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Scottish Parliament Speech: Cancer Drug Access (October 2008)

See this speech in context on They Work For You.

We are here today because of a tragedy - the illness and death by cancer of Michael Gray - and his wife's petition, which was founded on that experience. The issue is an emotional one for me because three and a half years ago my wife, Virginia, was diagnosed with an unusual cancer that had developed between regular scans.

It had moved to the liver and become inoperable. I still live out the time that was left to us and those days - there were only days - from the first consultations to the final diagnosis. I remember the kindness of nurses and doctors in the last weeks of the old Middlesex hospital, my wife's courage and composure, and the days of waiting at her bedside for death to come.

It is impossible not to feel for anyone who is facing such a situation, and to hope for some treatment that might reverse symptoms or at least prolong life. For those who know that they have only a short time, even that can be important. Anything that might enable the good death - arranging one's estate, providing for family, seeing projects through - is grasped. Surviving, at 64, I am in a minority among my friends, as many of them have died from cancer.

This issue concerns second opinions and alternatives. I telephoned my friend, Professor Theo Lippert, of the University hospital of Tübingen, who is a gynaecologist and pharmacologist. He delivered my daughter more than 26 years ago. He also lost his Scottish wife, Dr Elsie Lippert, to cancer. His view partly endorses the flexibility of the approach that is being urged in Tina McGeever's petition, which is to provide a framework for making cancer-treatment drugs available in medically justified cases to the relatively few who apply - the recent BBC availability study counted only 30 applications in Scotland in the past year - and making sure that the postcode lottery does not determine who can or cannot have access to drugs or other treatment. I agree with both aims.

Second opinions are important, and should not be sidelined due to cost or administrative considerations. However, the subject is opaque and drugs are not the only consideration. In a recent case, a constituent of mine was offered for prostate cancer a hormone treatment that would have extended his life for two to three years, but with a poor prognosis. He opted for surgery, which was not covered by the NHS. It was successful, but he had to negotiate it for himself, and became liable for the full costs. That is where we require flexibility, which is not necessarily limited to exceptional prescribing.

My Tübingen colleague, Professor Lippert, is sceptical of the treatments that rely on drugs alone and do not take an holistic view of the patient's past health and treatments, nutrition, nursing and other therapies. In general he - as I do - approves of a system of licensing and issuing of guidelines such as we have in Scotland through NICE, the SMC and NHS QIS. He is sceptical about the German experience and believes that of the roughly 1,000 well-marketed and often expensive cancer remedies on the market, only about 20 per cent benefit the patients. He believes that clinicians must concern themselves with factors such as nutrition, scanning and previous illnesses and treatments, and must work closely with pharmacologists, nursing experts and specialists, who have sometimes tended to remain marginal to the clinical process. He also insists that too much emphasis is placed on average rates of survival, rather than on concentrating on the particular situations of individual patients.

That approach - focusing on the individual patient in a more holistic view - is one aspect, but it must be viewed in the light of an Office of Fair Trading report that was published in February 2007, which accused the pharmaceutical industry of deriving £8 billion of excess profits from the national health service. I ask whether other medical approaches that do not involve expenditure on drugs, and other essential infrastructures, have advocates that are as persuasive and as well-heeled as the big pharmaceutical companies. As in so many other fields, equitability must lead to a stronger public presence.

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