Garford Gaskin, a citizen of the United Kingdom who suffers from malignant mesothelioma resulting from exposure to asbestos when he worked for British Rail some 40 years ago, has been denied access to Alimta, a drug recognized as having beneficial effects for mesothelioma sufferers.
The Derby City Primary Care Trust, the agency which makes health care decisions for residents of Derbyshire , England , denied Mr. Gaskin’s request to go on Alimta after his mesothelioma recurred. When Mr. Gaskin was first diagnosed, he underwent a radical surgery to remove large portions of his mesothelium, the membrane that surrounds the heart, lungs, and abdominal cavity. Mesothelioma is a cancer which attacks this lining, and when the disease is diagnosed at a very early stage, the removal of the lining has a good chance to remove the cancerous cells as well. Mr. Gaskin also underwent chemotherapy at the time of his surgery, in an attempt to kill any remaining cancer. However, tests recently indicated that Mr. Gaskin’s mesothelioma had recurred, and his physician, a clinician at the Derbyshire Royal Infirmary, filed a request to put Mr. Gaskin on Alimta, which slows the growth of tumors and relieves the symptoms of mesothelioma, including breathlessness, chest pain, cough, and loss of appetite. The Trust, however, denied the request, because Alimta has not been approved for use in patients who have already received chemotherapy.
In January of 2008, asbestos activists scored a major victory by persuading the National Institute of Health and Clinical Excellence to recommend the funding of Alimta treatments for mesothelioma patients. However, the institute’s guidelines for funding specified that only patients who had not received chemotherapy treatment should receive Alimta, as safety trials had not been carried out on post-chemotherapy patients. An internationally renowned mesothelioma researcher and oncologist, Dr. Jeremy Steele of Bart’s Hospital in London , was scathing in his criticism of the decision, saying “ “He wasn’t allowed the drug a year ago when he needed it and so had to have some second-rate chemotherapy treatment. And he cannot have it now because he has had this second-rate treatment. It’s absolutely disgraceful – just so penny-pinching. Everyone who treats the disease knows this drug has a chance of helping this man. Primary care trusts do not have to slavishly follow NICE guidelines. There is a very good case for treating this man.” Mr. Gaskin has been informed that he could purchase the drug for himself (at a cost of about $5000) but that he would then lose coverage under the United Kingdom’s National Health Service, and would have to pay for all subsequent care out of his own pocket. A spokesperson for NICE stated that the decision to fund or not to fund the Alimta treatment was ultimately up to the local trust.