Sally Crossing’s recent article about the media’s overenthusiastic promotion of the breast cancer drug Herceptin rang some loud bells for my colleagues and I.
We have analysed the media and political pressures put on the Pharmaceutical Benefits Advisory Committee (PBAC) when it was considering whether Gardasil, the vaccine used to protect against cervical cancer, should be subsidised by the public purse.
Our study, published in Health Policy online, is based upon an analysis of 523 newspaper articles mentioning Gardasil in the two years from December 2004, as well as related interview transcripts, media releases and fact sheets.
As with the Herceptin study, many of the media reports were verging on the promotional, trumpeting the vaccine as a “blockbuster”, “medical miracle” and “lifesaver”.
When the PBAC decided against subsidising the vaccine in early November 2006, the decision was loudly condemned by many politicians, consumers, doctors and advocacy groups. Experts, whose association with the company was not always declared, were also critical. Only one doctor, apart from former PBAC members, was reported as supporting the independence and due process of the PBAC.
CSL was able to provide data supporting its criticism of the decision, but the PBAC members — bound by confidentiality rules — were unable to publicly defend or explain their position.
Notably, politicians and health professionals did not ask the company to justify its price even though early research on the vaccine’s development was funded with Australian taxpayer or community funds.
After requesting further information from CSL, an extraordinary meeting of the PBAC on November 22 recommended funding of the vaccine.
Our study suggests that many in the media, politics, medical profession and advocacy groups did not recognise or understand the importance of the PBAC process.
The PBAC’s decision-making takes many factors into consideration, including equity issues — that funding one particular treatment may mean diverting money away from treatment of other groups of patients. It must weigh up many competing interests, and not only those represented by such vocal campaigns.
Many new pharmaceuticals have very high prices with only marginal incremental benefits. The independence of the PBAC listing process is critical to assessing the cost-effectiveness of new medicines and balancing efficiency and equity.
It is worrying that media and political campaigns such as those associated with Gardasil risk undermining the independence and sustainability of the PBAC. Politicians, the media, health professionals and others involved in such campaigns should remember that the PBAC helps ensure fair and equitable access to medicines.The community will be the loser if the PBAC’s independence and work is compromised.
Dr Vitry is based at the Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences