Monday, June 16, 2008

NHS drugs cheaper but much less effective

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves. One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy. The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care. Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Last week The Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors. John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about 2,200 pounds a month compared with about 800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control. A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan. Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added. Erbitux, costing about 3,000 pounds a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.


Classroom focus on expressing emotion 'leaves pupils unable to cope'

Schools and universities are producing a generation of "can't do" students, who are encouraged to talk about their emotions at the expense of exploring ideas or acquiring knowledge, academics claimed yesterday. The strong focus on emotional expression and building up self-esteem in schools and colleges was "infantilising" students, leaving them unable to cope with life on their own, according to the authors of a new book, The Dangerous Rise of Therapeutic Education.

Dennis Hayes and Kathryn Ecclestone, of Oxford Brookes University, argue that this "therapeutic" approach to education is at odds with the acquisition of knowledge because it views the emotional skills associated with learning as more important than subject content or criticism. "Turning teaching into therapy is destroying the minds of children, young people and adults," Dr Hayes told Times Higher Education. "Therapeutic education promotes the idea that we are emotional, vulnerable and hapless individuals. It is an attack on human potential."

They pointed to the increased presence of parents on campus, and substitute parents, such as counsellors and support officers. "Everyone looks for a difficulty to declare, like the hundreds of students who register themselves as dyslexic. Being dyslexic used to be something that people hid. Now students wear their difficulties as a badge of honour," Dr Hayes said.

Therapeutic education pervaded all levels of education. Dr Hayes cited the case of a primary school boy who was asked by an emotional learning assistant why he was so happy. When he said he was looking forward to a treat at McDonald's, she asked: "Are you sure there is nothing worrying you?"

The book follows the recent introduction into state schools of lessons in happiness and wellbeing under a programme known as Seal (Social and Emotional Aspects of Learning). Ministers are convinced that teaching children to express their emotions boosts concentration and motivation. But there is growing disquiet that this attitude could undermine teaching and learning.

Frank Furedi, Professor of Sociology at the University of Kent, said: "It inflates the importance of feelings to the point where they eclipse what is supposed to be going on in the classroom." It also made teachers and lecturers overcautious. "They will give a piece of work 55 per cent and then write on it 'this essay is superb' because they daren't say it's crap."

John Foreman, dean of students at University College London, agreed that students were not as "self-sustaining and robust" as they once were. He partly blamed overprotective parents. "If young people don't start learning to solve their own problems, when will they ever?" he said.

Anthony Seldon, Master of Wellington College in Berkshire, a pioneer of wellbeing classes, defended the approach. "Since we started wellbeing lessons [in 2005] our A-level results have gone up from 64 to 86 per cent of students getting As and Bs."


The Brits lose ANOTHER lot of secret files: "Secret British government documents detailing the fight against terrorist financing have been found on a train, a newspaper has reported, the second time in a week that top-secret files have been mislaid. The Independent on Sunday said the papers divulged Britain's policy on fighting global terrorist financing, drugs trafficking and money laundering, and analysed how Iran could contravene international financial rules to finance weapons. The newspaper did not reveal any details in the documents and said it had handed them back to authorities. "The confidential files outline how the trade and banking systems can be manipulated to finance illicit weapons of mass destruction in Iran," the paper reported, adding that the documents discussed countries signed up to the global Financial Action Task Force."

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