John Crown (Independent)

I ask the Leader to seek clarification from the Minister for Health on an issue I alluded to previously but which is becoming more acute, namely, whether there has been a change in the process for deciding what anti-cancer drugs will be made available through the health service.

Good research shows that countries which underspend on cancer drugs have inferior cancer outcomes. A famous study carried out by the Karolinska Institute several years ago caused a great deal of controversy in this regard and other research conducted by a young health economist working with me came to a similar conclusion.

The country on which we have most closely modelled our health system is the United Kingdom, which is the most advanced rationer of cancer drugs and among the large western health systems has the worst survival rates in many cancers for which records are kept. It is upsetting to discover that the philosophy followed in that country appears to be entering our health service. Our historically poorly developed cancer service, which had few specialists and a long waiting list, had the advantage of offering good access to drugs. Our ability to access drugs like taxotere, which is a good chemotherapy drug, herceptin, which was a stunningly important drug for a small number of patients with breast cancer, and other drugs was substantially better than our colleagues in the United Kingdom. A small amount of cancer tourism even took place under the radar with patients coming here for treatments that were unavailable in the UK.

However, it appears that the UK model is now being applied to our decision making process. An entity called the national centre for pharmaco-economics, the head of which was reared in the culture of British health care rationing, is now making decisions that appear to routinely deny drugs to cancer patients in Ireland. This has reached a crisis level with a particular drug called ipilimumab, which is used to treat patients with melanoma. Ipilimumab is expensive and does not work very well for most patients but a small number win the big lottery in that they seem to be cured.

As a society, we have to decide whether it is worthwhile to invest approximately €4 million per annum in providing this drug for suitable patients who have this disease and for whom no other curable therapy exists. It is an easy decision for me if our health system can afford to spend money to have the communications clinic write speeches for the Minister for Health or on establishing corporate affairs in every country. If we can afford to pay €10 million per year for HIQA, which has not saved a single life in this country, I cannot understand why we cannot make these drugs available to our patients. I have recently heard that another promising breast cancer drug is also being denied. Many of the treatments we routinely use today would never have been passed if the same rules were followed 20 years ago.

I am aware that we do not live in an economic vacuum. I do not argue that there should be limitless amounts of money to spend exclusively on expensive cancer drugs but we are misspending much of the money in other areas of the health service instead of investing in these drugs. For this reason I seek a clarification from the Minister on the status of the decision making process for cancer drugs and, in particular, ipilimumab. I have a 21 year old girl and a 32 year old mother of a young family who are asking me every day whether I can procure this drug for them. Not only is it being refused by the HSE but now the private insurers are following the lead. One small office somewhere in the bureaucracy is making powerful decisions to make these drugs unavailable across the entire health service.