opinion on what should happen to them if this situation arises. In this case, it is left to the family to decide, and often the family and the doctors can disagree on what is in the best interest of the patient, sometimes leading to court cases, which can prove just as costly as the drugs themselves. Some life-extending drugs can cost thousands of pounds a month. Why are these drugs so expensive? Part of the reason is that the drug business is very risky. For example, only one out of every ten thousand discovered compounds actually becomes an approved drug for sale, meaning that lots of money is spent in the early phases of development of compounds that will not become approved drugs. In addition, it takes about 7 to 10 years and an average cost of 500 million dollars to develop each new drug [3]. This money is spent before the drug is even approved, and if the drug is not approved, the company loses the money. Compounds that do eventually make it onto the market must cover these expenses. Furthermore the drug companies need to make profits – after all they are a business – but quite how much the profits are is an extremely controversial subject, as, after all, they are making money of the illness of others, and with the same drugs being supplied for much cheaper in the Indian pharmaceutical market [2], many people are questioning the excessive profits of the drug companies. Many people in the UK are denied certain drugs on the NHS because the NICE has deemed the drugs to not be cost effective enough. NICE is an independent organisation set up by the government to try to remove the postcode lottery by providing a definitive list of treatments that are available, and those that aren’t. NICE assess the drugs by reviewing each new treatment, and takes into account their cost effectiveness using a tool called a QALY (quality-adjusted life year) which represents the effects of the drug on both the quality of life and how much longer the patient may survive [4]. The quality of life aspect looks at the consequences on the patient’s ability to work and look after themselves; a treatment that extends life by only a small amount and also provides a low quality of life is unlikely to be approved by NICE [1]. The job that NICE has to do is extremely difficult as it knows that refusing to fund a drug may have fatal consequences for patients, and in many cases NICE has been criticised for refusing to fund some anti-cancer drugs that could potentially save lives. Some patients have even fought court cases against NICE and in some cases have been successful. The future of life-extending drugs has brought about serious ethical debate among members of the medical community, with some people suggesting that it may be unethical to pursue the extension of life too far. With drugs expected by to extend life beyond 100 years in the near future (Hall, 2003), people are questioning the use of these drugs as they cannot be available to everyone and may violate ‘natural order’ or ‘divine laws’. Is it right that the government spends public money on research that could allow wealthy inhabitants to live beyond the age of 150, while many poorer individuals die before reaching 50? [5] New, more powerful, life-extending drugs could exacerbate the problems of inequality, not only internally, but also internationally. Furthermore the rich will not only experience health benefits compared to the rest of the population, but they will also have more opportunity to consolidate wealth and power. There are, however, obvious benefits to more effective life-extending drugs, and research into anti-aging should continue, although the negatives should also be made aware of. In conclusion, life-extending drugs should be provided for on the NHS, although there is a balance between affordability and benefit. This balance is extremely tough to find when the commodity in question is human life, and there may be need for some adjustment in the future. As of 28th August 2014 Jeremy Hunt has set aside an extra £280m per year to fund these types of drugs, stating that the government needs to ‘focus our efforts on increasing access to innovative treatments’.[6] In addition, drug companies need to have an incentive to continue the development of new treatments so that healthcare can improve, which means that the price of cutting edge drugs is likely to remain high. Although the work of the pharmaceutical industry is often controversial, it puts a tremendous amount of resources into researching new technologies that ultimately shape the modern world, and maybe it is worth funding these expensive life-extending drugs so that research into newer, more effective, treatments continues. References [1]http://www.med.mcgill.ca/epidemiology/courses/EPIB654/Summer2010/NICE/cancer%20drugs.pdf [2] http://www.bbc.co.uk/news/health-21834442 [3] http://www.newscientist.com/article/mg19726371.500-paying-for-drugs.html#.U5rczZS8CWk [4] https://www.nice.org.uk/ [5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868535/ [6] http://www.independent.co.uk/life-style/health-and-families/health-news/ jeremy-hunt-promises-160m-boost-to-cancer-drugs-fund-9695324.html
E S SAY S
The Apurba Kumar Memorial Science Extended Essay Prize
L I F E - EXTENDI NG DRUGS : SHOULD THE NHS PAY FOR THEM?
CHARL I E MEERAN ( YEAR 1 3 )
T he National Health Service (NHS) and the National Institute for Health and Care Excellence (NICE) has come under considerable criticism for refusing to pay for drugs that could extend the lives of terminally ill patients. In this essay I will explore the ethical issues surrounding the financing of life-extending drugs and treatments. Life-extending drugs are products that keep a patient alive for longer than they are expected to live without that drug. A huge number of treatments come under this bracket, including things like blood pressure tablets, but also more costly and controversial drugs such as some cancer drugs that may not extent life for a long period, or may extend life at an extremely low quality. The problem with giving these kinds of drugs to everyone is that the treatments cost huge amounts of money, and the amount of people that could potentially benefit is also extremely large. This is a consequence of one of the biggest challenges in medicine today: the ageing population. People are living much longer, which means that they are more likely to suffer from degenerative diseases, which require more hospital time and are less easily treatable. With more people suffering from long- term illnesses that may be terminal and incurable, it is extremely hard to predict when somebody will die, and may also be hard to predict how long a certain treatment or drug will extend their life for. Cancer is a huge problem in Western Countries where the life expectancy is roughly 80 years old and is only set to increase. Cancer tends to affect people later in life and these patients offer a huge market for life-extending drugs. The refusal to fund some of these anti-cancer drugs has been especially controversial as cancer can be one of the most difficult diseases to treat, and new drugs can often be seen as miracle cures. Furthermore, cancer can also affect younger people who still have most of their life to live, or possibly those with young children, and it is hard to not feel that these people should be given any treatment available, no matter the cost. When cancer affects the elderly, the funding of expensive drugs and treatments becomes much more complicated as patients who have retired and have grown up children may be those, who, even if the treatment keeps them alive for many more years, may not have a good quality of life, and will only cost the country in the long term. These patients also tend to be those who will react most unpredictably when given these drugs. Furthermore, the longer they spend in hospital the more likely that they catch other diseases that eventually could worsen their condition. Of course, these patients still deserve treatment, but the benefits to society are limited. Everybody dies. People have more faith in modern medicine than they perhaps ought to, as many people, instead of dying at home, are taken to hospital and are kept alive for as long as possible, even if there is a very slim hope of recovery. Some families expect that doctors can save anyone, and even when the doctors themselves advise against treatment, families or patients can insist on receiving every last possible treatment, some of which can be very painful for the patient, and in some cases only prolong suffering. Maybe the huge amount of resources used to keep these patients breathing could be better used elsewhere. People need to appreciate that there is a limit to medicine, and that eventually everybody dies. Modern medicine has distorted the meaning of death, as a person can be sustained in hospital for a long time after their body could naturally keep them alive. Some patients can be kept in a vegetated state for months; but with no apparent mental capability and unable to still survive outside of the hospital bed, are these people really alive? It is an extremely difficult question for anybody to answer, especially as the patient themselves cannot communicate, and may have never expressed an
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