The concept of free, socialised healthcare at the point of source is something that most people in the United Kingdom take for granted. Since 1948, the National Health Service has been providing care of an almost bewildering range to those who live on this little island off the west coast of Europe, and it has been said by many that this very concept is the greatest gift that Britain has given the world. In the twenty-first century, however, it has come to feel as if the NHS is under attack. Persistent rumours that the full privatisation of the service is imminent have refused to die, and stories such as the crisis at the Mid-Staffordshire NHS Foundation trust have only added fuel to fires created by some with ideological or financial (or, of course, both) interests in the dismantling of this most august of institutions. The NHS isn’t perfect, but it’s worth saving. Many of us don’t even realise how much we’d miss it if it wasn’t there any more.
Under increasingly tight financial constraints, the NHS is not always able to offer all of the treatments that it may wish to. In the case of cancer, a baffling array of different of treatments are available for those fighting the many forms of this disease, and their effectiveness spans a broad spectrum, from offering cures to acting as palliatives for those amongst us who have fought a losing battle against it. The NHS spends £1.3bn per year on the routine commissioning of cancer drugs, and this money has to be spent as effectively as it can be. Since 2013, this has been administered through by NHS England through the Cancer Drugs Fund but when drugs are withdrawn from the CDF, the results can be devastating.
Introduced in 2012 by the German pharmaceutical giant Bayer AG, Regorafenib (which is known in the United States of America under the somewhat less unwieldly brand name of Stivarga) is a drug used in the treatment of gastrointestinal stromal tumors (GIST cancer), a thankfully rare – around 900 per cases are diagnosed per year in the United Kingdom – form of gastric cancer. Regorafenib is, however, expensive. Treatment for a four-week cycle of it costs a staggering £4,493 and despite its proven efficacy, the CDF last month concluded that this is too high a price to pay for the results that they were getting from Regorafenib. Of course, the problem with all of this is that the numbers can only ever make up a part of the story behind the usefulness or otherwise of any particular drug, and the personal stories that make up much of the rest of this story can be heartbreaking.
Jemma Mitchell is thirty-one years old, lives in West Sussex in England, and was diagnosed with GIST cancer while she was expecting her second child. After ten blood transfusions and a three day long stay in a high dependency unit at hospital she pulled through, but this cancer has returned, and in its “wild” form, this time Jemma cannot win this fight. A combination of three drugs, however, of which Regorafenib is one, gave her a chance of extending her remaining time with her family. Now that has been taken away, with NHS England stating that the drug “represented insufficient value.” In a world in thrall to that most nebulous of concepts, The Market, everything has a price these days and Jemma’s chances of extending her life thanks to this drug seems to have one that the health service deems too high to be able to support.
Where does the blame with this awful state of affairs rest? We might choose to blame NHS England for such rationing or the government for insisting on £20bn worth of cost-cutting, a decision the tentacles of which have spread into many areas of the service’s budget. We may choose to lay the blame at the door of a society that puts a cash value on just about everything it can. We may choose to blame the big pharmaceutical companies, who justify their price-tags on the basis of research and development costs when there is evidence that, at least in the United States of America, these companies spend far more on advertising their products than on any R&D (although we should point out that this isn’t an accusation being made specifically against Bayer), a subject that was skilfully dissected by John Oliver on Last Week Tonight in the first episode of that programme’s new series on Sunday.
None of this blame-apportioning helps Jemma, of course, and neither does it help her two young children, neither of whom are currently aware of the full extent of their mother’s illness. And this, perhaps, is the crux of the matter. Regardless of whose responsibility this dreadful situation ultimately rests with, we expect healthcare that will do everything that it can in order to save our lives if they are in danger, or to attempt to prolong them, even if the ultimate prognoses are inevitable. If the NHS is to become one of the key battlegrounds of the next general election, then this battle has to fault at a human level rather than under the cold, calculating gaze of spreadsheets full of numbers. And let people aware of the fact that no less than seventy of their current elected representatives (along with scores of past representatives) – including some very familiar names – have links to or interest in private healthcare companies.
Where lives are endangered or likely to be shortened, all concerned should be reminded in the strongest possible terms that human and happiness should not be treated as commodities, and that behind each over-inflated pharmaceutical price tag, each budgeting decision and each decision to hack away at the NHS’s budget are people’s lives, parents and children, many of whom are already buckling under the strain of the worst that the human condition can throw at them. Where those lives can be saved, lengthened or made more tolerable, money should not be an object. Jemma Mitchell, and thousands of others who are blighted by an entire culture that sometimes seems to treat numbers on a spreadsheet as being more important than them, deserve better.
You can find out more about GIST by clicking here.
You can sign a petition calling on the government to reintroduce Regorafenib by clicking here.
You can follow Jemma on Twitter by clicking here.
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