Moral ambivalence towards the Cancer Drugs Fund

2019 ◽  
Vol 45 (9) ◽  
pp. 623-626 ◽  
Author(s):  
Ilias Ektor Epanomeritakis
Keyword(s):  
Cancer Patient ◽  
Procedural Justice ◽  
Resource Distribution ◽  
Public Welfare ◽  
Cancer Drugs ◽  
Ethical Concerns ◽  
Accountability For Reasonableness ◽  
Present Essay ◽  
Moral Ambivalence ◽  
Robust Framework

The UK’s Cancer Drugs Fund (CDF) was introduced in 2010 following the Conservative Party’s promise to address the fact that numerous efficacious cancer drugs were not available because of their cost ineffectiveness, as deduced by the National Institute of Health and Care Excellence. While, at face value, this policy appears only to promote the UK’s public welfare, a deeper analysis reveals the ethically unjustifiable inconsistencies that the CDF introduces; where is the analogous fund for other equally severe diseases? Have the patients without cancer been neglected simply due to the fear-inducing advertising and particularly ferocious speech which surrounds cancer? The CDF is unjustifiable when challenged by such questions. However, it is troubling to think that the CDF might be repealed in order to abolish these ethical concerns. Intuitively, one feels uncomfortable stripping the cancer patient of their benefits just so that they might be on an equally pessimistic footing with others. In the present essay, I argue that, although there are no ethically justifiable grounds for the CDF’s introduction, its removal would be inappropriate. Following this realisation, I investigate whether the procedural steps of the CDF itself—theoretically removed from the context of resource distribution for all disease types—represent an ethically justifiable system. I believe that the answer is yes, given the CDF’s conformity to accountability for reasonableness, a robust framework of procedural justice, which continuously improves the ethical and epistemological standards of the policies to which it is applied.

scholarly journals Priority Setting, Judicial Review, and Procedural Justice

2019 ◽  
pp. 185-196
Author(s):  
Daniel Wang ◽  
Benedict Rumbold
Keyword(s):  
Health Care ◽  
Procedural Justice ◽  
Priority Setting ◽  
Judicial Review ◽  
Procedural Fairness ◽  
Policy Decisions ◽  
Philosophical Literature ◽  
Accountability For Reasonableness

The justification for the judicial review of priority-setting decisions in the NHS is premised upon a distinction between substantive policy decisions and matters of procedural fairness, with courts themselves perceiving their function as restricted primarily to assessments of procedure. This approach finds normative ground in the ‘procedural turn’ in the philosophical literature on justice in health, in particular in the influential idea of ‘Accountability for Reasonableness’. However, this chapter will argue that relying on the substance/procedure distinction to identify the appropriate role for the courts in the control of allocative decisions in health care will attract to judicial review a series of concerns raised in the philosophical literature with regard to the idea of securing just priority setting through procedural means.

scholarly journals 6-STEPPPs: A Modular Tool to Facilitate Clinician Participation in Fair Decisions for Funding New Cancer Drugs

2008 ◽  
Vol 4 (1) ◽  
pp. 2-7 ◽  
Author(s):  
George P. Browman ◽  
Braden Manns ◽  
Neil Hagen ◽  
Carole R. Chambers ◽  
Anita Simon ◽  
...  
Keyword(s):  
Cultural Values ◽  
Clinical Performance ◽  
Cancer Drug ◽  
Cancer Drugs ◽  
Group Leaders ◽  
Pharmacy And Therapeutics Committee ◽  
Accountability For Reasonableness ◽  
Tumor Group ◽  
Modeling Data ◽  
Therapeutics Committee

Purpose: To design a tool to assist clinician participation with cancer drug funding decisions. Public policy-makers and insurers are struggling with funding decisions regarding increasingly expensive new cancer drugs. Increasingly, oncologists are contributing to the process of review that leads to such decisions. We were asked to design a system for ranking new cancer drugs for priority-based funding decisions. Methods: The “Accountability for Reasonableness” framework informed the design of a six-module multistakeholder decision process blending evidence-based traditional technology assessment methods with individual and cultural values elicitation. The tool was piloted in three settings: (1) videotaped simulated multistakeholder deliberation sessions; (2) clinical oncology leaders; and (3) a regional (Canadian provincial) pharmacy and therapeutics committee making formulary decisions. The modules involve: decision clarification, drug eligibility screening (filtering), clinical performance scoring index, cost modeling, data integration and values clarification, and process evaluation. Results: The tool was feasible to use, acceptable to participants, and able to rank candidate drugs. The pharmacy and therapeutics committee with whom it was tested used the tool as a part of their deliberations, and the tumor group leaders requested its incorporation into organization-based decision making. Conclusion: The decision tool can facilitate priority-based cancer drug funding decisions that meet the conditions of fairness as perceived by participants, including oncologists.

scholarly journals PDXGEM: Patient-Derived Tumor Xenograft based Gene Expression Model for Predicting Clinical Response to Anticancer Therapy in Cancer Patients

2019 ◽  
Author(s):  
Youngchul Kim ◽  
Daewon Kim ◽  
Biwei Cao ◽  
Rodrigo Carvajal ◽  
Minjung Kim
Keyword(s):  
Gene Expression ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Drugs ◽  
Drug Responses ◽  
Drug Activity ◽  
Anti Cancer ◽  
Expression Model ◽  
Gene Expression Model ◽  
Pdx Models

AbstractBackgroundCancer is a highly heterogeneous disease and shows varying responses to anti-cancer drugs. Although several approaches have been attempted to predict the drug responses by analyzing molecular profiling data of tumors from preclinical cancer models or cancer patients, there is still a great need of developing highly accurate prediction models of response to the anti-cancer drugs for clinical applications toward personalized medicine. Here, we present PDXGEM pipeline to build a predictive gene expression model (GEM) for cancer patients’ drug responses on the basis of data on gene expression and drug activity in patient-derived xenograft (PDX) models.ResultsDrug sensitivity biomarkers were identified by an association analysis between gene expression levels and post-treatment tumor volume changes in PDX models. Only biomarkers with concordant co-expression patterns between the PDX and cancer patient tumors were used in random-forest algorithm to build a drug response prediction model, so called PDXGEM. We applied PDXGEM to several cytotoxic chemotherapy as well as targeted therapy agents that are used to treat breast cancer, pancreatic cancer, colorectal cancer, or non-small cell lung cancer. Significantly accurate predictions of PDXGEM for pathological and survival outcomes were observed through extensive validation analyses of multiple independent cancer patient datasets obtained from retrospective observational study and prospective clinical trials.ConclusionOur results demonstrated a strong potential of utilizing molecular profiles and drug activity data of PDX tumors for developing a clinically translatable predictive cancer biomarkers for cancer patients. PDXGEM web application is publicly available athttp://pdxgem.moffitt.org.

scholarly journals Health technology appraisal and the courts: accountability for reasonableness and the judicial model of procedural justice

2010 ◽  
Vol 6 (4) ◽  
pp. 469-488 ◽  
Author(s):  
Keith Syrett
Keyword(s):  
Decision Making ◽  
Procedural Justice ◽  
National Level ◽  
Health Technology ◽  
Technology Appraisal ◽  
Publicly Funded ◽  
Health Technologies ◽  
Accountability For Reasonableness ◽  
Evaluation Of Evidence ◽  
Health Technology Appraisal

AbstractRecommendations issued by agencies undertaking appraisals of health technologies at the national level may impact upon the availability of certain treatments and services in some publicly funded health systems, and, as such, have regularly been subject to challenge, including by way of litigation. In addition to expertise in the evaluation of evidence, fairness of procedures has been identified as a necessary component of a claim to legitimacy in such circumstances. This article analyses the assessment of courts in three jurisdictions of the fairness of decision-making by such agencies and evaluates the judicial reading of procedural justice developed in this particular context against the conditions of ‘accountability for reasonableness’.

1565: Semen Cryopreservation in Adolescent Cancer Patient

2004 ◽  
Vol 171 (4S) ◽  
pp. 413-413
Author(s):  
Deborah M. Spaine ◽  
Renata Fraietta ◽  
Agnaldo P. Cedenho ◽  
Miguel Srougi
Keyword(s):  
Cancer Patient ◽  
Semen Cryopreservation ◽  
Adolescent Cancer

CMS to Cover Some Off-Label Cancer Drugs

2005 ◽  
Vol 38 (21) ◽  
pp. 55
Author(s):  
Joyce Frieden
Keyword(s):  
Cancer Drugs ◽  
Off Label

When Does Voice Have to be More Than Only Listening? Procedural Justice Effects as a Function of Confident Leadership

2010 ◽  
Vol 9 (2) ◽  
pp. 69-78 ◽  
Author(s):  
David De Cremer ◽  
Maarten Wubben
Keyword(s):  
Procedural Justice ◽  
Interaction Effect ◽  
Laboratory Experiments ◽  
Negative Emotions

The present research examined how voice procedures and leader confidence affect participants’ negative emotions and willingness to withdraw. It was predicted that receiving voice would be valued out of instrumental concerns, but only when the enacting leader was high in confidence. Two laboratory experiments indeed showed an interaction between type of voice (pre-decisional vs. post-decisional) and leader’s confidence (low vs. high) on participants’ negative emotions and willingness to withdraw. In particular, post-decision voice only led to more negative responses than did pre-decision voice when the enacting leader was high in confidence. Negative emotions mediated this interaction effect of type of voice on willingness to withdraw. Implications for integrating the leadership and procedural justice literatures are discussed.

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