One of my photos


May 31st, 2006 · Posted by Skuds in Life · 1 Comment · Life

There was an interesting article on the BBC website today about the use of statistics – a subject which has always interested me. It talks about shampoo and obesity figures, but ends up on the topic of Herceptin.

I am not a scientist and I am not a doctor, but for a while I have had a gut feeling about this Herceptin drug. The media keep describing it as some sort of ‘wonder drug’ for the treatment of breast cancer, even though it has not been fully approved yet. Cancer patients have been kicking up a fuss about not being prescribed this drug, and yet I do wonder if they have not been mislead about its supposed benefits.

One statistic quoted in the piece is that it cuts the return rate of breast cancer by 50%. Sounds like that can only be a good thing, but the numbers behind it are a lot less dramatic – quite apart from the fact that those results are from just one study.

Now I am well aware that cancer is an emotive topic, especially for anyone who has fallen victim to it. At this point it is traditional to point to Stephen Jay Gould’s essay The Median Isn’t The Message which describes his own experiences with cancer and how an impartial look at statistics helped him through it.

It must be quite easy for someone recovering from breast cancer to be afraid of it returning and to feel that it is almost inevitable. Cutting the chances by half must be attractive; but the normal rate for return without Herceptin is about 17% while use of the drug reduced that rate to about 9%

That is saying two things. Firstly it is saying that the chances of the cancer returning are less than 1 in 5 to start with and the drug will reduce that to just less than 1 in 10. Still a valuable straw to be clutched at, but really a reduction of 8 percentage points. The second thing it is saying is that for 83% of patients there was nothing to worry about in the first place, and the drug would have no effect.

Actually it is a bit worse than that. What the BBC story does not point out is that one of the side-effects of Herceptin is cardiac dysfunction in 2-7% of cases, and also risks of severe or fatal allergic reactions.

Taken at its worst, that would mean that, statistically, for 100 patients given the drug, 8 would be spared from the return of breast cancer, while up to 7 could suffer cardiac dysfunction. Possibly a different 7 who would not have had the breast cancer return. If one other suffered an allergic reaction there would be a net benefit of zero.

Far from being a wonder drug, there is every chance that it could be sparing 8% of patients from one condition by causing a different condition in a further 7%. I do not see an overwhelming case for rushing it through without full tests.

And at what cost? A figure of £20,000 for treatment is mentioned. The incidence of breast cancer must be something like 34,000 per year, leading to a potential cost of £680 million of which about £625.6 million would be wasted by treating those who did not need it and a smaller number for whom it has no effect. Ok those are over-the-top figures because not all cases of breast cance would be suitable for the drug, but there are still big numbers involved.

Who would really benefit from rushing Herceptin into use? The patients? Certainly there would be a benefit to a small percentage, while an equal number are offered a false hope by the PR this drug has been getting and a much larger number are exposed to false fears whipped up by the media. But then there is the other group who are needlessly exposed to the side-effects. No benefit there. The health service? I imagine that most NHS trusts have limited budgets and a whole lot of treatments which they know to be effective which would be prevented by prescribing this. Of course we could all pay more tax to fund this. Always a popular move.

How about the drug company which markets Herceptin? Of course. They are the one party which will benefit enormously. The more scaremongering they can encourage the media to whip up, the better it is for them. They will not care if they are offering false hope, or allowing patients to overestimate their risks. They will not care if the money paid to them is at the expense of more effective treatments for other conditions being cancelled or from overall taxes being increased – its all the same to them.

One thing I really cannot fathom is why the media go along with it? What is in it for them? They can’t all be owned by the drugs companies can they?

Tags: ···

One Comment so far ↓

  • Danivon

    The media love a drama. Here we have an evil bureaucracy denying ‘lifesaving’ treatment on the basis of cost. What a story! Even if it is complete twaddle, it makes them look all concerned and sell papers.

    And there are some commentators (Melanie Phillips of the Daily Heil?) who seem to have a pathological hatred for conventional medicine, the NHS, logic etc…