Basket Case

The voice of colorectal cancer patients, who called a hunger strike to protest the exclusion of Avastin from the "drugs basket" of state-subsidized medications, has attracted enormous media attention. The heart melted at the sight of those unfortunates struggling for their lives, who cannot afford the expensive drug that might save their lives?

The prime minister's heart was touched, too: yesterday Ehud Olmert announced that he would ask the Drugs Basket Committee to find a way to add Avastin, thus assuring that colon cancer patients could get the treatment at the expense of the taxpayer; at the expense of the Drugs Basket.

What the prime minister didn't say, nor did anybody else, is that including Avastin will mean other drugs already in the basket must be kicked out. The hunger strike worked: the colon cancer patients will be treated, while others will have to go without the drugs they need, which had been approved and which will be taken out of their hands.

The colon cancer patients are due fulsome praise for the effectiveness of their fight. But the people who succumbed probably do not deserve praise. The principle they created is that in Israel, the ones who scream the loudest get the attention: there is no place for professional judgment in the management of the state. It's all politics.

Can't they do math?

The facts are that the 2006 budget allocated NIS 200 million extra to the Drugs Basket, which is now worth NIS 4 billion a year, and is one of the most generous of its kind in the world. The government set a budget framework for the basket, yet the Drugs Basket Committee - a government panel whose job is to choose which drugs should be added each year - recommended additions that would cost not NIS 200 million a year, but NIS 468 million.

Anywhere else, the health minister would have fired them on the spot for incompetence.

The government's job is to set a budget and the panel's job is to choose new drugs within that budget, not vice versa. The police chief can't just up and decide that he'll spend another billion shekels on the force this year and the Drugs Basket Committee may not decide what its budget is.

But Israel is Israel and therefore, instead of sending the committee members packing, they are being silently supported by the ministry in charge, Health; they are even being supported by the prime minister, all to the applause of the popular press.

The lies and nothing but the lies

Nobody at all is telling the truth to the public. The truth is that extra budget or no, the committee hadn't recommended adding Avastin to the basket. That's right: the NIS 468 million extra it recommended didn't cover Avastin.

Why? Because oncologists didn't recommend it.

Avastin, it turns out, is a highly controversial drug whose success in saving the lives of cancer patients is not assured. Oncologists voted for other drugs entirely.

In other words, not only is there no economic reason to include Avastin in the basket: there is no medical reason either. The doctors say so themselves.

But they only say that in the official papers that they submit to the Basket Committee. In the figures presented to the press, their opinion is well concealed.

The result is that a drug that isn't even highly recommended by the medical establishment is about to join the national health basket at the expense of other drugs that are highly recommended.

Another result is that the professional standing of the Basket Committee, as an expert body supposed to set the priorities for state support for drugs based on a specific budget, has crumbled.

And worst of all is that the State of Israel has entirely lost its ability to manage policy and set priorities on matters concerning human life: politics will win the day.