Archive for April, 2010

David Cameron’s gaffe – more serious than Brown’s?

April 29, 2010

Before the dust settles on the Brown’s gaffe  and it’s effect on the outcome of the election, I would like to consider whether David Cameron’s claim that he knew people who died because they could  get access to cancer drugs? This is an article [link] which deals with that claim in detail: 

He made the claim in the first TV debate last Thursday. Specifically, what he said was:  “I have a man in my constituency called Clive Stone who had kidney cancer who came to see me with seven others. Tragically, two of them have died because they couldn’t get the drug Sutent that they wanted, that was on the market, that people knew was a good drug. That’s a scandal in our country today.” 

Sutent (sunitinib) is a kidney cancer drug that was appraised by the National Institute for health and Clinical Excellence (NICE) in February 2009. NICE concluded that for some patient groups, but not others, sunitinib appears to offer benefits compared with existing treatments in terms of overall survival, progression-free survival and tumour response. For people with a poor prognosis and those unsuitable for the standard treatment (immunotherapy) there was limited evidence and no conclusions about the clinical effectiveness of sunitinib as a first-line treatment in these groups could be made.

NICE approved sunitinib for use on the NHS for those patients in whom it showed a benefit. The fact that the seven patients who visited Cameron were not getting it indicates that they belonged to other groups for whom there was limited evidence of benefit. They may indeed have wanted the drug, but it is stretching a point to say that two of them had died because they didn’t get it. If NICE is right, indeed, there is no basis in evidence for making such a claim. 

However, let us assume for the sake of analysis that the benefits had applied to them. Would Cameron’s remarks then have been justified?  

Professor David Spiegelhalter has made an interesting analysis of this question on the website Understanding Uncertainty. He points out that that survival benefits of drugs are expressed as a hazard ratio. If a drug has a hazard ratio of 0.8, then a patient taking it has 80 per cent of the chance of dying in the following month as he would if he were not taking it. 

Furthermore, the hazard ratio can be used to work out the chances of an individual getting a drug outliving one not getting it. This is the result of a simple calculation. If the hazard ratio is expressed as h, then the probability of anybody getting the drug outliving anybody not getting it is 1/(1+h). (The proof is on the Understanding Uncertainty website.) 

So how does this apply to sunitinib? Median survival time on the drug (for those it is appropriate for) is 37 months, without it 27 months. From this, making some assumptions, Professor Spiegelhalter works out a hazard ratio of 0.73 (27 divided by 37). From this it can be calculated that the chances of anybody getting the drug outliving anybody not getting it is 58 per cent (1/1.73). 

This means that even a drug that on average provides a reasonable survival advantage cannot be guaranteed to do so for every patient.  

Cameron’s claims were therefore wrong in two ways. First, for the particular patients he identified, there was little evidence of possible benefit. And second, even if there had been, you cannot say that any given patient will benefit even from a drug known to be effective. While Cameron can be forgiven for not knowing the second reason, the first ought to have been clear enough.  

His sympathies were properly engaged; but to call it “a scandal in our country” was certainly overstating the case.

It is hard to see how wrongly suggesting that two people he knew died as a result of their being denied can be simply “overstating the case”. What did the relatives of the two dead men think? I imagine that being told by a well-informed and well-briefed person that their relatives should not have died cannot have been comforting.

What about those who are still living? Is it likely that they are now living in more hope than they should reasonably entertain? I would say that it is likely that they are.

Is the Cameron going the take back or qualify what he said? Do pigs fly?

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Who’s anti Obama’s finance reform bill?

April 28, 2010

The Guardian’s Chris McGreal has identified one group of opponents:

 America’s major banks are pouring millions of dollars into an apparently successful attempt to weaken Barack Obama’s finance reform bill, currently stalled in Congress by Republican opposition.

In the face of deep public anger over the financial crisis and government bailouts, banks have flooded Congress with lobbyists seeking to curtail key parts of the sweeping regulatory bill – such as provisions to create an office for consumer protection and more strongly regulate the vast derivatives market.

Well, well, well. Wonders will never cease.

The Sun stoops to conquer.

April 28, 2010

John Naughton was the (unintended?) recipient of this

A copy of an intriguing email just popped into my inbox:

Please do let me know if you think you can help.

From: [redacted]
Sent: 27 April 2010 11:15
To: [redacted]
Subject: request from Jenna Sloan, The Sun

If you have relevant information for the media professional concerned
please click this link to reply:
jenna.sloan@the-sun.co.uk

Request deadline: Thursday 29 April, 2010, 4:00 pm

Contact me by e-mail at jenna.sloan@the-sun.co.uk

My request: I’m looking for a teacher and a nurse to be case studies in The Sun next week.
This is for a political, election feature and both must be willing to say why they feel let down by the Labour Government, and why they are thinking about voting Conservative.

We’ll need to picture them, and also have a chat about their political opinions.
We can pay the case studies £100 for their time.

Is this genuine, I wonder? If so, interesting, ne c’est pas? First of all in terms of the implicit journalistic ’standards’, but also in terms of chequebook journalism. It just shows you what they think of teachers and NHS Staff — assuming that they’d be willing to pimp themselves for £100. Max Clifford’s clients wouldn’t blow their noses for that.

It says a lot about the regard in which we hold the fourth estate that we do not entertain for a moment the possibility that either Jones or the Sun is above this kind of “dirty trick”.

The biotechnology ethics debate.

April 1, 2010

In a fascinating essay, published in BioNews 551 compares what happens in France and UK when the subject of biotechnology is on the agenda for discussion

 ‘Certain countries in Europe, France in particular, are trying to resist the ultra-liberal individualist ideology of the reproductive market. It’s too bad that some other countries have maintained a conspiracy of silence on that subject.’ (1) Guess who’s the villain of this recent statement by the French philosopher Sylvane Agacinski? Here’s another hint from a different source, Philippe Gosselin of the ruling UMP party: ‘We can’t be reduced to things, and the human body is not an object of commerce.’ (2) France, he says, needs to stand up for other values than the utilitarianism that dominates biotechnology debate in – yes, that’s right – the United Kingdom……[Read More].

 This is not Dickenson at her most eloquent, but it is her putting a case that I’ve not heard anybody in the UK put, and that makes what she has to say worth attending to.