Editor's blog Friday 21 May 2010: Cancer drugs, ASDA, faith and markets
This press release from Wal-Mart subsidiary Asda catches the eye, for several reasons.
The concept of cancer provokes fear that is both wholly rational (the thought of our own bodies' cells trying to kill us) and can lead to irrationality. Perhaps it is a sign of an age without religious faith that cancer - practically a pseudonym for death, rather than the long-term condition it will one day be - has acquired doctrinal status within the church of healthcare.
The Conservative policy of creating a National Cancer Fund (with money from what the NHS would have spent on the cancelled employer part of the coming NI increase) made it into the coalition policy.
The cancer syllogism
It doesn't seem to matter how expensive cancer drugs are, or how ineffective.
They are cancer drugs.
Cancer is A Bad Thing.
Therefore the NHS must fund them.
Evidence-based policymaking, anyone?
An end to NICE?
This policy does make you wonder why NICE is there, as I've said (also here).
Even after the Richards review's recommendations on raising rarer cancer cost-effectiveness thresholds and permission of topping-up were accepted, access to cancer drugs remains an issue.
Decentralised decisions about what the Cancer Drugs Fund should reimburse?
This is also a potential challenge to the notions of greater decentralisation of power puffed in yesterday's document.
If the choice of funding is truly decentralised down to individual practices, or even individual GPs, there will be variation - which the public, manufacturers and idiot-produced media will not find acceptable in a national service. If it is made by LMCs, or PCT medical directors, the same will be true.
Asda and Wal-Mart are, we should remember, red-in-tooth-and-claw capitalists who believe in competition and profit.
They have done a public service by reminding us of the variation in retail prices made by pharmacists (their release states that their price for "Iressa, used to treat lung cancer, is now available for £2,167.71 compared to £2,601.25 at Lloyds Pharmacy, £3,251.57 at Boots and £3,253.56 at Superdrug". This is useful information.
Timing and motivation
The reasons stated in their press release are noble and philanthropic ones. The question of timing does arise, though, published as it was yesterday, on the day of the Coalition Agreement.
And thus the issue of motivation rears its head. It can be seen as unclear why Asda are making this "commitment to sell all privately prescribed cancer treatment drugs on a permanent ‘not for profit’ basis", on the day when the new Cancer Drug Fund policy suggests that the NHS will fund practically any cancer drug.
One possible reason is that Asda are well aware of this policy, and the story will provide them with a positive corporate image. There will be very few private prescriptions for cancer drugs in future.
Another is that they might be raising a sceptical corporate eyebrow at the Cancer Drug Fund policy's likely effectiveness - and that this may be about getting some pharmaceutical market share.