FT Health: Cancer and quackery
Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
Sign up here to receive your free briefing by email every Friday
Is cancer fundraising fuelling quackery? That is the title of an investigation from the British Medical Journal highlighting how crowdfunding sites are enabling those with advanced cancer to spend serious amounts on alternative treatments.
Some may benefit, but many are being lured into paying for crank therapies which are not only unproven but can actually do harm, involving everything from coffee enemas to intravenous vitamin C.
The study comes as IARC, the World Health Organization's cancer research arm, projected 18.1m new cases of the disease worldwide in 2018 and 9.6m deaths. Ten cancers are responsible for 65 per cent of incidences and deaths, with female breast cancer and lung cancer the leading categories. The situation is set to worsen as populations age and “western” lifestyles spread across the globe, meaning the number of deaths could reach 16m by 2040.
Crowdfunding websites are not alone in sowing confusion. Newspapers, too, fuel perceptions that the best way to help cancer patients and improve outcomes is to “allow them access to new (and expensive) medicines, whose performance is often hyped and gives rise to unreasonable expectations,” according to the Royal Society of Medicine in another report this week.
Despite the alarming rise in the global burden, the knowledge that around 40 per cent of cancers are preventable offers grounds for optimism. Much can be done through better education on smoking, alcohol, diet and the role of exercise.
But there is no time to waste. As Christopher Wild, IARC Director, puts it: “Efficient prevention and early detection policies must be implemented urgently to complement treatments in order to control this devastating disease across the world.”
Read our special report on combating cancer from earlier this summer
We spoke to Wilbert Bannenberg, president of the Dutch Pharmaceutical Accountability Foundation, on his plans to fight high drug prices such as the 500-fold increase for Leadiant’s CDCA, which is used for treating a rare hereditary metabolic disorder.
What is the purpose of your foundation?
A network of organisations worried about high drug prices thought it would be useful to create a group not only with health and pharmaceutical expertise but also lawyers. We will focus on redress through competition law, human rights, civil law and rights for access to essential medicines. We started in July by looking at 12 cases by drug companies and are doing due diligence to look for the best case to bring. We were overtaken by events with CDCA.
What are your concerns?
All the cases we have looked at use the same type of business model: buy an old, cheap product, get the old versions off the market, win orphan drug designation, and put up the price as high as you can. We think this is not socially acceptable. Some companies are misusing the system to get higher profits, and patients are being affected. European orphan drug legislation needs to be reformed.
Why are the Dutch so focused on drug prices?
It’s a subject hotly debated in the press and by three political parties who have raised it in parliament. Generic drugs are very affordable but new medicines for cancer are extremely expensive. Our previous Health Minister Edith Schippers put the problem high on the EU agenda during the Dutch presidency, which led to a report on what government could do.
Hunger and nutrition A UN snapshot of nutrition and food security showed 821m people undernourished in 2017, up from 804m the year before. Conflict, climate events and economic problems have all contributed. The situation is worsening in South America and much of Africa and the UN target to eradicate hunger by 2030 looks unlikely to be achieved. The same goes for shorter-term hopes on stunting, wasting, anaemia, overweight children and adult obesity. (FAO)
Tackling TB The Global Fund to Fight Aids, Tuberculosis and Malaria said it had saved 27m lives since it began in 2002, but reported a slowing decline in HIV rates and progress against malaria stalling. TB is now the leading infectious disease killer with 1.7m deaths a year and is the subject of a UN High-Level Meeting on September 26. (Global Fund, Stat)
Financing health The Global Financing Facility, a scheme to help channel public and private money into women's, children's and adolescent health, has achieved improvements in outpatient care in Tanzania; progress on vaccination in DRC; a doubling of the relevant budget in Cameroon; and new Nigerian commitments on primary care and service delivery. Look out for our interview next week. (GFF)
Ecig clampdown The US Food and Drug Administration on Wednesday gave the five top-selling ecigarette brands — Juul, Vuse, MarkTen XL, Blu and Logic — 60 days to show how they will cut sales to young people. FDA chief Scott Gottlieb said usage had hit “epidemic” levels. The number of vapers in Britain has now passed 3m. Listen to our podcast on Juul and the rise of ecigarettes. (FDA, BBC, FT)
Booze battle English health authorities came under fire over the involvement of a charity funded by the alcohol industry in a campaign to cut heavy drinking. Public Health England defended its decision, saying it would “work together with any partner that speaks to the evidence and shares the same commitment”. (Guardian, Public Health England, BBC)
Drug price defence Nostrum Laboratories, the US drugmaker, defended its quadrupling of the price of an antibiotic to more than $2,000 a bottle, arguing there was a “moral requirement to sell the product at the highest price”. Alex Azar, the US health secretary, told an FT conference that drug prices would get lower “using the tools we know are successful — competition, negotiation and pricing incentives . . . Lower prices for drugs will mean, in some cases, slimmer profit margins.” (FT)
State of Europe's health Life expectancy in Europe increased from 76.7 years in 2010 to 77.8 in 2015 and maternal and infant mortality dropped, as did deaths from the four big non-communicable diseases (see chart). Smoking, alcohol, high rates of overweight and obesity are still a problem in several countries. (WHO)
This is England A snapshot of health in England showed life expectancy increasing to 79.6 years for men and 83.2 for women with the number of people over 85 expected to top 2m by 2031. Obesity and smoking are the most serious threats to health, and although smoking is decreasing, diabetes is forecast to affect almost 5m people by 2035. (Public Health England)
Europe splutters The EU spending watchdog warned that weak legislation and poor implementation of policy meant citizens were still breathing harmful air. Particulate matter, nitrogen dioxide and ground-level ozone are responsible for most of the bloc's 400,000 premature deaths from air pollution each year. (Europa)
Decriminalising drugs The west Africa Commission on Drugs recommended a relaxation of laws on personal use of drugs and a focus on treatment and tackling trafficking. The use of cocaine, heroin and amphetamines is rising in countries that were once simply transit points between South America and Europe but are now active consumer markets. (IDPC, Reuters)
Warning on 'legal highs' Ivory Wave, Benzofury, Mexxy, Meow Meow: One estimate says 10 per cent of young people in the UK are using 'legal highs' — and half of these are consuming the drugs at potentially dangerous levels. Synthetic cannabinoids such as Spice and K2, common in the UK drugs scene, are said to be particularly dangerous for amplifying the risks of psychosis and schizophrenia. (FT)
Science of psychedelics The story of how LSD and magic mushrooms moved from being hippie indulgences to possible treatments for depression, isolation, addiction and post-traumatic stress. (New Statesman)
Animal-to-human link New research suggests antibiotic use in animals can have repercussions when their meat is eaten by humans. Earlier studies lacked evidence that meat strains and human infections were linked. (Wired)
Striding for mobility UK scientists have developed “smart trousers” with artificial muscles and electronic sensors to restore mobility to the frail and disabled. The lead researcher’s aim? “If we can give someone who is disabled just a 10 per cent increase in their muscle strength and mobility, that will make a significant difference to their life, helping them to live independently and with dignity.” (FT)
Best of the journals
Tackling tobacco Analysing the lessons for public health from the Tobacco Master Settlement of 1998. This was the largest ever US legal deal and a model for similar litigation to hold industries accountable when they knowingly deceive and injure consumers. (NEJM)
Climate change The first study of the health impacts of global temperature rises, outlined in the Paris climate agreement, said deaths could be limited if rises were kept below 2°C. Current trajectories show an increase of 3°C. (Climatic Change)
State of Indian health Jumps in diabetes, cancer and above-average rates of air-pollution related lung diseases are some of the findings in a group of reports on India. Suicide was the leading cause of death for those aged 15-39, accounting for 37 per cent of global suicides of women and 24 per cent of men. (The Lancet)
Trial tracking Half of European clinical trials have not complied with EU rules on reporting results, says a new survey. Its lead author said: “This problem strikes to the heart of evidence-based medicine. We cannot make informed choices about which treatments work best, as doctors and patients, unless all results are reported.” A new trial tracker shows which organisations are compliant. (BMJ)
Contrary dairy finding Dairy products might actually be beneficial against cardiovascular disease such as stroke, especially in poorer countries where consumption is much lower than North American and Europe. But experts warned it would be premature to change dietary guidance based solely on the study. (The Lancet, FT)
Healthcare and markets An opinion piece argues against any expansion of the private sector's role in Britain's NHS. It says a market in healthcare impedes attempts to monitor care quality and outcomes as well as compromising cost efficiencies. (BMJ)
Podcast of the week
Opioids and the Sackler family David Crow discusses his FT series on the role of the Sackler dynasty's Purdue Pharma business in fuelling the market for opioids in the US. You can read his full series here. (FT, 22m)
Join the debate
FT Health is free to read — please forward and encourage others to register here
Previous edition: healthcare: Quality not quantity
Corporations and public health The arguments over the involvement of a charity with alcohol industry links in the UK campaign to moderate drinking have been fierce. Is it right for these companies to be involved or does it damage health authorities’ credibility? Share your thoughts with us on the above channels.