Race claim in cancer care cash

Pharmac has been accused of institutional racism and breaching the Treaty of Waitangi for funding drugs for melanoma, but not lung cancer – a disease responsible for a disproportionately high number of cancer deaths among Mā ori.

Cancer Society medical codirector and Hei Ā huru Mō wai, Mā ori Cancer Leadership Aotearoa spokesman George Laking said a 2016 decision to fund immunotherapy drug Keytruda to treat advanced melanoma had created an unjust precedent.

‘‘Here’s the tricky thing: Melanoma is a disease that, all things considered, is more likely to happen in people of fairer complexion.’’

Lung cancer accounts for about 20 per cent of all cancerrelated deaths in New Zealand, with incidence and mortality rates up to four times higher for Mā ori and Pacific people.

Laking said it was hard to escape the conclusion that the funding policy was racist.

But the medical oncologist also took aim at multinational pharmaceutical company Merck Sharp & Dohme (MSD), which manufactures and supplies Keytruda, saying the drug was ‘‘overpriced’’.

‘‘I’d go so far as to say it’s price gouging,’’ he said. The company had capped the cost of Keytruda for New Zealand patients at $60,000, with a three-weekly infusion costing about $8000, MSD New Zealand managing director Paul Smith said.

Laking’s comments follow the release of a report on lung cancer in the Asia Pacific region by the Economist Intelligence Unit, sponsored by MSD, which found New Zealand was on par with the Philippines and Thailand in respect to lung cancer funding.

Of seven drugs used across 13 non-small cell lung cancer indications, none were funded in New Zealand.

This was in stark contrast to the situations in Australia and Japan, which funded 11 and 13 of the indications respectively, the report found.

Pharmac, which has a budget of more than $1 billion and funds about 1000 medicines for 3.7 million people, is under review by an independent panel appointed by the Government.

A damning interim report released by Pharmac Review last week found the agency’s medicine-buying strategy appeared to disadvantage Mā ori, Pasifika, disabled people and those with rare disorders.

A 2020 study by Waitematā District Health Board staff, published in the New Zealand

Medical Journal, found cancers of

the airways caused by smoking tobacco were responsible for one year of the seven-year life expectancy gap between Māori and Pacific people and non-Māori/ non Pacific people.

Laking said while there may be evidence of greater efficacy of Keytruda for melanoma, the much poorer outcomes for Mā ori lung cancer patients had not been taken into account.

Pharmac’s director of operations, Lisa Williams, said the decision to fund two immunotherapy drugs for melanoma ‘‘was based on its relative value compared to all other funding applications we were considering at that point in time, as well as available budget’’.

Pharmac had ‘‘several open applications for treatments for lung cancer’’, she said.

Williams said the agency was focused on ensuring New Zealanders had equitable access to funded medicines, but ‘‘solutions to health inequities do not lie solely with the funding of medicines, or even within the health system across the board’’.

Smith said MSD had put in several applications to Pharmac over the past five years to fund Keytruda for lung cancer.

The high price reflected the company’s investment in the drug’s development and the cost of thousands of clinical trials.