When an Englishman's home is his lifeline
The Telegraph 05 Feb 2007
By 2025, a new generation of drugs will mean up to 80 per cent of us will survive cancer. We'll just have to sell up to pay for them, says Nick Horley
One in three of us gets cancer. I had testicular cancer at the age of 32 and was cured, but this doesn't mean I've had my ration and can take up smoking and gorge myself on lard for the next 50 years without fear of getting another tumour: the statistics say my chances of getting another type of cancer are much the same as yours.
So the other day I decided to plan for it. I know it sounds morbid, but once you've had cancer you realise there is a chain of cause and effect at work, which starts with diet or DNA, not destiny. If I want to stop worrying about my next cancer, I can't leave it to fate: I should anticipate it.
If I get cancer again I'll probably be over 65: that's when two thirds of cases happen. I'm 45 now; who knows how treatable cancer will be in 20 years?
Professor Karol Sikora, a cancer specialist and former chief of the World Health Organisation Cancer Unit, knows as much as anyone. When it comes to cancer he is the guru's guru. Doctors, think tanks, politicians and health insurers are in his thrall.
The Prof has great news! Drugs under development mean that survival rates will shoot up. Today 60-70 per cent of patients with cancer die of it, but by 2025 only 20 per cent will. Almost as impressive is that the drugs are molecularly targeted, which means they only attack tumours – an obvious function of a cancer drug, you might think, but traditional chemotherapy can be so toxic that, prescribed on its own, it would kill you long before the cancer did.
You have to take a slew of drugs to preserve the bits of your body you want to keep. Some organs don't come out of this chemical warfare too well. In my case the baldness, vomiting, 95 per cent reduction in IQ, distended hands and feet and infertility were temporary; the tinnitus and poor circulation are permanent. The side effects of the new drugs will typically be mild.
The first molecularly targeted drugs have appeared, and sadly they are in danger of becoming well known simply because the nation allegedly can't afford them. Herceptin (for breast cancer) and Avastin (for bowel cancer), at £60,000 and £70,000 for a year's treatment, are often denied to patients until they've battled the NHS on the evening news – which is too traumatic for most people to go through, especially if they have just endured failed chemotherapy and are staring death in the face.
Look out for more drugs in the news later this year: Sutent, Nexavar, Tykerb, Panitumomab and Ranibizumab will be licensed soon and, says Prof Sikora, "the NHS can't afford any of them". Some of the drugs still in the lab will cost even more: up to £100,000 a year.
But it's not their price that promises to wreck the NHS budget, it's the fact that often they will only stabilise the cancer, not cure it. If I get cancer at 65 and the treatment controls it so that I live to 85, I could run up a bill of £2 million for prescriptions alone. No wonder Prof Sikora estimates that in 2025 cancer treatment could gobble up today's entire NHS budget of £90 billion. But after 2008 the Government doesn't plan to increase NHS spending by much more than inflation.
So if the NHS won't treat me I'll have to get health insurance. A typical premium is £1,000 a year. I rang five leading providers to find out what would happen if I were to claim a £100,000 annual drugs bill for 20 years. They all had the perfect get-out clause: health insurance is designed to cover only short-term conditions. Every day patients find out that their claim has been cancelled because their disease has not responded to treatment.
Some policies make special provision for cancer and cover it indefinitely. This doesn't cost much because chemotherapy is typically £4,000 a year and if a patient isn't cured within a few years he generally dies. These policies will be drastically revised as the wonder drugs have an impact. If you already have such a policy, I suggest you check it very carefully to find out if it's worth having.
All the insurers I spoke to were well aware of Prof Sikora's forecasts, but the only one prepared to speculate on how my claim might be handled was WPA. Chief executive Julian Stainton bluntly told me I could claim in year one, but after that only "rich patients will pay for themselves". I somehow doubt I'll ever make up the balance of £1.9 million, but he has kindly made provision for me on a ghastly graph: he predicts that by 2050 15,000 Britons with cancer will be opting for euthanasia instead.
To be fair to the insurers, they can't print money: all they can do is redistribute it from one policyholder to another. So if they decide to pay claims like mine the premiums would be unaffordable, as they are becoming in America, where they often exceed mortgage payments.
With health insurance clearly not an option for me, I checked out critical illness insurance, which pays out a big lump sum that you can spend how you like when you're diagnosed with something nasty.
But at my age if you take out a new policy to cover you through your retirement it's little better than a Christmas club; you get out pretty much what you put in. And if you have the good fortune not to fall ill, you lose all the money you've invested.
So I've run out of options: I shall have to leave it to fate after all. The canny solution would be to amass a stockpile of cash with a portfolio of buy-to-let properties. I wouldn't call them Dunroamin or Rose Cottage: they would be Avastin or Nexavar.
The frustrating thing about this is that the politicians know what's coming; Prof Sikora told them in 2004. They all privately believe that the NHS needs drastic changes to the way it's run and funded, but they refuse to start the debate for fear of seeming eager to carve up our country's sacred cow.
Health Secretary Patricia Hewitt does nothing but repeat the mantra that "investment in the NHS has never been higher", while behind the scenes Tony Blair's advisers tell him it will be 10 years before any government dares to instruct the public on alternative methods of funding the NHS, such as much higher prescription charges for expensive drugs or even a shift away from a tax-based system.
David Cameron is just fiddling on the sidelines, pretending he could coerce the drug companies to slash their prices.
In the meantime, an extra tier to our health system is growing fast as more and more patients who are refused drugs by the NHS buy them on the internet without prescription.
I worked out my own solution to this mess on the back of an envelope. In 2025, this country will have about 25 million households. To raise an extra £90 billion all we have to do is increase the annual tax burden per household from £20,000 to £23,600. It seems a reasonable price to pay for a society with equal access to cancer care, rather than one in which the best drugs become status symbols for the rich, while the rest take their chances with toxic chemotherapy or queue up for euthanasia.
If nothing is done, I have my own forecast, inspired by Macmillan Cancer Support's discovery that six per cent of cancer patients lose their homes.
I predict that between now and the middle of the century, when Prof Sikora expects reasonably priced cancer cures to be widely available, many hundreds of thousands of retirees will sell their homes with desperate speed to extend their lives by a few years, triggering a property crash the likes of which we have never seen.
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