
Drug giants Novartis and Bayer fail to stop NHS offering cheaper eye treatment - cirrus-clouds
https://www.bbc.co.uk/news/health-45588983
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olvar_
Where I live doctors are only allowed to give prescriptions for the generic
chemical compound and are forbidden to give prescriptions for specific brands.
They may suggest the use of a particular brand if they know of a benefit over
others but the one who decides is the patient. Of course this is not very
useful when the drug is patented or if there is only one laboratory producing
it, but none the less it seems like a sane default. And this is in a private
healthcare system, it is surprising that the NHS doesn't have a rule like this
when is their taxpayer's money being used.

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makomk
The cheaper alternative that the NHS wants to offer is not actually the same
as the more expensive drug that's licensed to treat wet age-related macular
degeneration. It's related and there's every reason to believe it's as safe
and effective as the licensed drug, but it's still not the same stuff.

~~~
gerdesj
The cheaper one is 3.5% and 5% the price of the other two and is recommended
by WHO and used widely around the world, including the US. As always the
decision as to what will be appropriate will lie with the doctor but at least
they have the option now.

I expect that the price of the other two will mysteriously drop quite
dramatically now ...

~~~
candiodari
Yes but there's 2 issues:

1) not in the same concentration/dose (patient will need to change the dose by
breaking pills)

2) not according to the UK government (which has never approved the cheaper
drug)

So now the big question is, suppose this goes very wrong for a patient, who is
responsible ? The doctor ? The patient ? The government ?

~~~
jaclaz
>1) not in the same concentration/dose (patient will need to change the dose
by breaking pills)

Specifically I don't think they are using pills (untouched or broken) to make
intraocular injections.

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btian
I don't understand their arguments. Do they have proof that their licensed
drugs are safer and/or more effective than the replacement?

The article says "In January, the National Institute for Health and Care
Excellence (NICE) concluded that Avastin was as safe and effective as the two
licensed drugs, Lucentis and Eylea."

If they have no proof, they should stfu.

~~~
candiodari
No. The issue is different. You see, the government demands drugs are proven
to be safe before use, and safe for specific purposes, specific treatments.

Now I say "demands" because the government does zero research on the subject,
zero testing. Rather, the government demands that the pharmaceutical companies
do this, at great expense, by third parties, extensively regulated, involving
at least hundreds of UK patients, ... a total maze (that somehow seems to
provide excellent, HIGHLY paid jobs for ex-government regulatory doctors in
these pharmaceutical companies). Also, this has to be done on a per-country
basis.

Now there was an issue. These companies had done that for one drug for this
specific treatment, this was the more expensive drug. They hadn't done it for
the "cheaper" alternative they used elsewhere in the world for that treatment,
but that drug was being used for another treatment. Note: this makes it highly
illegal for these companies to suggest using that drug.

(so the accusation made that these companies were preventing the use of the
cheaper drug is ... evil. I don't know another word for it. They refused to
allow prescription of that drug for the eye problem _because the government
forces them to refuse that_. And now the government also decided it's illegal
as well. Great. If we're unlucky they'll just withdraw the drug altogether.
Then eye and cancer patients are fucked, but hey, the government won't have to
pay. Hurray !)

Also cheaper is between quotes because it's only cheaper because they never
went through the governments' expensive approval process, which would have
added to the cost and therefore changed the picture. Furthermore it would have
factored in the pricing decisions made by the companies.

So now we have established that the government gets to completely disregard
it's own safety rules to save a buck (no worries "it's safe" because it's
proven to be safe elsewhere with a differently manufactured pill with the same
active substance ... except ... no it isn't, or at least, you can't be sure).
And if, for some reason, there is a difference between the drug when using it
for cancer and using it for eye treatment ... who will pay for the damage
caused to patients ? Because does this now also mean the government assumes
responsibility for this drug (which they did in the past (not for this drug),
then when it cost them money ...).

The issue with drugs "having issues" is that generally patients die or develop
a very serious health issue when drugs have unanticipated side effects. This
whole safety regulation is setup to avoid that and to make sure pharmaceutical
companies never take too much risk, and can be forced to carry the cost of
fucking up.

Note: this is an example of the UK government "taking responsibility" for it's
own medical fuckups: [https://www.bbc.com/news/uk-england-
birmingham-45101091](https://www.bbc.com/news/uk-england-birmingham-45101091)

I would argue that even if this turns out to be safe, sooner or later letting
the government just bypass drug safety rules will cause very severe issues (or
should I say, will cause very severe issues _again_ ), and then these people
are going to find out that not only does the government not take care of them
... well ... read the above link and then read the next paragraph:

> In October 1979, three judges at Birmingham Magistrates' Court dismissed the
> prosecution's evidence that the University of Birmingham had contravened the
> Health and Safety at Work Act.

(Just so we're clear, at this point it was clear that the government had not
only failed to provide adequate isolation to a lethal disease, but gotten a
report that it had failed to do so BEFORE any actual harm, THEN the government
lab accidentally infected someone working above the laboratory, imprisoned her
and most of her family and colleagues immediately (with zero compensation),
... and then decided the government had zero culpability in all this. Why ?
Because it was impossible that this woman was infected with a lethal disease
that didn't exist anywhere in the country except in that lab, but she had not
gotten it from that lab, so ... no compensation ... yes, really. To add
extreme insult to very severe injury and death, the queen granted honors to
the witness that exonerated the government later that year ...

So to say that I don't think the UK government should be trusted to make
medical decisions like this is a vast understatement. We are all going to die)

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pkaye
Suddenly drug companies don't want off-label use when it doesn't suit them...

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mirchiseth
This debate has happened in the US for many years. Here is a wsj article from
2011
[https://www.wsj.com/articles/SB10001424052748704463804576291...](https://www.wsj.com/articles/SB10001424052748704463804576291572903925578)

