Thursday, January 22, 2015

Before you sign the CDF petition...



I love a good petition, me; equal marriage, women's rights, end of life care, I'm all over issues like that and usually first in line to add my name to the cyber-voice but as I get numerous requests from Facebook friend and Twitter chums to sign a petition protesting against cuts to the UK Cancer Drugs Fund (CDF) I'm afraid that I must decline. I do not intend to get into a justification regarding my non-participation, instead I would ask that you, dear reader, just consider the following points before you decide to sign the petition or not.


  1. The CDF was created to meet a political agenda not a clinical need. The lobbying power of big pharma companies and the ideological stance of the coalition government translated into what Professor Peter Clark (an oncologist who runs the CDF) refers to as a way of exploits the special willingness to pay for cancer drugs (http://www.bbc.co.uk/news/health-30834543)
  2. In the UK NICE take responsibility for assessing both the clinical and cost effectiveness of medications and treatments. Despite the image portrayed by certain sections of the media, a NICE meeting does not consist of a group of uncaring people seated around a table dismissing treatments by simply saying saying' this is too expensive'. On the contrary, NICE committees are made up of experienceclinicians, academics and lay people and they scrutinise all submissions very carefully. Often, the weaker the submission the  harder the committee tries to find evidence to support funding the treatment. Believe or not, the people of a NICE committee do not have 'No' as their default setting.  However, the cancer drugs fund will consider funding any treatment that is too new or too expensive to obtain NICE approval. What has this done to the pricing regime of the pharmaceutical industry? What has this done to NICE?
  3. There is clearly an underlying attitude that providing extra time for people who are dying is a societally acceptable, and this cannot easily be contested as a bad thing. However this begs the question; why only people dying of cancer? Why are people dying of AIDs or MS or any other number of terminal illness not equally worthy of preservation? It would be cynical in the extreme, perhaps, to point out that generally cancer is a disease of old age and older people are the ones likely to vote.
  4. There is no bottomless pot of money here, if we continue to support he CDF, what services do we reduce or close? IVF clinics? Dementia centres? Drug and alcohol services? The  money must come from somewhere. Helen Crump, in her recent blog on this subject his highlighted that we have no information about which services have already suffered through the development of the CDF and this is an important issue in these increasing squeezed times
  5. There are increasing concerns regarding the relationship between charities and big pharma. Some are open about this relationship see here, for example but others may be less transparent, this has been discussed by  GP Margaret McCartney and further highlighted by blogger Dick Puddlecote here. Once this relationship is considered it make the lobbying of charities a little harder to countenance.
Cancer is a terrible disease and one that most of us fear, if we are honest, and initially this makes protecting the Cancer Drugs Fund a no-brainer when we are asked to sign the petition because who would want to deny treatment to dying cancer patient.  What I hope this blog post will do is make people think about the consequences of continuing to support this black hole of funding which overspent by 30.5 million pounds in the last financial year, or at least google it to get both sides of the argument before they make up their mind whether to sign or not. 


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