The government has spectacularly driven itself into a brick wall by its failure to fund the 13 cancer drugs Chris Luxon promised on the campaign trail last year, and there has been no shortage of commentators, from both the right and the left, probing its self-inflicted wounds in the wake of its baffling Budget omission.
It looks increasingly as if the least-worst option might be for the government to fund even a few of the drugs as quickly as possible to signal its good intentions but the question remains why the National Party made its very specific promise in the first place. It reveals a woeful lack of knowledge not only of Pharmac’s negotiating processes but also of the rapidly changing therapeutic landscape.
The list Luxon relied on to select the 13 chosen drugs — which was based on a report compiled in 2021 of drugs publicly funded in Australia and other countries but not in New Zealand — was already out of date when he announced National’s policy last year. It was never intended to be a “shopping list”, as one of its authors put it. And it didn’t cover blood-cancer drugs.
National’s Health minister, Dr Shane Reti, has somehow been spared crucifixion so far over the debacle. Speaking to Leah Panapa on The Platform, patient advocate Rachel Smalley described Reti as being “firmly ensconced in primary care” — which appeared to tactfully imply he has a limited overview of his portfolio. She also wondered about “how much influence Reti has around the Cabinet table”.
RNZ’s Lisa Owen asked Dr Rodger Tiedemann, a consultant haematologist at Auckland Hospital, why he thought the Prime Minister and Minister of Finance were publicly defending the bungled policy rather than leaving that task to the Health minister. Tiedemann said he thought Reti was “lying low… he’s got himself into a little bit of trouble with promising the 13 medicines without really consulting Pharmac on that, and without including blood cancers”.
The drugs Luxon promised to fund are used to treat solid tumours (such as lung, liver, kidney and bowel cancer) but blood cancers (which include leukaemias, lymphomas and myelomas) form an entirely separate, and substantial, category. Unlike solid tumours which can be treated with surgery and radiotherapy, blood cancers can only be treated with medicines.
Unfortunately for Reti, he made a quasi-promise to blood-cancer patients when announcing National’s policy last year, reassuring them: “We have not forgotten you.” Then in March, he made that explicit by saying that he expected the list of 13 medicines would be updated to include consideration of blood-cancer medicines once the Cancer Control Agency had produced its recommendations — which are expected to be published by June 30.
Last week, 50 haematologists — including Tiedemann — joined patient advocacy groups in writing an open letter to the government seeking a reassurance that those commitments to the country’s 21,000 blood-cancer patients would be honoured.
Tiedemann added: “There is a huge gap in the funding of blood-cancer medicines in New Zealand that is at least equal to that of solid tumours. Blood-cancer patients have been assured that they would not be forgotten and the cancer medicines plan would include them. As haematologists, we feel compelled to speak up on this important commitment made to our patients that has fallen silent.”
Now it appears Reti has reneged on his promise and retreated even further into his bunker. Declining to be interviewed by The Post this week on the question of blood-cancer drugs, he would only say in a statement: “We are committed to funding [the promised 13] treatments before the next Budget.”
That means the government has now broken two promises to different groups of cancer patients and their families, some of whom will have voted for National largely because they trusted its pledges.
It is worth noting here that the drugs haematologists are seeking are not the latest cutting-edge treatments such as CAR-T cell therapy but rather medications — such as daratumumab for multiple lymphoma — that have become the standard of care in a host of other countries. Forty-nine in daratumumab’s case, to be exact.
No matter how much the government engages in damage control to patch up its botched promises, however, the question of why New Zealand remains so far behind our peers in the provision of modern cancer drugs will not go away.
Tiedemann is a regular commentator at patient seminars and in the media and he makes the point that New Zealand’s recent spending on health overall per person of $US6061 ($NZ10,202) is hardly miserly — falling between the UK and Germany and behind France. He has noted that sum “even appears generous” as a percentage of GDP, but that New Zealand’s spending on medicines — the Combined Pharmaceutical Budget — “is incomprehensibly tight-fisted” at only 0.38 per cent of GDP.
“That is less than a third of the average OECD national expenditure on medicines of 1.41 per cent of GDP.”
In short, successive New Zealand governments have made a political choice to allow medical care to be strangled in one critical area.
Tiedemann also argues that New Zealand is not, in fact, a poor country — which is frequently offered as an excuse to explain why we have fallen so far behind other nations in the provision of modern drugs. While it is true that Australia has a significantly higher per capita GDP than us, it will surprise many to learn that our GDP per person is higher than the UK’s and that we’re close behind Germany’s, both of which fund far more modern drugs than New Zealand. Our per capita GDP puts us ahead of France, Italy, Japan and Spain — all of which funded at least five times more new drugs than New Zealand did from 2015-2020.
The reasons why we have fallen so far behind in funding standard drugs — in the past decade in particular — are complicated. One obvious reason is that politicians have long been able to hide behind the widespread belief that Pharmac’s hard-nosed negotiators get the very best deals possible for medicines and consequently the agency is “the envy of the world” — a claim Andrew Little was still making in December 2021 as Health minister, despite the overwhelming evidence even then that it wasn’t true.
The portrayal of a plucky Pharmac valiantly battling — and winning — on behalf of all New Zealanders meant that, for a very long time, any criticism of the agency was seen as tantamount to heresy by both the right and left, which conveniently spared the funding policies of both Labour- and National-led governments from close scrutiny.
The fact is that Pharmac itself can’t know if it’s getting the best deals on new drugs because it is not told what other nations ultimately pay for any medicine after substantial — and highly confidential — rebates have reduced the effective price.
Another problem arises from the left being so deeply suspicious of profitable businesses that Big Pharma is readily cast as a devilish cartel which requires a very long spoon to sup with — and preferably avoided if at all possible.
Senior Labour MP Carmel Sepuloni’s disgraceful description of Act’s Todd Stephenson in Parliament last month as a “pharmaceutical industry plant” is just the most recent expression of this distaste. Instead of viewing Stephenson’s 17 years’ experience with pharmaceutical companies in Australia as an advantage to the government — and for David Seymour in particular as Associate Health Minister with responsibility for Pharmac — Sepuloni played the evil-corporation card which places pharmaceutical companies in much the same reviled category as the tobacco industry.
It’s true, of course, that Stephenson should have had the foresight to understand that his shares in pharmaceutical companies might become at least an apparent political problem for Act but he has now, albeit belatedly, agreed to sell them.
The fierce debate over the funding of modern medicines has already become a flashpoint over where taxpayer money is justifiably spent, how much is wasted, and where savings could be made to pay for drugs — and it will undoubtedly ramp up further.
The left decry National’s Budget commitment to implementing tax cuts that could have funded them while the right look to specific areas where spending could be slashed and the money repurposed.
This week the Taxpayers’ Union launched a campaign to remove public subsidies for the film industry, calling on the government to “fund medicines, not movies” — especially when that money goes to “Hollywood film and video game studios”.
“This year, Wellington is doling out more than $100 million of taxpayer money on corporate welfare to the film and gaming sectors. Meanwhile, the cost to fund new cancer treatments
is $70–$80 million.” The union cited Treasury advice that “suggests the [film] subsidies cost more than the economic benefits they generate”.
The Budget’s cancer-drugs debacle has undoubtedly damaged perceptions of the government’s competence and compassion, but the intense spotlight it has shone on Pharmac’s budget has also given it licence to further cut expenditure that appears of marginal benefit — and to use those savings to pay for a swag of medicines.
David Seymour has been a vocal critic of several taxpayer-funded bodies he sees as eminently dispensable. He has long criticised the Human Rights Commission, viewing it as a hotbed of left-wing ideology “masquerading as a government department” that largely fails to perform its core function. He favours its abolition (while retaining the Human Rights Review Tribunal), alongside removing “demographic ministries” such as the Māori Development Ministry, Ministry for Pacific Peoples, Ministry for Women and Ministry for Ethnic Communities.
The tens of millions of dollars saved each year by abolishing these entities would buy an impressive number of drugs and give New Zealand a chance to catch up with the many nations we lag.
And if it comes down to a contest for public sympathy between the piteous cries for help we see most days in the media from patients and their families begging for the thousands of dollars needed to keep them alive and the jobs of well-paid bureaucrats in what are widely seen as ineffectual and often politicised roles, the bureaucrats aren’t going to win.
Graham Adams is an Auckland-based freelance editor, journalist and columnist. This article was originally published by ThePlatform.kiwi and is published here with kind permission.
The list Luxon relied on to select the 13 chosen drugs — which was based on a report compiled in 2021 of drugs publicly funded in Australia and other countries but not in New Zealand — was already out of date when he announced National’s policy last year. It was never intended to be a “shopping list”, as one of its authors put it. And it didn’t cover blood-cancer drugs.
National’s Health minister, Dr Shane Reti, has somehow been spared crucifixion so far over the debacle. Speaking to Leah Panapa on The Platform, patient advocate Rachel Smalley described Reti as being “firmly ensconced in primary care” — which appeared to tactfully imply he has a limited overview of his portfolio. She also wondered about “how much influence Reti has around the Cabinet table”.
RNZ’s Lisa Owen asked Dr Rodger Tiedemann, a consultant haematologist at Auckland Hospital, why he thought the Prime Minister and Minister of Finance were publicly defending the bungled policy rather than leaving that task to the Health minister. Tiedemann said he thought Reti was “lying low… he’s got himself into a little bit of trouble with promising the 13 medicines without really consulting Pharmac on that, and without including blood cancers”.
The drugs Luxon promised to fund are used to treat solid tumours (such as lung, liver, kidney and bowel cancer) but blood cancers (which include leukaemias, lymphomas and myelomas) form an entirely separate, and substantial, category. Unlike solid tumours which can be treated with surgery and radiotherapy, blood cancers can only be treated with medicines.
Unfortunately for Reti, he made a quasi-promise to blood-cancer patients when announcing National’s policy last year, reassuring them: “We have not forgotten you.” Then in March, he made that explicit by saying that he expected the list of 13 medicines would be updated to include consideration of blood-cancer medicines once the Cancer Control Agency had produced its recommendations — which are expected to be published by June 30.
Last week, 50 haematologists — including Tiedemann — joined patient advocacy groups in writing an open letter to the government seeking a reassurance that those commitments to the country’s 21,000 blood-cancer patients would be honoured.
Tiedemann added: “There is a huge gap in the funding of blood-cancer medicines in New Zealand that is at least equal to that of solid tumours. Blood-cancer patients have been assured that they would not be forgotten and the cancer medicines plan would include them. As haematologists, we feel compelled to speak up on this important commitment made to our patients that has fallen silent.”
Now it appears Reti has reneged on his promise and retreated even further into his bunker. Declining to be interviewed by The Post this week on the question of blood-cancer drugs, he would only say in a statement: “We are committed to funding [the promised 13] treatments before the next Budget.”
That means the government has now broken two promises to different groups of cancer patients and their families, some of whom will have voted for National largely because they trusted its pledges.
It is worth noting here that the drugs haematologists are seeking are not the latest cutting-edge treatments such as CAR-T cell therapy but rather medications — such as daratumumab for multiple lymphoma — that have become the standard of care in a host of other countries. Forty-nine in daratumumab’s case, to be exact.
No matter how much the government engages in damage control to patch up its botched promises, however, the question of why New Zealand remains so far behind our peers in the provision of modern cancer drugs will not go away.
Tiedemann is a regular commentator at patient seminars and in the media and he makes the point that New Zealand’s recent spending on health overall per person of $US6061 ($NZ10,202) is hardly miserly — falling between the UK and Germany and behind France. He has noted that sum “even appears generous” as a percentage of GDP, but that New Zealand’s spending on medicines — the Combined Pharmaceutical Budget — “is incomprehensibly tight-fisted” at only 0.38 per cent of GDP.
“That is less than a third of the average OECD national expenditure on medicines of 1.41 per cent of GDP.”
In short, successive New Zealand governments have made a political choice to allow medical care to be strangled in one critical area.
Tiedemann also argues that New Zealand is not, in fact, a poor country — which is frequently offered as an excuse to explain why we have fallen so far behind other nations in the provision of modern drugs. While it is true that Australia has a significantly higher per capita GDP than us, it will surprise many to learn that our GDP per person is higher than the UK’s and that we’re close behind Germany’s, both of which fund far more modern drugs than New Zealand. Our per capita GDP puts us ahead of France, Italy, Japan and Spain — all of which funded at least five times more new drugs than New Zealand did from 2015-2020.
The reasons why we have fallen so far behind in funding standard drugs — in the past decade in particular — are complicated. One obvious reason is that politicians have long been able to hide behind the widespread belief that Pharmac’s hard-nosed negotiators get the very best deals possible for medicines and consequently the agency is “the envy of the world” — a claim Andrew Little was still making in December 2021 as Health minister, despite the overwhelming evidence even then that it wasn’t true.
The portrayal of a plucky Pharmac valiantly battling — and winning — on behalf of all New Zealanders meant that, for a very long time, any criticism of the agency was seen as tantamount to heresy by both the right and left, which conveniently spared the funding policies of both Labour- and National-led governments from close scrutiny.
The fact is that Pharmac itself can’t know if it’s getting the best deals on new drugs because it is not told what other nations ultimately pay for any medicine after substantial — and highly confidential — rebates have reduced the effective price.
Another problem arises from the left being so deeply suspicious of profitable businesses that Big Pharma is readily cast as a devilish cartel which requires a very long spoon to sup with — and preferably avoided if at all possible.
Senior Labour MP Carmel Sepuloni’s disgraceful description of Act’s Todd Stephenson in Parliament last month as a “pharmaceutical industry plant” is just the most recent expression of this distaste. Instead of viewing Stephenson’s 17 years’ experience with pharmaceutical companies in Australia as an advantage to the government — and for David Seymour in particular as Associate Health Minister with responsibility for Pharmac — Sepuloni played the evil-corporation card which places pharmaceutical companies in much the same reviled category as the tobacco industry.
It’s true, of course, that Stephenson should have had the foresight to understand that his shares in pharmaceutical companies might become at least an apparent political problem for Act but he has now, albeit belatedly, agreed to sell them.
The fierce debate over the funding of modern medicines has already become a flashpoint over where taxpayer money is justifiably spent, how much is wasted, and where savings could be made to pay for drugs — and it will undoubtedly ramp up further.
The left decry National’s Budget commitment to implementing tax cuts that could have funded them while the right look to specific areas where spending could be slashed and the money repurposed.
This week the Taxpayers’ Union launched a campaign to remove public subsidies for the film industry, calling on the government to “fund medicines, not movies” — especially when that money goes to “Hollywood film and video game studios”.
“This year, Wellington is doling out more than $100 million of taxpayer money on corporate welfare to the film and gaming sectors. Meanwhile, the cost to fund new cancer treatments
is $70–$80 million.” The union cited Treasury advice that “suggests the [film] subsidies cost more than the economic benefits they generate”.
The Budget’s cancer-drugs debacle has undoubtedly damaged perceptions of the government’s competence and compassion, but the intense spotlight it has shone on Pharmac’s budget has also given it licence to further cut expenditure that appears of marginal benefit — and to use those savings to pay for a swag of medicines.
David Seymour has been a vocal critic of several taxpayer-funded bodies he sees as eminently dispensable. He has long criticised the Human Rights Commission, viewing it as a hotbed of left-wing ideology “masquerading as a government department” that largely fails to perform its core function. He favours its abolition (while retaining the Human Rights Review Tribunal), alongside removing “demographic ministries” such as the Māori Development Ministry, Ministry for Pacific Peoples, Ministry for Women and Ministry for Ethnic Communities.
The tens of millions of dollars saved each year by abolishing these entities would buy an impressive number of drugs and give New Zealand a chance to catch up with the many nations we lag.
And if it comes down to a contest for public sympathy between the piteous cries for help we see most days in the media from patients and their families begging for the thousands of dollars needed to keep them alive and the jobs of well-paid bureaucrats in what are widely seen as ineffectual and often politicised roles, the bureaucrats aren’t going to win.
Graham Adams is an Auckland-based freelance editor, journalist and columnist. This article was originally published by ThePlatform.kiwi and is published here with kind permission.
6 comments:
So Dr Reti "made a quasi-promise" last year by saying: “We have not forgotten you.” Then in March, he said he expected a list of 13 medicines would be updated. Where's the promise to fund any particular medicine?
I think Dr Reti is overall doing a good job. Do you prefer the health system under the previous government where your treatment depended on your ethnicity, and most of the surgeons were leaving the country?
Yes, yes, yes - get rid of the divisive demographic ministries. We are all New Zealanders with the same rights and duties. Redirecting that funding to medicines would be of far more benefit to us all.
My column made no comment on whether Dr Reti is doing a good job "overall". It was focused entirely on his (at least implied) promises made last August and in March this year regarding blood-cancer drugs.
He didn't promise to fund any particular drug but he reassured blood-cancer patients that their needs would not be overlooked.
On August 21 last year, he said when announcing the ‘13 medicines’ policy:
“I want to give a shoutout to the non-solid [tumour] cancer sufferers – that’s the people with myeloma and leukaemia [and lymphoma, among other blood cancers] – we have not forgotten you… but where we are now is that the Cancer Control Agency hasn’t done the piece of work like they have done with the solid tumours, to be able to give us that guidance as to what those treatment gaps are. So again, we are sending out a signal to the people with myeloma and the people with leukaemia, we understand, we haven’t forgotten you, we just need that piece of work to be done by the Cancer Control Agency”.
He made it clear that he was only waiting on that advice before he could take specific action.
The money wasted over the 4 Covid scamdemic years might have come in really useful for real medical needs, don’t you think?
And as the saying goes "to add insult to injury", both past and present Government's continue to extract GST on the misery of those unfortunates that have to fund their own treatment regimes - in some instances amounting to many ten's of thousands of extra dollars on top of the hundred's of thousands they personally pay. This is a disgrace and to claim that they don't want to mess with GST, as I've heard uttered from some politiicans, is just willful ineptitude and/or otherwise the turning of a callous blind eye.
If it befell them, I wonder how long it would take to effect some change?
How dumb must the advisor's to our government ministers be to not honor an election pledge that sticks right to the heart of every kiwi.
To put it right now is like locking the barn door after the horse bolted.
In the overall budget this was and is a small amount. But it's a action that will stay on the minds of voters for years to come.
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