GESTIÓN EN SALUD PÚBLICA: UK politician calls for quicker access to experimental cancer treatments

domingo, 4 de febrero de 2018

UK politician calls for quicker access to experimental cancer treatments

UK politician calls for quicker access to experimental cancer treatments

Bioedge

UK politician calls for quicker access to experimental cancer treatments

by Xavier Symons | 3 Feb 2018 |

Should cancer sufferers have greater access to experimental treatment?

Yes, says British politician and former cabinet minister Tessa Jowell, who addressed the House of Lords on the matter late last month.

Baroness Jowell, who is suffering from a malignant brain tumour known as glioblastoma, argues that the approval process for cancer treatments needs to be quicker, and advocates the use of what are called “adaptive clinical trials” to test cancer drugs.

Current UK trial methods require that each new drug have an individual trial path, involving several phases that can be extremely costly and take several years.

Adaptive trials are designed to improve the speed and efficiency of drug development. They do this by taking a more flexible approach, allowing multiple drugs to be tested within the same trial. As a result, drugs that hold promise can be rapidly identified and tested, while other less effective drugs can be discarded.

“So many cancer patients collaborate and support each other every day...All we now ask is that doctors and health systems learn to do the same”, Jowell said to the Parliament.

Some scientists are supportive of Jowell’s proposal.

Writing in The Conversation, neuropathologist Silvia Marino and oncologist Peter Hall of Queen Mary University described the use of adaptive trials as a “more flexible approach for a new era”: “For patients with rapidly progressing, life-threatening conditions, such as glioblastoma, [adaptive trials] can make the difference between having access to a new drug or not”.

But many are sceptical of the proposal.

In a 2015 paper, Indiana University clinician Scott Saxman warned of significant ethical concerns that arise from such studies. According to Saxman, these concerns include “loss of equipoise, lack of processes for adequate informed consent, and inequalities inherent in the research design which could lead to perceptions of injustice that may have negative implications for patients and the research enterprise”.

Saturday, February 3, 2018

For years bioethicists of a utilitarian cast have argued that conscientious objection has no place in medicine. Now Canadian courts are beginning to put their stamp of approval on the extinction of doctors’ right to refuse to kill their patients.

The Superior Court of Justice Division Court of Ontario ruled this week that if doctors are unwilling to perform legal actions, they should find another job (see report in BioEdge).

The case is sure to be appealed, but if the doctors championing conscientious objection fail, the consequences will be dire. Throughout Canada, doctors would be required to refer for euthanasia. If they refuse, they will be hounded out of their profession, or, at best, shunted into specialties where the question will not arise, like pathology or dermatology.

This ruling shows how quickly tolerance vanishes after euthanasia has been legalised. In the Carter decision which legalised it, Canada’s Supreme Court explicitly stated that legalizing euthanasia did not entail a duty on the part of physicians to provide it. Now, however, 18 months and more than a thousand death after legalisation, conscientious objection is at risk.

It also shows how vulnerable religious-based arguments can be. The plaintiffs contended that referring patients violated their right to religious freedom. While this is true, is this the main ground for conscientious objection? As several doctors pointed out in the Canadian Medical Association Journal last year, “Insofar as all refusals of therapy are ultimately justified by the ethical belief that the goal of therapy is to provide benefit and avoid harm, all treatment refusals are matters of conscience.”