Medical Life

Sir Liam Donaldson, the Government's Chief Medical Officer, let me have it with both barrels at last week's swine flu briefing. I couldn't blame him. It must be extremely galling, after you have worked tirelessly, without a break, to build up Britain's defences against the pandemic and received accolades for your efforts from around the world, to be asked whether the cost of the exercise can be justified. Hardly surprising, then, that he let his irritation show. "I totally disagree ... that we have overdone it on flu," he said, calling up images of "parents standing by intensive care cots in life or death situations."

It's easy for me. I only have to ask the questions, with the benefit of hindsight. He has to make the decisions in advance, without that benefit. He would argue, rightly I believe, that given our state of knowledge about the behaviour of the flu virus at the time, Britain acted wisely to develop a pandemic plan and to enact it when swine flu emerged in Mexico last April.

But when the pandemic is over – possibly not for another two or three years – the reckoning will come. And now is our last chance, in Britain, to view its natural course – before the roll-out of vaccination halts it in its path.

If this turns out to be the weakest pandemic in history, as I have previously suggested, it may be that our response – with one of the biggest stockpiles of anti-viral drugs and vaccines in the world – will appear disproportionate. It is still too early to say because the virus could resume spreading or mutate into a more lethal strain. But if it does not, the question for virologists will be why, after years of warnings, the pandemic turned out to be a kitten, not a tiger. We were warned to prepare for avian flu, with a 60 per cent mortality, not swine flu with a 0.005 per cent mortality.

It is then that the cost of the exercise – more than £1 billion – will come under scrutiny, which could affect plans for future pandemics. Many people feel uncomfortable with adjusting spending in line with the predicted loss of life. But £1 spent on swine flu is a £1 less for other needs. Equity demands that we consider costs – to ignore them would be unethical.

In my question to Sir Liam I had pointed out that the National Institute for Clinical Excellence (NICE) had that morning ruled against a drug, sorafenib, for advanced liver cancer because it was too expensive. NICE has, as usual, been castigated for this decision, which has been called "scandalous" (Macmillan Cancer Support), "enormously frustrating" (Cancer Research UK) and "absurd" (Professor Karol Sikora).

Not a single voice, to my knowledge, has been raised in criticism of the high price charged – £3,000 per patient per month – by the drug's manufacturer, Bayer Healthcare. Why? Because the drug industry has a stranglehold on our doctors, researchers and charities. They dare not bite the hand that – directly in grants or indirectly in research funding – so prodigiously feeds them.