Editorial: Brave voice deserves to be heeded

A week has passed since two lobby groups for women's health, the Federation of Women's Health Councils and Women's Health Action, gave public support to Pharmac's decision not to fund the drug Herceptin for the early stage of a type of breast cancer. No more time should elapse before the bravery of those two organisations is acknowledged.

They were immediately attacked, as they must have expected, by the Breast Cancer Advocacy Coalition which takes the view of groups dedicated to sufferers of any disease, that no amount of public money should be spared for any benefit that can be brought to them. This view is perfectly understandable, particularly where cancers are concerned. It will be shared by sufferers, doctors and all sympathisers who do not have to worry about making the best use of finite public finance.

Only the Government and the Ministry of Health have to worry about that. Advocacy groups such as Women's Health Action can close their eyes to the financial implications if they wish and demand as much as a desired drug may cost.

The cost of Herceptin is astronomical, more than $100,000 on average for each patient. It is effective only for an aggressive type of breast cancer that occurs in about 20 per cent of cases. Pharmac funds it for women with advanced cancer. To extend it to early-stage cases would cost at least $20 million a year, more than half the public hospital budget for cancer drugs overall. Trial data suggests it would give women with a first cancer an 80.6 per cent prospect of being alive after three years without a recurrence, as compared with a 74 per cent survival rate for those on other treatments.

That difference, Pharmac has decided, is not worth the cost.

Individual sufferers might decide differently; some women in this country are finding the money for the drug themselves, sometimes remortgaging their houses to do so. They must believe the 6 percentage points improvement in their survival chances is worth it.

But individual sufferers do not have to consider financing more than one life-threatening condition, the public health has to consider a great many. As the convenor of the Federation of Women's Health Councils noted, heart disease and strokes kill many more women than breast cancer. Any comparisons are invidious of course, but public funding agencies must make them, and it is highly responsible of groups genuinely concerned for women's health overall to do likewise.

Britain's National Health Service has approved funding of Herceptin for the early-stage cancer after a strenuous, and sometime raucous, public campaign in which the manufacturer, Roche, played a hand. In this country Pharmac and district health boards say they will keep the issue under review. Emotional appeals such as we have heard from the Breast Cancer Advocacy Coalition will continue.

Popular appeals leave an exaggerated impression of a drug's benefits. Herceptin is no more a "cure" than any other cancer treatment. It can help to delay and maybe prevent a recurrence of one, fairly uncommon, type of breast cancer. Decisions made in Britain, Australia or any other places are not a reason for this country to follow suit. If time improves the drug's results, Pharmac will no doubt re-evaluate it.

And if, in the meantime, the Federation of Women's Health Councils or Women's Health Action come around to favour the drug's funding, their voice will carry particular weight. They have proved themselves responsible watchdogs for the greater good.