by Vern Pitt
As the refusal of National Institute for Health and Clinical Excellence to authorise the use of drugs to treat early stages of Alzheimer's continues to raise questions over the economic model they use, Adam Whishart's documentary provides new insight into the difficult decision the committee is faced with.
As the refusal of National Institute for Health and Clinical Excellence to authorise the use of drugs to treat early stages of Alzheimer's continues to raise questions over the economic model they use, Adam Whishart's documentary provides new insight into the difficult decision the committee is faced with.
The hour long film follows the debate surround myeloma drug, Revlimid.
It is easy to get swept up in the highly emotional situation of the three cancer patients Whishart shows us. They simply want a drug which will buy them a few more years with their families, that they cannot have it is heartbreaking, a sensation he plays up with lilting piano accompaniment. But theirs is only one side of a multi-faceted story. On the others are cheaper and more effective services for greater numbers of people, politicians under public pressure and a drug company with questionable motives.
In the middle is Nice and its chairman, Professor David Barnett. Barnett lends what could otherwise be a characterless bureaucracy a face. His level of compassion for those that Nice's decisions effect is shown to be in excess of that which some would have you believe. A doctor himself we see him treating patients at his day job likening Nice's decisions to the clinical choices on patient treatment made every day.
Whishart does well to not cast any one party as the villain of the piece. The closest is CEO of Revlamid's manufacturer, Sol Barer. His capitalism drives innovation doctrine, doesn't have the same appeal post economic Armageddon. But it does at least explain the price and when at the 11th hour they reduce it (presumably because making some money is better than making none) you can buy into Meryil Goozner's criticism that drugs are over-priced.
What Nice are really entrusted with doing is uncomfortable because it defies what until now has been a base assumption in our society, that living longer is always a goal to be strived for. Circumstance obliges us to reconsider that in the light of another variable - quality of life. As that's not quantifiable it doesn't fit easily into the mathematical equations Nice are obliged to formulate.
The film cleverly, but unintentionally, demonstrates the problem with doing this. When in the closing minutes Nice decide to authorise the drug for use on the NHS the celebratory punch is soured by news that Julia, one of the cancer sufferers, has died before she can receive the drug due to a mistake at the hospital on another treatment. Despite their best efforts doctors are unable to save her. It acts as a chilling reminder that the health service is run by humans and all systems are fallible, as are their decisions.
It's the quantifying of the choice between drugs (and effectively between lives) that is the impossible task Whishart confronts us with. He wisely resists the temptation to provide us an answer instead showing the human aspects of all sides. The uncomfortable truth is that unless taxpayers are willing to write drug companies a blank cheque then a figure for what we will spend must be decided at some point. Inevitably someone will lose out, it is tragic but unavoidable.
By focusing on a rare form of incurable cancer, where drugs only buy time, Whishart makes the dividing lines clearer. In the case of Alzheimer's the benefits of treatment are even more difficult to quantify. One can argue that the quality of life the drugs in question buy is worth more than the couple of years Revlimid affords myeloma sufferers. It may seem unfair to compare the two but that's exactly the kind of choice Nice is making with every decision. It's one that by the end you're glad you're not making.
The cold comfort this documentary offers to those campaigning for Alzheimer's drugs is that decision is never taken lightly.
It is easy to get swept up in the highly emotional situation of the three cancer patients Whishart shows us. They simply want a drug which will buy them a few more years with their families, that they cannot have it is heartbreaking, a sensation he plays up with lilting piano accompaniment. But theirs is only one side of a multi-faceted story. On the others are cheaper and more effective services for greater numbers of people, politicians under public pressure and a drug company with questionable motives.
In the middle is Nice and its chairman, Professor David Barnett. Barnett lends what could otherwise be a characterless bureaucracy a face. His level of compassion for those that Nice's decisions effect is shown to be in excess of that which some would have you believe. A doctor himself we see him treating patients at his day job likening Nice's decisions to the clinical choices on patient treatment made every day.
Whishart does well to not cast any one party as the villain of the piece. The closest is CEO of Revlamid's manufacturer, Sol Barer. His capitalism drives innovation doctrine, doesn't have the same appeal post economic Armageddon. But it does at least explain the price and when at the 11th hour they reduce it (presumably because making some money is better than making none) you can buy into Meryil Goozner's criticism that drugs are over-priced.
What Nice are really entrusted with doing is uncomfortable because it defies what until now has been a base assumption in our society, that living longer is always a goal to be strived for. Circumstance obliges us to reconsider that in the light of another variable - quality of life. As that's not quantifiable it doesn't fit easily into the mathematical equations Nice are obliged to formulate.
The film cleverly, but unintentionally, demonstrates the problem with doing this. When in the closing minutes Nice decide to authorise the drug for use on the NHS the celebratory punch is soured by news that Julia, one of the cancer sufferers, has died before she can receive the drug due to a mistake at the hospital on another treatment. Despite their best efforts doctors are unable to save her. It acts as a chilling reminder that the health service is run by humans and all systems are fallible, as are their decisions.
It's the quantifying of the choice between drugs (and effectively between lives) that is the impossible task Whishart confronts us with. He wisely resists the temptation to provide us an answer instead showing the human aspects of all sides. The uncomfortable truth is that unless taxpayers are willing to write drug companies a blank cheque then a figure for what we will spend must be decided at some point. Inevitably someone will lose out, it is tragic but unavoidable.
By focusing on a rare form of incurable cancer, where drugs only buy time, Whishart makes the dividing lines clearer. In the case of Alzheimer's the benefits of treatment are even more difficult to quantify. One can argue that the quality of life the drugs in question buy is worth more than the couple of years Revlimid affords myeloma sufferers. It may seem unfair to compare the two but that's exactly the kind of choice Nice is making with every decision. It's one that by the end you're glad you're not making.
The cold comfort this documentary offers to those campaigning for Alzheimer's drugs is that decision is never taken lightly.
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