Three cheers for Peter Wise! Finally someone is calling for better consent/education processes and better ethical treatment.
Considerable amount of money is spent on cancer.
There has been considerable investment and innovation in creating new cancer drugs that have been approved in the past 10 years. It has been found that these drugs have had little effect on the survival in adults with cancer, which is raising a number of concerns, according to an expert in the British Journal of Medicine. A former consultant at Charing Cross Hospital in London, Peter Wise, says that spending an annual six figure sum to prolong life by a few weeks or months might be inappropriate for many patients. The global sales of cancer drugs in 2015 were around $110 billion. He is calling for stricter drug approval criteria and improved consent processes to achieve the ethical treatment and reduce cancer costs.
Peter Wise is concerned as to just how much the cancer survival can be attributed to new drugs. There are other factors that are actually more likely to have been responsible for this survival rate. Couldn’t a lot of this be from alternative methods? From many of the new drugs that have been approved in the last decade, life has just been prolonged by only one to two months. And at what cost and discomfort has this been to the patient?
Ethical questions concerning approval of cancer drugs.
Certain ethical questions are raised with the approval of drugs with such small survival benefits, including whether the recipients are aware of the drugs’ limited benefits, if the high cost/benefit ratios are justified and if the trials are providing the right information. Peter Wise’s major interest lies in the ethical elements of medical research
and care. Limitation of cancer drug trials, such as the use of surrogate endpoints that allow earlier approval of new drugs, but are not always true indicators of survival benefit, should be considered and looked at. The recent integration of the Cancer Drugs Fund into the National Institute of Health and Care Excellence (NICA) in England might make it possible to monitor the real world benefit of these drugs.
There is also concern over the US Food and Drug Administration’s (FDA’s) accelerated and breakthrough category that compounds the risk of premature approval on limited evidence. This low bar of approval for expensive drugs ignores the ethical principle of fairness and equity. He writes, “By promoting marginally better treatment of poorly responsive cancers it diverts valuable resources that might be better employed for other health needs, within and outside cancer care.”
Lack of fully informed cancer consents.
There is a lack of fully informed consent for cancer treatment and this is a concern, quite often leading to misinformed patients with unrealistic expectations.
Patients should be able to demand good cancer care with accurate, impartial information followed by genuinely informed consent in both the clinical trial and the therapeutic settings. All of the ethical portions of patients consenting for these drugs should be addressed and corrected.
Most importantly, the threshold for approval of new and existing cancer drugs needs to be raised, using more meaningful disease specific criteria of risk-benefit and cost-benefit.
We are so up-side down on the cancer care/treatment that it has got to start getting fixed some way. Maybe just starting at being honest about the treatment would be a good place to start. Thanks Peter Wise for trying.
–Dr Fredda Branyon