Will evidence-based medicine, and panel of experts now decide who lives and who dies in Canada?

By Gilles Gervais

(CRC)—National Post health-care reporter Tom Blackwell has recently shed a troubling light on the Pan-Canadian Oncology Drug Review panel of experts (p-CODR) in a November 21st article in the Post online entitled ’New agency looks to make cancer drug funding decisions more reasoned, less emotional for provincial governments’.

While the Post article overall is pro p-CODR, nonetheless the reporter has a few disturbing quotes from some critics of the national panel of experts :

“They are basically denying access to medications for patients who at this point in their lives have no other alternatives,” complained Doug Grant, a vice president at Bayer Canada, which makes the product (Stivarga-a drug for late-stage colorectal cancer patients). “They’re saying 1.4 months is not enough. You’re wondering ‘How are they making that leap?’ It’s quite disturbing.”

He noted that an earlier, interim recommendation suggested palliative care for such patients was still the most reasonable treatment. “You have a national review board saying patients are better off going home and dying.”

Roman Gawur is equally dismissive of the process, saying that even drugs with minimal benefits on average can work wonders for a minority of patients. The Toronto resident fought an earlier battle for government funding of another medication, Avastin, also to treat colorectal cancer, and says the drug has helped keep him alive today, after he was told in 2007 he had 20 months to live.

“Personally, I don’t believe that cost should be part of the calculation,” he said.

What is now clearly put in jeopardy is the Hippocratic Oath taken by all Canadian medical students to do their utmost to deliver compassionate and quality health-care to all their patients. What is now being promoted are medical decisions for individual patients based on the pseudo-science of cost-accounting and clinical trial statistics.

In a 2009 commentary The Evil Intention of Evidence-Based Medicine (1) Doctor Cathy M Helgason argued that evidence-based medicine succeeds in divesting physicians of responsability for the patient’s well-being, while making them believe they have done so with the good of science and society in mind. In analyzing what is wrong with clinical trials, Doctor Helgason concludes her commentary by saying that :

“Large, randomized statistical studies do not capture the level of efficacy of a treatment that a physician sees in his daily practice, because the treatment groups of the large studies are managed in an all-or-none fashion. There can be no response to the changing degree demanded by the clinical dynamic. Probability-based statistics confer a level of certainty in the mind of the user, and that certainty excuses the guilt the user feels when treatments are withheld.

“Science is, after all, a human and humane endeavor. But evidence-based medicine is all about the dehumanization process. Because it claims certainty, it claims authority, but in the process, the relationship between truth and certainty gets distorted. People who have deep empathy have difficulty believing certainty and crisp boundaries. The Hippocratic Oath is the intention behind the practice of medicine. The details of medical decisions are constantly changing and depend on the moral, ethical, and professional judgment of the good physician within the unique context of the individual patient.

“The present health-care reformers, like Hitler’s doctors, would remove this intention and replace it with cost-efficiency. That is the truth about how evidence-based medicine threatens to change medicine —and kill the sick and elderly.”