The cost of survival
A LOW-BUDGET 2018 movie from China, Dying to Survive, will hopefully make history for saving many lives around the world.
Based on a real-life story in China, the movie focuses on the inability to access expensive, effective cancer drugs which are widely available. We in Malaysia share the same problem and heartache. This emotional movie has forced a response from the China government, whose subsequent renegotiations with the pharmaceutical industry have led to a reduction in the price of 17 lifesaving cancer drugs. In return, these corporations have been offered greater access to the China market. Tariffs have been lifted and health insurance coverage has also been expanded to include these drugs.
We, from Together Against Cancer Association Malaysia, an organisation consisting of cancer survivors, prominent cancer specialists and researchers, were encouraged to see that the Chinese Premier Li Keqiang was sufficiently moved by the movie to take action.
Financial toxicity due to cancer is, however, not a challenge in China alone. The Asean Costs of Oncology (Action) Study showed that within one year of being diagnosed with cancer, 29% of patients in low- and middle-income countries in South-East Asia have died and a further 48% faced financial ruin. The principle investigator of the study from Malaysia, Assoc Prof Dr Nirmala Bhoo Pathy, who is also a committee member of Together Against Cancer, found that in Malaysia, 46% of cancer-stricken households had used up their personal savings, with 22% being unable to pay their rent or mortgage and about 20% discontinuing their cancer medicine. This, in turn, may force them to face earlier, premature deaths.
For those with frequent contact with cancer patients, there is a recurring theme where fighting and surviving cancer can lead to impossible financial decisions. How do you reconcile impoverishing your family to acquire effective but unaffordable treatment? Will you be tempted by the cheaper, probably ineffective (probably dangerous) alternatives promising a miracle on the Internet and elsewhere?
From my own personal experience in Malaysia as a vice-president of the Quolin (Walking) Qikong, Malaysia, a cancer survivors’ group with over 2,000 members, I have seen many advancedstage lung cancer patients suffer or die after they stopped responding to the first-line therapies. Second-line drugs offered to them can prolong life but may cost more than RM10,000 a month.
As a vice-president of the Prostate Cancer Society Malaysia, I have seen many advanced prostate cancer patients who failed and/or became resistant to initial hormone therapy, failed to get effective second-line therapies to prolong live due to its high cost.
Dying to Survive highlights the great cost discrepancy between patented cancer medications and equally effective, generic drugs available at a tenth of the price.
Unfortunately, accessing these drugs within China and Malaysia may not be in line with World Trade Organisation arrangements.
Dying to Survive touched on the basic moral fibres of humans; we should be striving to save lives and eliminate hardships among our fellow beings.
China, following Canada’s example, has renegotiated with the pharmaceutical industry to reduce the price of non-generic cancer medications. If Canada, with a population of 37 million, can renegotiate cancer medication costs, then Malaysia, with a population of 32 million, may be able to do so as well.
We hope the Health Ministry, together with the pharmaceutical industry, will be able to agree upon a more doable price structure to suit our patients’ financial capability and the country’s GDP. The ministry can also look into allowing faster registration of good quality generic cancer medications that will bring about a healthy competition of drug prices within the country.