When I got up on Monday I didn't expect to spend most of the week writing about breast cancer and Herceptin, but this story, which appeared yesterday in the Guardian, cannot go unremarked.
It refers to a new pan-European advocacy group, Cancer United, which has been pitched as "a pioneering effort by a coalition of doctors, nurses and patients to push for equal access to cancer care across the EU," but which turns out to be entirely funded by Roche, the company that produces Herceptin and another new cancer drug, Avastin.
The new campaign's secretariat is not an independent charitable organisation, but a PR company. And not just any PR company. It's Shandwick Weber. You know how Google's company motto is "Don't be evil"? You could say that Shandwick's is one word shorter.
Sourcewatch has the Shandwick backgrounder. It includes a reference to the Timberlands saga in New Zealand, which, of course, also centred on a fake grassroots advocacy group.
The Guardian story includes this passage:
However, one of the UK's leading cancer experts, Michel Coleman from the London School of Hygiene and Tropical Medicine, told the Guardian he had grave concerns about Cancer United.
"Governments will no doubt be pressed to fund a big increase in expenditure on cancer drugs - on the entirely spurious grounds that such an increase has been proven to increase national survival rates. I wonder if all the dignitaries on the executive board of Cancer United are aware of this murky background.
"Cancer patient groups should think twice before accepting sponsorship from Cancer United."
Coleman was also highly critical of Cancer United's reliance on single study which links patient survival to the amount their governments spend on drugs. He described it as "woefully simplistic research... This is clearly nonsense. For most cancers, higher survival results from earlier diagnosis and a combination of expert surgery and/or radiotherapy, as well as from the use of cancer drugs."
The study is particularly interesting in light of a new review from Denmark's Cochrane Centre, which compared meta-analyses of cancer studies and found that analyses funded by drug companies "tended to recommend the experimental drug without reservation," while those not funded by big pharma reached quite different conclusions.
The Cochrane Centre spokesman said that the drug company-funded analyses were often queered by the fact that they only used information from the companies' own databases and that the centre would ignore such studies in future. Unfortunately, these studies often appear in respectable medical journals.
Roche has a particular interest in turning the focus of public health strategies towards new cancer drugs. Those new drugs are the main reason that its latest quarterly sales were up 20% to $US8.3 billion. The company now has an application in for European Union approval for the use of Herceptin in conjunction with hormonal therapy, which analysts say would add hundreds of millions to its annual sales.
This is fine in itself: profit provides the motive to undertake such expensive research, and embrace the risk of equally expensive failure. Capitalism's good like that. But it behoves us to recognise that profit, and not altruism, is the motive behind what Roche says and does. That's how capitalism works. The sums of money at stake here are vast. And, if, as the Cochrane Centre asserts, that money is distorting academic research, then something truly odious is going on.
Auckland Hospital associate professor of oncology Vernon Harvey wrote a very clear and useful behind-the-hype commentary on cancer treatments for the Herald yesterday, which outlines the drug treatments that are available to women here in advance of funding in either Britain or Australia (that 60 Minutes report just looks worse every day, doesn't it?), but have received "little fanfare" in the media. I wonder why that would be?
When I ask my patients what they think will happen if they get Herceptin, they answer that their chances of survival will increase by 50 per cent.
When I ask them what will happen if they don't get it, the answer is that they will die. Neither of these is true. Medicine is seldom as black and white as the media would like to portray it, or as simple as our patients subsequently perceive it to be.
Herceptin is an exciting therapy for a particular type of breast cancer - cancers with positive HER2 receptors - but not quite the wonder drug portrayed in the media.
With what, in the context of this week's debate, amounts to monumental stupidity, the paper placed Harvey's column behind its silly Premium Content paywall, but you should just go in the back door and read it.
True story: I woke up this morning to the sound of a man shouting about the police. I thought there must be some sort of fracas on the street outside (it has been known to happen), but it turned out to be Gerry Brownlee on the radio, doing his Angry Man thing in Parliament. Brownlee clearly has a talent for this (but where's Don?) but some of his colleagues aren't quite so good at it. Watching Lockwood Smith try and keep his game face on, on the TV news last night, was hilarious.
I partially agree with Mr Slack on the happenings in Parliament this week. The validating legislation was necessary to validate expenditure made in good faith all the way back to 1989, but scooting it through in a rush was not. But I also think Brownlee's bitching about the new, ultra-cautious approach from Parliamentary Services is bloody rich.
Parliamentary Services, slated in the Auditor General's report for rubber-stamping what he subsequently deemed to be unlawful expenditure, now clearly doesn't know what's permissible and what isn't. So it has flagged as a "point of discussion" the status of MPs' Christmas cards, funded out of its budget. Take it away Gerry:
"They (Parliamentary Service) have been fired up by Michael Cullen and Co who are simply acting out of deep guilt over their own flagrant misuse and abuse of parliamentary funds," said National Party deputy Gerry Brownlee.
"What they are wanting to do is become the tick box thing. So I say I want to buy a new set of pens for my office, they'll say yes or no to that.
"I'll need some new letterhead paper, they'll say yes or no to that. I'd like to go home at the end of the parliamentary week – yes or no. These people are massively overstepping the mark and getting in the road of the free operation of a democracy."
This is, of course, what all the other parties have been saying while National has been loudly insisting that the AG's report throws up no problems at all. And some of the communications deemed unlawful by Kevin Brady would seem to have a bit more to do with the "free operation of democracy" than taxpayer-funded Christmas cards.
I've been surprised that there hasn't been more comment on a little column by Richard Prebble, tucked away in the Herald on Sunday. Prebble reports that he was dinged by Brady to the tune of $192, for placing an advertisement for a public meeting held before the announcement of an election in which he wasn't even standing. Prebble sums up the problem (the words in square brackets are his, not mine):
The Solicitor-General has examined High Court rulings, including Winston Peters' case over spending on the Tauranga election and determined that if my advertisement had said, "come and hear Richard Prebble criticise government policy", that would have been OK. But as the advertisement said "and hear our alternative policy", it was campaigning. [The wags will say this explains why National did not offend - they had no policy] …
It seems nuts to me that MPs can spend taxpayer money criticising policy but not on saying what their alternative is. The rules will have to be changed.
New interim rules are being drawn up and will be presented to Brady for approval. Which makes sense, because at the moment, he and the Solicitor-General appear to be the only ones who know where the goalposts actually are.
PS: TVNZ head of programming Annemarie Duff is going to be spending more time with her family from the end of this year. Given the ratings trend, it's hardly surprising. I wonder if that desire to wean TV1 off its "heavy reliance on British product" will survive her departure.