FT Health: Cancer optimism tempered by ‘financial toxicity’

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The good news: scientific breakthroughs mean more people are surviving cancer than ever before. The bad news: cases are rising globally as more countries adopt western lifestyles, with obesity set to displace tobacco as the disease's number one cause.

Combating Cancer, today's FT special report, focuses on the progress of some of the breakthroughs: the rise of immunotherapy, using a patient's own immune system to tackle cancerous cells; the monitoring apps that help extend patients' lives; “tissue-agnostic” treatments; and liquid biopsies — referred to this week as "the holy grail of cancer research".

With research showing that up to 40 per cent of cancers are preventable, there is a growing role for public health initiatives to support healthier lifestyles and help minimise the risks.

But the price and affordability of cancer drugs are significant barriers to treatment. “The perverse reality of the market today is that cancer treatment comes with its own financial toxicity,” says the head of the US Food and Drug Administration. A patient “should not be penalised for their biology”.

Read the full report: Combating Cancer

Three questions

Ilona Kickbusch, director of the Global Health Centre at the Graduate Institute in Geneva, and a member of the WHO Independent High-Level Commission on Non-communicable Diseases which publishes its report today.

What are the key issues to emerge from the commission?

I think there is a need to look at the financial flows that drive the NCD epidemic, and talk with those investors — pension funds and insurers — that have [already] decided not to invest in tobacco and alcohol to devise a new strategy. Some see these areas are not good long-term investments. Politicians now need to address the commercial determinants of health in a global consumer society.

What recommendations are there for politicians?

There is a call for high level politicians — prime ministers, presidents, finance, agriculture and foreign as well as health ministers — to get involved because NCDs are important for the economies of their countries, and because the issues are so inter-sectoral. There is also an increasing realisation that mayors and local officials have impact. In some cases they have significant powers — on regulation, local taxation and the environment, on parks and bicycle paths.

Why was there no official call for sugar taxes?

That was a major clash in the commission, and we couldn’t reach agreement. Some members felt there was not enough evidence. That reflected realpolitik. The World Health Organization’s “best buys” on NCDs were formulated quite a while ago, when sugar was not on the public health community‘s mind. There have been recommendations to include sugar taxes and it will be an aim at the UN General Assembly [in September] that sugar gets on the agenda.

Chartwatch

Development data The World Bank's Atlas of Sustainable Development Goals carries graphic depictions of more than 1,400 indicators across more than 220 economies including life expectancy, fertility, mortality, health coverage and injury.

News round-up

WHO sets new course The World Health Assembly agreed the need for increased investment in the WHO, a wider donor base, deeper political commitment from member states and stronger partnerships with the academic community and NGOs. The Global Preparedness Monitoring Board was set up to bring together political leaders, UN chiefs and experts to strengthen global health security. (Devex, Council on Foreign Relations, UN News)

Ebola response Health officials were described as "cautiously optimistic" about containing the Ebola outbreak in the Democratic Republic of Congo, as rival companies jockey for position to test their drugs. This podcast discusses the response to the current outbreak compared with that of 2014. (ReliefWeb, Stat, Global Dispatches)

Nipah mystery India stepped up efforts to contain the outbreak of Nipah, a brain-damaging virus with no effective treatment or vaccine and one of the WHO's “priority pathogens”. (Business Standard, FT)

Tobacco breaks hearts A new report from the WHO showed tobacco — “the only legal drug that kills many of its users when used exactly as intended by manufacturers” — affects communicable disease as well as cardiovascular health. Industry giants PMI and BAT lobbied Pakistan to weaken anti-smoking measures. Such measures in France have led to 1m smokers quitting in just a year, but despite their proven efficacy, taxes on tobacco, sugar and alcohol are underused by policymakers. (WHO, Reuters, BBC, The Lancet)

HIV/Aids costs The number of workers killed globally by HIV and Aids is projected to fall to 425,000 in 2020, from 1.3m in 2005. People in their late 30s — when workers are at peak productivity — will be the most affected group. Lost earnings would total $7.2bn, albeit down from $17bn in 2005. African Americans are suffering disproportionately. (ILO, Guardian)

Fighting obesity and brain hijacking Food experts said junk food marketing could hijack a child's brain. A study showed half of all TV ads seen by children aged between four and 15 was for products high in fat, sugar or salt. UK MPs called for restrictions such as a ban on cartoon characters on packaging while teachers demanded compulsory home economics lessons in schools. (Guardian, Houses of Parliament, IFS, Times)

Booze battles The alcohol industry in Canada allegedly lobbied the Yukon government to end an experiment putting cancer warnings on alcohol bottles, according to the Globe and Mail. A campaigner writes on the strategy that led to the world's first minimum unit pricing regime in Scotland. (Globe and Mail, Vital Strategies)

3D corneas Scientists have 3D-printed human corneas for the first time by mixing stem cells from a healthy donor cornea with a gel derived from seaweed and collagen to create a "bio-ink" solution that can be printed. About 10m people worldwide each year need surgery to prevent corneal blindness because of diseases such as trachoma and 5m lose sight in both eyes due to corneal dysfunction. (FT)

The politics of abortion A decisive vote to repeal Ireland's anti-abortion laws in the Irish referendum threw the spotlight on its neighbours in Northern Ireland, where restrictions are at odds with the rest of the UK. The decision is complicated by the fact that the province's socially-conservative DUP is keeping Theresa May's government in power in Westminster. (Irish Times, FT)

Midwifery and mortality The US is the worst in the industrialised world for pregnancy and childbirth-related deaths. One reason could be the low use of midwives. (ProPublica/Vox video)

Care conundrum Monthly payments for care insurance in Japan have doubled since 2000 and are among a range of compulsory payments to support the country’s ageing population. Social insurance costs could hit 24 per cent of gross domestic product by 2040. But there are still lessons to be learned from the way the country cares for its old. (FT, The Conversation)

Hypothecating for health A think-tank reopened the debate over a dedicated tax levy for the UK's National Health Service. The current cash squeeze was highlighted by figures showing NHS hospitals ended the year almost $1bn in the red. FT columnist Martin Wolf says only “political cowardice” is holding back tax rises. (FT) l

Perils of business travel A new study makes worrying reading for those frequent flyers. Excess business travel can lead to anxiety, depression, alcohol dependence; lack of exercise; smoking; and trouble sleeping. And the odds of being obese are much higher. (Harvard Business Review)

PR response of the week Roseanne Barr, the US actor sacked for a racist tweet is not the first celebrity to blame an insomnia drug for “erratic behaviour”. In this case, manufacturer Sanofi was quick to put the record straight. (FT, Twitter)

Best from the Journals

Data sharing fears The EU's General Data Protection Regulation — the reason for those pesky emails asking for your renewed “opt-in” to receive information — is raising fears in the research community. Scientists fear excessive caution could become the default position and undermine their collaborative work. (Nature)

Counting the dead Death tolls can be difficult to quantify after major disasters but health systems need reliable data to plan responses. The official death toll of last September's hurricane in Puerto Rico was 64: this study says the death toll probably exceeded 4,645 — or 70 times the official estimate. (NEJM)

Preventing pandemics Bill Gates called for better tools, an early detection system, and a global response framework to prevent pandemics. If a pathogen like the 1918 flu struck today, nearly 33m would die in just six months, he argues. A mock pandemic simulation for the US government resulted in 150m people dying because of the failure to develop a vaccine quickly enough, illustrating the need to "go from bug to drug faster." (Washington Post, NEJM)

Smoke signals Respiratory doctors and scientists warned of the dangers of nicotine in ecigarettes and called for a ban on flavourings and on marketing to the young that positioned products as lower-risk alternatives. Here is a summary of the rise of vaping in five charts. (European Respiratory Journal, BBC)

Podcast of the week

Air pollution and health As the European Commission clamped down on member states failing to control air pollution and the UK put its clean air strategy out for consultation, FT Health convened a panel of experts to discuss the problem and what could be done about it. (FT, 16m)

Video: Listen: How is pollution affecting our health?

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Final thought

Smart toilets New research shows the interaction between what we eat, how it is processed by our gut microbes and how we accumulate fat in our bodies. Get ready for smart toilets or smart toilet paper that will give us a snapshot of what's in our gut and how to rectify any imbalances. (The Conversation)