Mean Medicine
Pharmac finally gave approval for the use of a combination of drugs that preserve kidney function in diabetes last week – four years after it’s worth was confirmed by a large clinical trial. As Auckland diabetes physician Dr. Paul Drury says:
“Potentially, there are 100 people out there in end-stage renal failure who could have been spared . . . dialysis.”
He is right. There has been substantial evidence available since 2004, when the DETAIL study results were released, that treating diabetics aggressively with a combination of two drugs – an ACE inhibitor and an ARB – reduces the chance of developing diabetic kidney disease and reduces the severity of that kidney disease. Pharmac fund the first medicine, but only fund the ARB instead of the first one and then only under a specific set of circumstances. Both drugs are freely available in Australia.
So why has Pharmac been dragging their feet? Pharmac denies that that they are doing this, citing their caution in approving the class of drugs known as glitazones, subsequently found to cause heart damage. But it is one thing to be cautious in approving brand new drugs, especially new classes of drugs, it is another to obstruct the use of well-known drugs which have been found to be effective in well-constructed trials. As Dr. Drury comments on Pharmac’s slow approval process:
““This is fine for most patients, but God help you if you’re an atypical case and the common drugs are ineffective for you, because it’s incredibly difficult to get alternatives.””
Indeed. The most obvious difference between New Zealand and Australia’s health services is the stunning paucity of drugs available in New Zealand. It is clear that Pharmac’s grip on drug choice is very, very tight. Their restrictive stance and their insistence on almost near-certain proof of usefulness, makes it very hard to provide modern medicine to the people of New Zealand. It is to be hoped that National’s increased funding and drive to free up the approval system will have some positive effects on available drugs over the next couple of years.
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