UK pays less for cancer drugs than some countries

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology.

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology

While the UK, Greece, Spain and Portugal pay the least, on average, for the drugs they use, Germany, Sweden and Switzerland pay the most.

The authors said more transparency was needed because some countries risked overpaying for drugs. The pharmaceutical industry said the UK was getting a fair deal on medicines.

Prices of cancer drugs have risen steeply in recent years, placing major stress on many healthcare systems, including the NHS.

The report said drugs had accounted for nearly a third of the EU’s £37 billion cancer healthcare spending in 2009.

And the researchers then compared the 2013 price of 31 cancer drugs in 18 high-income countries, including the UK, Australia, New Zealand, France, Greece, Switzerland, Sweden and Portugal.

Prices in Greece were the lowest for 14 out of the 24 cancer drugs available there.

The price of drugs in the UK was also low.

Prices of drugs in Switzerland, Germany and Sweden were frequently the highest – and for some drugs, such as interferon alfa 2b to treat leukaemia and skin cancer, were twice as high.

The price figures come from the Pharma Price Information service in Austria, which details what manufacturers charge per unit – a single tablet or vial of a drug, for example.

But although the official list prices published in this report are freely available, any further discounts – which are often negotiated by organisations in different countries – remain confidential.

David Watson, director of pricing and reimbursement at the Association of the British Pharmaceutical Industry, said the report was evidence that newer medicines “are affordable in the UK”.

He said the UK was “getting a fair deal with regards to medicines pricing” and the NHS was “getting good value for money”.

Antibiotic resistance- world on cusp of post antibiotic era

The world is on the cusp of a “post-antibiotic era”, scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed.

The world is on the cusp of a "post-antibiotic era", scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed

They identified bacteria able to shrug off the drug of last resort – colistin – in patients and livestock in China.

They said that resistance would spread around the world and raised the spectre of untreatable infections. It is likely resistance emerged after colistin was overused in farm animals.

Bacteria becoming completely resistant to treatment – also known as the antibiotic apocalypse – could plunge medicine back into the dark ages.

Common infections would kill once again, while surgery and cancer therapies, which are reliant on antibiotics, would be under threat.

Chinese scientists identified a new mutation, dubbed the MCR-1 gene, that prevented colistin from killing bacteria.

The report in the Lancet Infectious Diseases showed resistance in a fifth of animals tested, 15% of raw meat samples and in 16 patients.

And the resistance had spread between a range of bacterial strains and species, including E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

There is also evidence that it has spread to Laos and Malaysia.

Resistance to colistin has emerged before. However, the crucial difference this time is the mutation has arisen in a way that is very easily shared between bacteria.

The concern is that the new resistance gene will hook up with others plaguing hospitals, leading to bacteria resistant to all treatment – what is known as pan-resistance.

Early indications suggest the Chinese government is moving swiftly to address the problem.

New drugs are in development, such as teixobactin, which might delay the apocalypse, but are not yet ready for medical use.

A commentary in the Lancet concluded the “implications [of this study] are enormous” and unless something significant changes, doctors would “face increasing numbers of patients for whom we will need to say, ‘Sorry, there is nothing I can do to cure your infection.'”

AnE visits for alcohol poisoning double in six years

Hospital visits for alcohol poisoning have doubled in six years- with the highest rate among females aged 15 to 19.

Hospital visits for alcohol poisoning have doubled in six years- with the highest rate among females aged 15 to 19.With the holiday season on us emergency admissions due to the effects of alcohol, such as liver disease, have also risen by more than 50% in nine years to 250,000 a year in England.

Rates were highest in deprived areas and in the north, and among men aged 45-64, the Nuffield Trust revealed.

The Nuffield Trust said their figures were an underestimate of the impact of drinking because they did not include alcohol -fuelled falls and fights, just illnesses such as alcohol poisoning and liver disease.

Nor do they count people who come to A&E drunk and are then sent home without being treated or admitted as a patient.

Half of all A&E attendances likely to be due to alcohol poisoning – when a person drinks a toxic amount of alcohol, usually over a short period of time – took place on a Friday, Saturday or Sunday, peaking between midnight and 2am.

Three in four arrived by ambulance – putting a strain on already stretched resources, said the Nuffield Trust.

Young women aged 15 to 19 were admitted to hospital for alcohol poisoning 1.4 times as often as young men in the same age group.

A&E attendance rates that are likely to be due to alcohol poisoning and emergency hospital admissions linked to alcohol were three to four times higher in the poorest fifth of the population, the figures showed.

The report also reveals the number of people actually being admitted to hospital with alcohol-related problems, such as liver disease.

Men aged between 45 and 64 made up the largest share of this group.

Joint author of the report Claire Currie said: “With the Christmas party season in full swing, it’s worth considering the full burden over-indulgence in alcohol is placing on our NHS, as well as the obvious human cost.

“Our research has uncovered a picture of rising and avoidable activity in hospitals, representing a stark challenge for the Health Service at a time when it’s already great pressure. Hospitals alone cannot tackle this issue – the government must consider measures such as minimum unit pricing, restricting availability and limiting marketing and advertising.”

In England in 2013, approximately 18% of men and 13% of women drank at a level considered to be putting them at increased risk of harm.

In 2013/14, approximately 1 in 20 emergency admissions in England were related to alcohol.

Figures from the Office for National Statistics suggest binge-drinking among young adults in Britain is continuing to fall, and more than a fifth of UK adults now say they do not drink alcohol at all.

A government spokesman said: “People should always drink alcohol responsibly – very busy ambulance services and A&E staff can do without this extra demand.

“The government has taken action to tackle cheap alcohol by banning the lowest priced drinks and we are already seeing fewer young people drinking on a regular basis.”

Health Direct repeats the maxim- please drink moderately over the festive break.

Drug firms accused of overcharging by CMA

Pfizer and Flynn Pharma have been accused by the Competition and Markets Authority of charging “excessive and unfair” prices for an anti epilepsy drug.

Pfizer and Flynn Pharma have been accused by the Competition and Markets Authority of charging excessive and unfair prices for an anti-epilepsy drug.
Phenytoin sodium capsules, used by 50,000 people in Britain, are made by Pfizer and sold by Flynn.

When Pfizer made the drug under its Epanutin brand name, the NHS spent about £2.3 million on the drug, the CMA said. This amount soared to £50 million in 2013.

The CMA said Pfizer sold UK distribution rights to Flynn in 2012, but continued to make and supply the drug to the company.

This is a provisional report, with allegations made by the Competition and Markets Authority. The companies now have a chance to give formal responses and a final ruling may not be made until next year.

But it comes at a time of intense debate about NHS finances, as patient demand and the cost of treatment rise faster than budget increases. NHS England is grappling with the need for ambitious efficiency savings. It has been under fire for reducing the number of treatments available to patients through the Cancer Drugs Fund.

So today’s provisional findings, with renewed scrutiny of drug spending, are the last thing the pharmaceutical industry needs.

It was after this deal that prices rose, said the watchdog in a provisional finding.

“The CMA’s findings on dominance and abuse are provisional and no conclusion can be drawn at this stage that there has, in fact, been any breach of competition law. We will carefully consider any representations from Pfizer and Flynn Pharma before deciding whether the law has been infringed.,” said Ann Pope, CMA senior director of anti trust enforcement.

Companies can be fined as much as 10% of annual sales for abusing a dominant position in a market, depending on the seriousness of the abuse.

Pfizer and Flynn can now supply their own views and evidence before the watchdog makes a decision, it said.

“Ensuring a sustainable supply of our products to UK patients is of paramount importance to Pfizer and was at the heart of our decision to divest the product,” said Pfizer in a statement. “Pfizer is co-operating fully with the CMA’s ongoing investigation.”

Study suggests safe alcohol guidance unrealistic

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits.

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits
Men are currently recommended to drink no more than three or four units a day, and women no more than two or three.

But the study found that the guidelines are largely ignored because most people do not drink every day. Instead they drink heavily at the weekend – in order to get drunk.

Many people taking part in the research also found the idea of alcohol “units” confusing as they measured their intake in pints, bottles and glasses.

The results suggested that people think the recommended quantities of drink are unrealistic, as they don’t recognise that many people are motivated to drink to get drunk.

When participants did regulate their drinking, this was usually down to practical issues such as needing to go to work or having childcare responsibilities, rather than health concerns or due to guidance on safe limits.

Researchers found that participants preferred the current Australian and Canadian guidelines, which include separate advice for regular drinking and for single occasion drinking, which were regarded as more relevant and flexible to occasional drinkers.

Australia recommends drinking no more than four standard sized drinks on one occasion, or two drinks a day.

The study was carried out by researchers from the UK Centre for Tobacco and Alcohol Studies, which includes the universities of Stirling and Sheffield.

They interviewed focus groups in Scotland and the north of England. The results have been published by the Addiction journal.

The chief medical officers in both England and Scotland are looking at new guidelines to be published next year, and the researchers have been feeding their results to them.

Prof Linda Bauld of the University of Stirling’s Institute for Social Marketing told BBC Scotland that the advice on “safe” alcohol limits was helpful, but needed to be revised.

And she said more emphasis should be put on helping people to drink more sensibly rather than simply telling them what they need to do.

Prof Bauld added: “The Scottish government is trying to push forward with pricing measures, for example, we need to look at marketing, we need to look at glass sizes.”

War on drugs is unwinnable

Four decades after President Nixon declared a “war on drugs”, US states have legalised the sale of marijuana and most Americans support legalisation.

War on drugs is unwinnableAcross the world, drug laws are being relaxed, from Uruguay to Portugal, Jamaica and the Czech Republic.

After many years prosecuting drugs offences as an Assistant US Attorney, growing frustration with the approach inspire

The US prison system is a disaster. There’s virtually no rehabilitation. Locking up low level individuals who have drug problems or who have limited other options is not effective, because they go to jail, they come out, they get involved with drugs again, and they go right back to it.

The war itself is at a draw- which will be maintained indefinitely unless there’s a dramatic change in our approach to drugs and drug trafficking.

Former Colombian President Cesar Gaviria worked on the Global Commission on Drug Policy report in 2011 which called on states to decriminalise drugs.

“Our recommendation is regulation for everything. That’s what Portugal did.

“If you look at the last 50 years, what has been done? In the US, 600,000 people in jail, £27 billion of spending a year. The highest rates of consumption of the whole world. You have to say that it doesn’t work. It’s a failed policy, and public opinion knows that.

“Ten years ago it was unthinkable that the US would move massively to the legalisation of cannabis. That taboo has been broken. In the US, a majority of people are talking about approving legalisation of marijuana.”

He cites the example of Uruguay, the first country to legalise the marijuana trade.

“All Latin America’s looking at Uruguay. It’s a country that also looks how to deal with the production, with the supply of the marijuana that is in the state hands. I don’t expect any major set back of the policy that the Uruguayans have put in place.”

“From the beginning in 1961, the objective of the UN Conventions has been to live in a world free of drugs, but it’s a utopia. It’s something unreachable. It’s not to recognise human nature.”

Professor Peter Reuter from the school of public policy at the University of Maryland has been a leading academic in the field of drugs policy for decades.

“The need for national leaders to stand up and talk about the scourge of drugs, and signal to the population that being tough on drugs was a priority was an important part of the war itself.

“There’s going to be less and less of that. I think there’s going to be a change both in tone and substance, so the ‘war on drugs’ will become a less and less plausible metaphor for describing policy. I think it’s going to be a public health rhetoric for the foreseeable future.

“I do believe that we have in a sense had an experiment with trying to be very aggressive about controlling drugs through use of prohibition. And we have a sense that that did not work well. And so we’re now trying to find better ways of managing the problem, and I think that’s welcome.

“If you look at the number of people who are in prison for drug offences, at least in the US, that’s an important indicator of the change in real policy, and those numbers are starting to go down. Not dramatically, but they are definitely going down, and many states are making changes that are likely to accelerate that decline.”

As drug laws soften he argues the question of regulation becomes key, as happened when gambling was legalised:

“Lottery play was always seen as a bad thing, you legalised it because you wanted to take money away from organised crime, but the result was that the state lotteries became the most aggressive promoters.

“You have slogans like ‘Why be a mug and work when you can play the lottery and win easily?’, just the kind of slogan you’d associate with the worst commercial promotion, but done by the state.

“Alcohol is still heavily promoted, and it’s promoted in states that have state liquor monopolies, and we’ve only recently really been able to restrict smoking promotions.

“You cannot with a straight face say that marijuana legalisation won’t lead to more marijuana dependence.

“Choose your problem. There is no solution. Use of psychoactive drugs is a social problem like a whole lot of other social problems. We manage it. And we may manage it better or worse, but the notion that we solve a problem is simplistic. We’re simply managing a problem.”

Obese could lose benefits if they refuse treatment

People who do work because they are obese or have alcohol or drug problems could have their benefits cut if they refuse treatment.

Obese could lose benefits if they refuse treatment David Cameron has launched a review of the current benefits system, which he says fails to encourage people with long term, treatable issues to get medical help.

Some 100,000 people with such conditions claim Employment and Support Allowance (ESA), the government says.

There is currently no requirement for people with alcohol, drug or weight-related health problems to undertake treatment.

Mr Cameron has asked Prof Dame Carol Black-  an adviser to the Department of Health, to look at whether it would be appropriate to withhold benefits from those who are unwilling to accept help.

Announcing the proposal, he said: “Some people have drug or alcohol problems, but refuse treatment. In other cases people have problems with their weight that could be addressed – but instead a life on benefits rather than work becomes the choice.”

“It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work.”

David Cameron sees the wide-ranging welfare reforms introduced in this Parliament as part of a “moral mission”. He has said they give new hope to people who have been written off by helping them back to work.

Similar proposals have been considered by the government before- in 2010 and 2012 the Conservatives considered plans to remove or cut benefits for drug and alcohol addicts who refused treatment.

At the time the plans were met with concern by charities, who said there was no evidence benefit sanctions would help addicts engage with treatment.

Disabilities Minister Mark Harper said people who were overweight or had alcohol or drug problems needed treatment to get back to work

ESA was introduced in 2008 to replace incapacity benefit and income support, paid because of an illness or disability. It requires claimants to undertake a work capability assessment to see how much their illness or disability affects their ability to work.

Once a claim is accepted, those receiving ESA get up to £108.15 a week. Some 60% of the 2.5 million people claiming ESA have been doing so for more than five years, government figures show.

Police not NHS should deal with drunks

The Police rather than the NHS should be dealling with drunks claims the AnE boss.

Police not NHS should deal with drunksPolice should crack down on binge drinking to stop hospital staff being distracted by disorderly drunks according to a leading doctor.

Dr Clifford Mann, president of the College of Emergency Medicine, said the “softer approach” used for anti-social drunkenness did not seem to be working. Police could instead increase arrests, convictions and fines, he suggested.

Crime prevention minister Lynne Featherstone said the government was “determined to tackle alcohol-fuelled harm”, which she said cost society around £21 billion a year.

The coalition had improved the powers available to the police and licensing authorities to tackle alcohol-related crime, and had banned the “worst cases of very cheap and harmful alcohol sales”, the Liberal Democrat MP said.

Dr Mann said: “All I am saying at the moment is the softer approach – where we don’t any longer arrest many people for being drunk and disorderly – certainly doesn’t seem to be working.”

He said the number of people arriving at A&E units while drunk was increasing year on year, while the number of licensed premises in the UK was also increasing and alcohol was getting cheaper.

“I think these people, by the nature of the disorder, they are distracting medical and nursing staff from looking after other patients and therefore are wasting public resources,” he said.

“I think they therefore fall into the category of being drunk and disorderly in their behaviour and the police can act to take them away.”

Health Direct agrees with the suggestion. To use the Greens’ parlance of “the polluter should pay”- the drunks should be charged- literally and financially. Until the politicians, police and society in general starts to deal appropriately of issue of people drinking too much alcohol then it is unfair and detrimental to the expect the NHS to pick up the pieces.

Not only would this approach save the NHS money- but the police and courts would make money by fining people who have paid to incapacitate themselves- and who are after all breaking the law.

Fourty per cent of cancers are avoidable

Four in 10 cancer cases- 600,000 in the UK- could be prevented if people led healthier lives say experts.

Fourty per cent of cancers are avoidableThe latest research figures from Cancer Research UK show smoking is by far the biggest avoidable risk factor- followed by unhealthy diets.

The charity is urging people to consider their health when making their New Year resolutions.

Limiting alcohol intake and doing regular exercise is also good advice.

According to the figures spanning five years from 2007 to 2011, more than 300,000 cases of cancer recorded were linked to smoking.

A further 145,000 were linked to unhealthy diets containing too much processed food.

Obesity contributed to 88,000 cases and alcohol to 62,200.

Sun damage to the skin and physical inactivity were also contributing factors.

Prof Max Parkin, a Cancer Research UK statistician based at Queen Mary University of London, said: “There’s now little doubt that certain lifestyle choices can have a big impact on cancer risk, with research around the world all pointing to the same key risk factors.”

“Of course everyone enjoys some extra treats during the Christmas holidays so we don’t want to ban mince pies and wine but it’s a good time to think about taking up some healthy habits for 2015.”

“Leading a healthy lifestyle can’t guarantee someone won’t get cancer but we can stack the odds in our favour by taking positive steps now that will help decrease our cancer risk in future.”

Public Health England says a healthy lifestyle can play a vital role in reducing cancer risk. It says campaigns such as Smokefree, Dry January and Change4Life Sugar Swaps all aim to raise public awareness.

Painkillers linked to reduced skin cancer risk

Regularly taking aspirin and ibuprofen may help protect against some forms of skin cancer new research suggests.

Painkillers linked to reduced skin cancer riskAn Australian analysis of all studies to date found that non-steroidal anti-inflammatory drugs (NSAIDs) reduced the risk of squamous cell carcinoma by 18%.

The drugs have previously been linked to a reduced risk of other cancers, including colon cancer.  The theory that NSAIDs such as aspirin may protect against skin cancer has been raised before, but the overall evidence had been unclear.

So researchers did an analysis of nine studies looking at use of the drugs and the risk of squamous cell carcinoma – the most common form of skin cancer.

Reporting in the Journal of Investigative Dermatology, they found that taking any NSAID was associated with an 18% lower risk of developing the cancer.  And taking NSAIDs other than aspirin was linked with a 15% reduced risk.

It is the most convincing evidence so far that the drugs help prevent the development of squamous cell carcinoma.

But experts still cannot be sure of the effects because some factors – such as how much sun someone is exposed to or even what doses of the drugs they take – have been difficult to pin down with any accuracy.

It is thought that NSAIDs, which also include diclofenac, may prevent skin cancer because they inhibit an enzyme called COX-2, which is involved in tumour development.

The researchers did find a greater degree of reduced risk associated with use of the drugs in people with pre-cancerous growths or a history of skin cancer.

It raises the possibility that the drugs could be used as a preventive treatment in some groups.

Some people are prescribed NSAIDs long term for conditions such as arthritis, but they are not recommended for regular use in healthy people because of side effects, which can include, in rare cases, bleeding in the stomach.