatment have not prevented new cancers forming, then there is no reason to suffer a third or fourth, completely ruining the immune system.
A terrible decision I have to admit.
I know several doctors, in the family and at bridge club and they just shake their heads when they hear of people starting a third or a fourth course of chemo. One died of cancer and refused chemo altogether.