Would you buy one of these? Yervoy is a new cancer drug that improves survival time for those eligible from an average of 6 months to 10 months. It costs over $110,000 per person per year. Monday, 26th August and Four Corners will be examining this and other drugs that have led leading cancer specialists to state that modern oncology is costing too much for too little benefit.
Speaking personally, I am deeply concerned by clear scientific evidence demonstrating that many people with cancer are being over treated with drugs that have a very high price tag (including serious side-effects) and yet have only marginal benefits. Also, it would seem that many of these same people are either unaware, uninformed , or worse being dissuaded from genuine self-help options that could be helping them to live better and longer.
I believe there is need for urgent discussion at all levels on these issues. Changes in management and attitudes would seem warranted. I hope the Four Corners program may break the taboos that seem to have been in place for too long when it comes to open discussion around these issues.
So this week we go Out on a Limb, reflect on the facts and question what is happening and why. But first
Thought for the day
Vision with out action
Is merely daydreaming,
But vision with action
Can change the world.
What does this turn into? See below.
The magnolias are on!
Yervoy. If you pay your taxes, then you have already bought it.
This new cancer drug (which is not a new chemotherapy, but a more biologically elegant way of attacking cancer metabolically - which does make it something of a step forward) was recently added to the PBS – the Government’s free (to the patients) drug scheme. But all of us who pay taxes are helping to pay for it. Described by the Health Minister Tanya Plibersek as “a major breakthrough”, what wonders what small progress looks like? She also called Yervoy “an important treatment option for patients who are not well enough to tolerate further chemotherapy”.
And there is more to all this. It seems that one in five who take Yervoy live an extra 3 years, a good result for them. But statistically, if the drug only takes average survival from 6 months to 10 months, it seems certain those who survive longer must be offset by others who die quicker than average, and yes, the drug does have a raft of side-effects some of which have been proven to be lethal.
How much will we the taxpayers be paying for this new drug? Somewhere between 30 and 60 million dollars a year.
While all my sympathy goes to people eligible for this new drug and we can easily understand their enthusiasm, the question has to be asked. If a top ten list had been made of things that need extra funding in cancer medicine, where would Yervoy have appeared? If you had $60 million to spend on cancer, how would you allocate it? I would love to hear your response via the comments section below.
Then there is the question of what is influencing our decision makers, as well as the public to support the use of so much chemotherapy and other cancer drugs in current time?
Consider this. Back in 2004 it was shown that when 22 of the common cancer types (which included 90% of all cancers) were investigated in Australia, chemotherapy was shown to increase the average 5 year survival time by only 2.3%.
Amazingly, that study was published in 2004 and to my knowledge there has been no up-date. We do not know what the overall success rate for chemo is in current time. This seems a major oversight or error of omission.
Then we have the deeply disturbing evidence from the medical literature that the drug companies are heavily distorting cancer drug trials, and in the process, powerfully influencing the recommendations of doctors and creating unrealistic expectations in patients, families and whole communities.
For example, the literature makes it clear that drug company cancer drug trials are twice as likely to feature positive findings as independent trials. Even more disturbing, published drug company sponsored trials are twenty times less likely to record a negative finding as independent trials. Get a negative finding? Simple. Do not publish it. The result? Distort the overall results and give a falsely positive indication of benefit.
So this means that the 2.3% benefit attributed to chemotherapy in 2004 was highly likely to be inflated. The real effect on 5 year survival actually may have been a negative one.
But it is not just the researchers and the doctors who are being influenced. Women in Sydney already treated for breast cancer with surgery and chemotherapy were asked how much benefit they would need to gain to agree to have more chemotherapy.
Asked to imagine they had 5 years to live from the time of the survey, and offered to imagine another round of chemotherapy that would add just one day to that five years; how many women do you think would agree to take the extra chemo?
In fact, over 50% said they would. (Ref 5 below).
Some time back two women sat talking in a group I was leading. Both had been treated surgically for early breast cancer, both had 2 children under ten. Both said they had considered the evidence, had found that chemo could probably improve their chances of 5 year survival by around 4 to 4.5% and that the treatment would probably involve a series of side-effects.
Both said they had discussed their options widely, had thought about it a lot and wanted to do the best for themselves and their families.
One decided to have the chemo – fair enough; the other decided not to – again, in my opinion, far enough. Both made well informed, well considered choices and decided what they thought best for them and their personal circumstances.
The outcomes? Very different. The woman who accepted the chemo was well supported by her doctors, all the support systems of her hospital and the breast cancer networks. She was treated as something of a hero by her family and friends, courageously going through a tough treatment. She received full support.
The lady who declined chemo described a nightmare. Firstly her male doctor overlooked the fact that she was a highly competent businesswoman with intelligence and no neurotic pathology. He told her she was “being a naughty girl” and that “if you did not take the chemo you will be putting your life at risk and so unless you change your mind, I do not want to see you again”.
But while this woman received no help from her hospital, her biggest problem turned out to be from amongst her extended family and friends. They pressured her relentlessly to accept the treatment; constantly challenging her decision and questioning her lack of consideration for her children.
They overlooked the evidence that simply exercising most days would reduce their friend’s risk of dying twice as much as the chemo (and no-one knows as yet how chemo and exercise really interact). She had good support from her immediate family and was strong enough to persevere through all the difficulties, but what is going on?
What has got into the popular psyche that chemotherapy and the newer cancer drugs like Yervoy have become embraced so thoroughly by the medical profession and the public alike? Has our obsession with quick fix drugs reached a point where evidence and cost is overlooked and hope at any price is acceptable? Are we so scared of dying that we are seeking survival at any price?
I will be fascinated to watch the Four Corners program and see what they have made of it. And I would love to hear your own thoughts. Are you a health professional with a different view? Are you a patient faced with choices, or someone who has made choices with particular consequences? Are you a family member or friend who has shared in or observed someone dear to you making their own choices? How do you feel about all this? What are your thoughts?
At the very least, I am hoping the program will stimulate discussion, maybe even constructive debate on these topics which to date have felt surrounded by unspoken taboos. So do consider adding your voice to the feedback on the program, either on the ABC website, or in your own social media pages, or via the wider media. Maybe this is a good blog to share. Please do add to the comments section below. My sense is we are long overdue for lengthy discussion in this challenging area.
You Can Conquer Cancer – outlines what I do recommend for people with cancer – and how to do it!
The Gawler Cancer Program – the CD or MP3 download that features how cancer develops and how the body and mind can be activated to counteract it.
What to do when someone you love has cancer - the CD or MP3 download that features the combined feedback from thousands of families and friends of people with cancer. What to do, how to be most helpful, how to look after yourself while looking after someone else.
Cancer, lifestyle and chemotherapy. – a detailed and documented analysis of this area that I wrote in 2006.
The Cancer Council, the survivors and the book
Twenty years and what has changed?
1. Mt Macedon workshop next weekend
Saturday August 24th, 10am (arrive 9.30) to 4.30pm
Duneira is an exquisite heritage hill station property on the slopes of Mt Macedon. The garden is like a meditative space, so beautiful and filled with majestic trees. I love being there!
Then the house itself is grand enough to host good sized but still quite intimate events. There is a tradition now at Duneira of hosting community events that range from music to personal development and Ruth and I have become regulars.
So, fancy a nice drive to a beautiful place for a meaningful event? If so, CLICK HERE
2. Retreats / Trainings filling
MEDITATION in the DESERT
If anyone is still thinking of joining us in the desert, you will need to let us know very soon.
Details: CLICK HERE
IMAGES, WORDS and SILENCE
Training/retreat for those interested in mind made healing – either for personal use or as a health professional.
With Dr Nimrod Sheinman, Ruth and myself in the Yarra Valley. Details: CLICK HERE
MEDITATION UNDER the LONG WHITE CLOUD
Ruth and I are leading our first meditation retreat in New Zealand in December at the beautiful Mana Retreat centre that has a similar high reputation for a good environment and great food as the Foundation. Details: CLICK HERE
5 DAY FOLLOW-UP CANCER PROGRAM
Specifically for people who have attended a CanLive program in NZ, or Gawler Foundation program. November 18 – 22 at Wanaka out of Queenstown - one of the most beautiful environments there is. Details: CLICK HERE
1. Flaherty KT et al. Combined BRAF and MEK Inhibition in Melanoma with BRAF V600 Mutations. N Engl J Med 2012; 367:1694-1703
2. THE HON TANYA PLIBERSEK MP, Minister for Health, MEDIA RELEASE: Sunday, 5 May, 2013
3. Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5 year survival in adult malignancies. Clin Oncol. 2004; 16:549-60.
4. Segelov, E. The emperor’s new clothes: Can chemotherapy survive? AustralianPrescriber. 2006; 29 (1):2-3.
5. Duric V et al. Ann Oncol 2005 Nov;16(11):1786-94. Epub 2005 Aug 26.
6. Delivering affordable cancer care in high-income countries. Sullivan R, Zalcberg J et al. Lancet Oncol. 2011;12:933-980.