Since someone on Twitter has no idea about
“chemo day”, and sees fit to tell me I don’t
know, let me tell you what it’s like.
Today, Ms T didn’t get her usual chair in
“siberia” – that part of the chemo suite reserved for people both on cytotoxins
and with superbug-risk. Someone else was there first, so she had the chair next
door.
He was an old gentleman who’d arrived, been
given morphine, been sent off to get an MRI before his chemo (this sounds bad
to me), returned, and waited. Then, before his chemo, he was visited by another
doctor, given a butterfly for morphia, recommended for admission and assigned a
bed, and sent off again for another MRI because they “wanted more information”.
This sounds really bad to me.
On the other side was a teenager who nearly
broke my heart: the beautiful-but-hairless that mostly I’d only seen in
fundraiser ads (and in our adventures at RPA, we’ve met many
cancered-and/or-transplant teenagers).
And there were the carers. On one side, a sixtyish
woman fussing over her husband; on the other, a fortyish woman fussing over her
daughter. In the middle, us: me arriving late, because I’d had other things to
do today, Ms T waiting after some hours because the chemo suite is busy.
We were, remember, in a corner: sibera. The
rest of the suite has maybe thirty chairs.
We got through with the small pleasantries
that make tolerable being around so much grief. Everybody here is dying, and
the carers are all cheerful. “Oh, I can’t stand to see the needle going in.” “I
fainted once, so I must be worse than you.” From the teenager’s seat: “Pussies!
I have to get the needle IN me, and my bags are bigger than yours!” (She was
right. She had a line-up that looked like three liters).
Every single
drug these three were receiving was an unbranded generic. There were two
cyclophosphamide patients, one on something I didn’t recognise but didn’t come
with a “big name” above the chemical name.
We all smiled and chatted. All of us thanked the nurses, whose job I wouldn’t take at two hundred
thousand a year, who were invariably happy and gentle and solicitous. We
chatted en-passant, wheeled our respective patients’ assemblies towards the
toilets as required, tried not to invade each others’ privacy (funny thing:
cram people in desperate circumstances into a tight space, and we’re all sensitive to each others’ privacy), and tried to smile.
In another corner of the world, the
government has decided not to pay full-price for one cancer drug that’s now
available as a generic. In essence the policy is this: “since the drug is
available for $X, we will pay $X. If big pharma wants to supply at that price,
fine. If not, we will buy it as a generic and pay $X.”
Whaddaya know? Within nanoseconds, the
entire Big Pharma machine is in swing.
I know how the machine works. I once worked
for the publisher of Australian Doctor, and not only did I get a close-up
day-to-day of the machine, I had an internal training session on its practises.
The “desperate patient” is the poster-child
of any pharmaceutical campaign, whether it’s for Viagra, the creation of a
brand-new (medicable) psych complaint, or “protect this cancer treatment”.
The last one is the best. Who’s going to
argue with a cancer patient’s needs?
Me. Someone inside the system. Someone
who’s seen it at work. Someone who knows how it works, both as a journalist and
carer.
The entire pharmaceutical campaign over the
funding of one – just one – drug is based on a simple premise: most people
don’t know.
The big thing they don’t know is this: most of the drugs you get in a hospital are generic. From the
paracetamol up. Want an anti-emetic? It’ll be generic. Need morphia? Ditto.
Artificial morphioid? Yep, generic. Cancer drug?
That’s the sensitive issue, but: most of
the drugs used to fight cancers are out of patent, dispensed as generics. Not
one person receiving those drugs wants them.
They just need them – and don’t care about the
brand name.
Some of those drugs are used for other
things, like locking down the immune system. Cyclophosphamide, my wife’s drug of
choice, came out of the 1950s: anyone arguing that the government must fund its branded versions, Cytoxan, Endoxan, Neosar, etcetera,
merely to demonstrate its “commitment” to the health system?
Stupid.
When the premium for the brand could be
spent somewhere else?
Stupid.
Should “paracetamol 500 mg” be replaced
with a branded product at six times the price, in hospitals, merely as an icon
of our “commitment to excellence” or some such shit?
Stupid.
Should the pharmacist insist that Ms T be
dispensed with “Immuran” instead of Azathioprine, just so the
government can pay more on the PBS to get the brand instead of the chemical
compound?
Stupid.
There is no good argument
for demanding that the government pay a brand-premium, when “brand” exists only
as an emotional consumer artefact to get people to pay premiums that they don’t
have to pay.
The idea that “extra
spending” should happen as a symbol of “commitment” is childish and simplistic.
