‘This house believes that patients have a right to the best medicines, regardless of cost’, was the motion carried at the PharmaTimes Great Oxford Debate, which saw stakeholders from all sides of healthcare come together to debate whether cost should be a barrier to treatment access.
The idea of medicines rationing on the basis of cost raises many ethical questions, and while it is hard to argue that cost has no place in the decision-making process at all, there is an overwhelming sense that a much greater emphasis should be placed on the value of a medicine as opposed to its price.
“You would think from the media that the cost of medicines is bringing about the end of civilisation”, quipped Professor Richard Sullivan, Director, Institute of Cancer Policy, kicking off his argument in support of the motion.
Given the small proportion of the National Health Service budget actually spent on medicines, we should really be looking at the enormous waste of monies elsewhere across the health system, he argued.
There is too much focus on the cost of medicines, largely because their economic value is not appreciated, and people fail to talk about their enormous societal benefit.
And on a different note, he pointed out that the development of medicines is not philanthropic but a private enterprise and, crucially, profits are funneled back into research which, in turn, leads to further innovative treatments, and so the cycle goes on.
Also in support of the motion, Stephen Whitehead, Chief Executive of the Association of the British Pharmaceutical Industry, unleashed a no-nonsense defense of the pharma sector, voicing his frustration over its reputation given the advances in the treatment of countless diseases and its importance to the UK economy.
Cost not the issue?
“Cost should not be a barrier to getting medicines to the patients with most need”, he stressed, and pointed out that the use of medicines “can immediately reduce healthcare cost if we move away from silo budgeting”.
Just 9% of the NHS budget is actually spent on medicines, but without them the system cannot and will not survive, he warned.
Look at Alzheimer’s disease – without new discoveries to better manage the condition, the healthcare system will implode by 2023, he said, underscoring the importance of generating profit to fund research.
Eric Low, OBE, Chief Executive, Myeloma UK, noted that increasingly patients in the UK are being denied treatments because of cost. “This is a situation no one should be in and, in this day and age, it should be better”. Again, this is not an issue of affordability, but an issue of value, he said.
On the other side of the fence, the Rt Hon Stephen Dorrell, MP, Chairman of the Health Select Committee, argued that embracing the principle of the NHS, and in order to keep it free at the point of delivery, he must disagree with the motion.
“In the real world, resources are limited and choices are made, and no-one can provide anything regardless of cost”, he said, and also pointed out that the pharmaceutical industry is not the only source of delivery in healthcare.
Also opposing the motion, Laura Weir, Head of Policy & Campaigns, MS Society and Chair of Patients Involved in NICE, stressed that the NHS has a budget and therefore cannot disregard cost.
“Measuring value is a tricky business, but wherever cost is, it is in a finite budget, and patients accept that cost is an important consideration on deciding whether a medicine is worth it,” she said.
NICE must ‘go further’
But she also stressed that access to medicines is an issue in the UK, and suggested that the work of the National Institute for Health and Clinical Excellence needs to go even further, to include a much broader assessment of medicines value that includes other ethical and societal factors.
Professor Mike Pringle, President Elect, RCGP, said the notion of delivering the best medicines regardless of cost is “absurd”.
And from a different viewpoint, he asked the audience to consider – what is the best treatment? “You only know this when you see the outcome. For every drug, some patients will benefit, some won’t, and some will be harmed, so the concept of best drug is a fallacy”.
The lively debate, in the world famous Oxford Union debating chamber, saw pretty convincing arguments delivered by both sides, but in the end the ‘ayes’ were victorious, beating the ‘nos’ by just two votes.
Want to know more? Full coverage of the event is coming up in the November issue of PharmaTimes Magazine.
