Should NICE or the Daily Mail decide on cancer drugs funding?

27 August 2010

The question is raised again as to whether populist decisions made by politicians (who will inevitably have an eye to the electorate's fickle feelings and the headline writers of the Daily Mail) are the best people to prioritise and allocate funds, funds which will never be sufficient to satisfy all demands.

The figures speak for themselves--a drug which may prolong a life for literally a few weeks, or the salary of a specialist nurse for a year. Of course we could prefer not to have to choose, but we do. NICE appraisal seems the least worst way of doing it. Replacing NICE won't create the extra resources needed to give everyone everything they want, people like Karol Sikora must know this.

The last Prime Minister but one, Anthony Blair, made breast cancer a priority saying that his mother had suffered from it. Now David Cameron has been elected Prime Minister-by the skin of his teeth-after, amongst other things, promising to make cancer drugs available to all. Very Santa Claus of him, but I prefer to trust the impartial and systematic deliberations of NICE rather than the gut feelings of vote seekers informed by focus groups.

There are some promising but costly new drugs in the pipeline for metastatic melanoma, as we have heard on the national news again this week, no doubt the drug companies are doing their best to place the stories with the media. Of course I hope the drugs will work and be affordable, but decisions to fund them at the £30,000 for an extra 3 months of life level we are hearing about should be systematically and unemotionally weighed against the QUALYs that could be gained by earlier detection by training primary care workers better in diagnosis. And indeed against non cancer priorities.

We should remember Dennis Burkitt's tap turner-offers and floor wiper-uppers. The floor wipers are doing a great job, but it would do more good and be cheaper if someone turned off the tap. The floor wipers are feted and drive Rolls Royces, the tap turners are ignored and ride bicycles.

Competing interests: teacher of dermoscopy to GPs

Competing interests: None declared

Stephen F Hayes, GP, GPwSI dermatology

66A Porstmouth road, Woolston, Southampton, SO19 9AL

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