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Pharma's woes: profits, policies and patients Pharma's woes: profits, policies and patients as NHS England tries to save money on drugs
(35 minutes later)
It’s not a great day to take the heat off Jeremy Hunt, just as he’s trying to force the endgame in his dispute with the not-so-junior doctors. As with most industrial disputes neither side has a monopoly of virtue, so let’s skip to another corner of the galactic health empire over which Emperor Jeremy and his Darth Vader, Simon Stevens, rule. What, on planet Earth, is Pfizer up to?It’s not a great day to take the heat off Jeremy Hunt, just as he’s trying to force the endgame in his dispute with the not-so-junior doctors. As with most industrial disputes neither side has a monopoly of virtue, so let’s skip to another corner of the galactic health empire over which Emperor Jeremy and his Darth Vader, Simon Stevens, rule. What, on planet Earth, is Pfizer up to?
You may have read the US pharmaceutical firm’s complaints about NHS England’s drugs policy – we’d be better off getting cancer in Scotland or even Greece, says its UK boss – in Thursday’s Telegraph or on Radio 4’s Today. But it was all in the Guardian last week, part of the paper’s epic This is the NHS series.You may have read the US pharmaceutical firm’s complaints about NHS England’s drugs policy – we’d be better off getting cancer in Scotland or even Greece, says its UK boss – in Thursday’s Telegraph or on Radio 4’s Today. But it was all in the Guardian last week, part of the paper’s epic This is the NHS series.
What Pfizer’s Eric Nordkamp is telling anyone who listens is that the widely admired National Institute for Health and Care Excellence (Nice), the independent assessor of new drugs’ clinical and financial value, has fallen behind international rivals, and behind NHS Scotland’s Scottish Medicines Consortium (SMC) too, in the way it goes about its business. Patients are suffering, he says. Pifizer is suffering too, he fails to add.What Pfizer’s Eric Nordkamp is telling anyone who listens is that the widely admired National Institute for Health and Care Excellence (Nice), the independent assessor of new drugs’ clinical and financial value, has fallen behind international rivals, and behind NHS Scotland’s Scottish Medicines Consortium (SMC) too, in the way it goes about its business. Patients are suffering, he says. Pifizer is suffering too, he fails to add.
This one is tricky, but even those anxiously scouring websites for medicines which may cure loved ones, prolong lives or just alleviate pain, should be wary of special pleading by “Big Pharma” (the largest players in the pharmaceutical world). They have troubles of their own, and rapacious shareholders demanding blood as they grapple with an uncertain future.This one is tricky, but even those anxiously scouring websites for medicines which may cure loved ones, prolong lives or just alleviate pain, should be wary of special pleading by “Big Pharma” (the largest players in the pharmaceutical world). They have troubles of their own, and rapacious shareholders demanding blood as they grapple with an uncertain future.
With so many industries going belly up or abroad, health is a fast expanding market with an endless supply of eager customers in countries rich and poor around the world. With so many industries going belly up or abroad, health is a fast-expanding market with an endless supply of eager customers in countries rich and poor around the world.
The Guardian’s NHS series addresses the pros and cons of a growing presence in the UK’s unusually state-dominated sector. The business pages of the FT are rarely without a report on a merger or takeover, hunts for new drugs to replace the postwar generation of brilliant (and lucrative) lifesavers which are rapidly falling out of patent protection. They have invested billions, but it’s tough going.The Guardian’s NHS series addresses the pros and cons of a growing presence in the UK’s unusually state-dominated sector. The business pages of the FT are rarely without a report on a merger or takeover, hunts for new drugs to replace the postwar generation of brilliant (and lucrative) lifesavers which are rapidly falling out of patent protection. They have invested billions, but it’s tough going.
That’s where you probably last heard of Pfizer. When you can’t find a useful product then use some financial engineering to beef up profits.That’s where you probably last heard of Pfizer. When you can’t find a useful product then use some financial engineering to beef up profits.
Pfizer, which has shrunk (not yet closed) its huge research campus at Sandwich, in Kent – gratitude for discovering Viagra, it is said – made a $100bn bid for the UK’s AstraZeneca. The idea was to soak up some global profits it was keen to keep abroad, out of the hands of the US taxman.Pfizer, which has shrunk (not yet closed) its huge research campus at Sandwich, in Kent – gratitude for discovering Viagra, it is said – made a $100bn bid for the UK’s AstraZeneca. The idea was to soak up some global profits it was keen to keep abroad, out of the hands of the US taxman.
Pfizer got seen off and has since continued with acquisitions and mergers elsewhere, the latest being Allergan. Yesterday the FT reported fears that Pfizer would now accentuate its move towards an Allergan-plus style strategy (common in risk averse boardrooms everywhere) of cutting down on its own famous inhouse research and buying smaller firms or university teams’ smart ideas. Cheaper and more effective, says Allergan’s CEO, Brent Saunders, who seems to be in line to head up Pfizer in due course. Pfizer got seen off and has since continued with acquisitions and mergers elsewhere, the latest being Allergan. On Tuesday, the FT reported fears that Pfizer would now accentuate its move towards an Allergan-plus style strategy (common in risk-averse boardrooms everywhere) of cutting down on its famous inhouse research and buying smaller firms or university teams’ smart ideas. Cheaper and more effective, says Allergan’s CEO, Brent Saunders, who seems to be in line to head up Pfizer in due course.
Not our problem or that of the NHS. Our problem is sick people and the best, most humane and cost-effective, way to treat them. Here Nice stands as a barrier between drugs sellers and patients, sometimes to the dismay of the latter’s relatives. It takes its time to evaluate a new product, it sometimes says no and even de-lists a drug that does not do what it promised on the tin. It is upsetting for patients and any newspaper allies for whom cancer is a bogeyword used just to frighten readers and enlist sympathy. Not our problem or that of the NHS. Our problem is sick people and the best, most humane and cost-effective way to treat them. Here Nice stands as a barrier between drugs sellers and patients, sometimes to the dismay of the latter’s relatives. It takes its time to evaluate a new product, it sometimes says no and even de-lists a drug that does not do what it promised on the tin. It is upsetting for patients and any newspaper allies for whom cancer is a bogeyword used just to frighten readers and enlist sympathy.
Deeming NICE’s lengthy procedures intolerable, in 2011 Andrew Lansley, then an NHS “reformer”, introduced the £200m Cancer Drugs Fund (CDF) to placate them both. But it rapidly overspent, prompting NHS England, led by Stevens, to play its own Nice role. It de-listed some cancer treatments, including the £90,000-a-year Kadcyla, as the Guardian’s Sarah Boseley reported. Its future is uncertain. Deeming Nice’s lengthy procedures intolerable, in 2011 Andrew Lansley, then an NHS “reformer”, introduced the £200m Cancer Drugs Fund (CDF) to placate them both. But it rapidly overspent, prompting NHS England, led by Stevens, to play its own Nice role. It de-listed some cancer treatments, including the £90,000-a-year Kadcyla, as the Guardian’s Sarah Boseley reported. Its future is uncertain.
Ministers, who are scrambling to save money, imposed a two-year freeze on the £12bn annual drugs budget (2014-16), adding to pharma woes. It has also acknowledged that the Nice procedures may not have kept up with best practice in a fast-changing medical world. It is just completing a consultation and hopes to introduce greater flexibility whereby temporary access to new drugs could be granted while Nice makes up its mind either way.Ministers, who are scrambling to save money, imposed a two-year freeze on the £12bn annual drugs budget (2014-16), adding to pharma woes. It has also acknowledged that the Nice procedures may not have kept up with best practice in a fast-changing medical world. It is just completing a consultation and hopes to introduce greater flexibility whereby temporary access to new drugs could be granted while Nice makes up its mind either way.
That’s not enough for Nordkamp, who fears a wasted opportunity, one in which the bigger picture – including patient involvement and fast development of drugs designed for small groups of specific cancers not one-size blockbusters – are better taken into account.That’s not enough for Nordkamp, who fears a wasted opportunity, one in which the bigger picture – including patient involvement and fast development of drugs designed for small groups of specific cancers not one-size blockbusters – are better taken into account.
Scotland does it better, he says, so do other EU states, including Greece, though as Boseley and Graham Ruddick point out in their Guardian article the Greek decision to make paramount the saving of life – do what you can, or the “rule of rescue” principle – helped bankrupt the social insurance fund which paid for them. So it’s private cash upfront for many Greeks in the current economic crisis.Scotland does it better, he says, so do other EU states, including Greece, though as Boseley and Graham Ruddick point out in their Guardian article the Greek decision to make paramount the saving of life – do what you can, or the “rule of rescue” principle – helped bankrupt the social insurance fund which paid for them. So it’s private cash upfront for many Greeks in the current economic crisis.
The unavoidable fact is that, however we choose to fund health care, the drugs bill continues to rise, and much of the money is wasted; perhaps because patients don’t need or discontinue the penicillin the GP shoudn’t have given them in the first place. Or, as so many reports confirm, some wonder drugs, especially where the c-word is invoked, do not do the job. The unavoidable fact is that, however we choose to fund health care, the drugs bill continues to rise, and much of the money is wasted; perhaps because patients don’t need or discontinue the penicillin the GP shouldn’t have given them in the first place. Or, as so many reports confirm, some wonder drugs, especially where the c-word is invoked, do not do the job.
So even the SNP government in Edinburgh, which prides itself on doing better than NHS England has had its own cancer fund’s costs double. It has instituted its own review. So even the SNP government in Edinburgh, which prides itself on doing better than NHS England, has had its own cancer fund’s costs double. It has instituted its own review.
Good, we can all learn from each other. Here’s a perfectly sensible contribution to the debate from Cancer Research UK.Good, we can all learn from each other. Here’s a perfectly sensible contribution to the debate from Cancer Research UK.
But remember, a large-scale NHS problem, its poor cancer outcomes, is to do with slow diagnosis further back the medical food chain. And, one £90,000 cancer drug that prolongs a life for six months is £90k not spent somewhere else in the NHS. It’s a lot of money and I’m not convinced that it or other very costly treatments should always be invested in the elderly, among whom I grudgingly include myself. As the Guardian’s NHS series has said in many ways the medicalisation of death has led to most of us dying in hospital when perhaps we want to die at home, the way people once did. But remember, a large-scale NHS problem, its poor cancer outcomes, is to do with slow diagnosis further back the medical food chain. And one £90,000 cancer drug that prolongs a life for six months is £90k not spent somewhere else in the NHS. It’s a lot of money and I’m not convinced that it or other very costly treatments should always be invested in the elderly, among whom I grudgingly include myself. As the Guardian’s NHS series has said in many ways, the medicalisation of death has led to most of us dying in hospital when perhaps we want to die at home, the way people once did.
It is partly our fault, in a society which often treats the death taboo as unrealistically as the Victorians treated sex, where also doctors are promising more than they, or Jeremy Hunt’s budget, can deliver. “Big Pharma” is also in the frame; in the 20th century it did once unimaginable wonders for humanity. But we can have too much of a good thing – even when we can’t afford it. It’s a curse of our materialistic age.It is partly our fault, in a society which often treats the death taboo as unrealistically as the Victorians treated sex, where also doctors are promising more than they, or Jeremy Hunt’s budget, can deliver. “Big Pharma” is also in the frame; in the 20th century it did once unimaginable wonders for humanity. But we can have too much of a good thing – even when we can’t afford it. It’s a curse of our materialistic age.