成人快手

There has been a lot of talk recently of a postcode lottery for expensive medical treatment. Herceptin, the breast cancer medicine, topped the bill in recent times. Thought I'd explain a little bit of the background.

When a new medicine is discovered, it usually takes about 10 years to come onto the market. By law, its benefits have to be proven and any adverse effects not to outweigh those. After trying the compound out on rats, mice, and other animals, the clinical trials start. Patients who meet certain criteria are given either the new compound or a similar looking empty - a placebo. Instead of a placebo an established treatment can also be used. Quite often, neither the doctor, nor the patient nor anyone else directly involved with the patient knows what is what. The difference of response to either treatment is noted, and taken as a measure of efficacy. Rarely, the response to the new compound is so good that it is deemed to be unethical to withhold it from the other patients.

After the drug is licensed and marketed, the National Institute for Clinical Excellence NICE has to make a judgement where the new compound stands in comparison to other treatments. In other words, is it to be specially recommended or is it just another in a long line of similar medicines.

What happens in the case of Herceptin is that it was licensed for use in advanced breastcancer. NICE have not yet made an assessment on its use in early-stage breastcancer, although trial results also showed that it helped in that category. Unfortunately, because it is so expensive, health authorities across the country felt they could not afford it to be used outwith the license. It is an ethical dilemma, because either you withhold a beneficial treatment from someone who could die of the disease. Or you give it to an early stage breast cancer patient, and draw away resources which could otherwise be used to treat other patient groups, who may not be as vocal. Antibiotics can be very pricey, mental health patients use expensive drugs as do many others.

It's a difficult call.

I'm aware I'm slightly off subject, because Herceptin treatment in the islands is likely to be carried out in a mainland centre like Inverness or Glasgow.