How does the operation of PHARMAC's 'Community Exceptional ...

effectiveness of treatment. However, not providing funding to terminally ill
people for experimental treatments which ultimately prove to be beneficial, even
curative, may mean that people will die unnecessarily. Not paying for
treatments which exist, but come at a prohibitively high cost, may leave people
who are critically ill with a sense of abandonment in their hour of need (Daniels
& Sabin, 2008).
An example of the Rule of Rescue lobbying occurred in 2008 in the UK when
NICE declined to place four cancer drugs on the national formulary. One of
these drugs was described by the London Daily Telegraph as being able to
“double life expectancy” and called the NICE decision “a devastating death
sentence for cancer patients” (Tapu, 2008). The drug referred to was
Herceptin 7 . Even if Herceptin was shown to improve the life expectancy (not
provide a cure) of patients after twelve months of treatment, the costs might be
too large for Britain and other European countries, compared with other
priorities to publicly fund other health services. The newspaper article claimed
that this drug, plus a raft of other designer cancer drugs, was so expensive that
they could spell the end of Europe’s tradition of social health care (Tapu, 2008).
Funding difficulties related to the provision of Herceptin in New Zealand is also
discussed in the Research Findings (Chapter 6) of this thesis.
The Rule of Rescue develops questions about just what is a prohibitively high
cost. How much is too much to save a person’s life? How much is too much to
attempt to save a person’s life? How much is too much to spend attempting to
prolong a person’s life? How much is too much to attempt to prolong a person’s
life for a few more days or hours?
Hadorn (2006) acknowledged these questions are real dilemmas for individuals.
However, he advocated that public health services should rule ‘out of bounds’
any appeals to the imminent death or ‘only hope’ treatments which fail the
7 Throughout this thesis I have used the AMA Manual of Style (10th edition) protocol for using the names of
branded medicines. Specifically the AMA states that a trademark, for example ®, TM or SM, should not be
used in scientific journal articles or references, but the initial letter of a trademarked word should be
capitalised(American Medical Association, 2007). Note that I have capitalised ‘Herceptin’ because it is a
branded trademarked name of a medicine. The use of scientific componentgeneric names of medicines is
not capitalised, for example prednisone (as seen on p. 194 of this thesis). PHARMAC’s table of
Community Exceptional Circumstances claims released under the OIA (Appendix 7 p.272) gives many
examples of this convention e.g. Suboxone which is a branded drug and buprenorphine which is a generic
drug.
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