Discussion on the Drug Basket Committee for Financing Genetic Flooring Takes Place Shortly After Hadassah Hospital Becomes First in the Middle East Where One of the Test Types Will Be Performed • And Who Manages the Hospital? Prof. Rothstein, Who Also Heads the Committee • Hadassah: Should He Disqualify Himself, so are the representatives of the HMOs

• Prof. Rothstein // Photo Archive: Oren Ben Hakun

Has the chair of the Hadas Pharmaceuticals Committee and CEO, Prof. Ze'ev Rothstein, refrained from reporting to the committee a prominent conflict of interest in which he is present?

Last week, the committee discussed public funding for genetic flooring tests to tailor personal care for lung cancer patients. The hearing took place shortly after Hadassah signed an agreement that the hospital will be the first institution in the Middle East where the most prominent test in this area, the Roche Company's "foundation", was submitted to the drug basket this year. The Ministry of Health and the basket committee argue that the conflict of interest is an "institutional" and non-personal conflict of interest, so Rothstein should not have reported it.

This means that if Foundation enters the basket - alongside additional or exclusive tests - the hospital under Rothstein's management will be able to perform the test not only for all lung cancer patients in the country in the drug basket, but also for many more patients.

Hadassah Ein Kerem // Photo: Oren Ben Hakon

Even before the basket committee hearings begin, its members are required to sign a proper disclosure form stating that they have no relationship between them and a commercial company that prevents them from expressing their opinion objectively. Immediately following the public announcement of conflicts, which states that Prof. Rothstein has no conflict of interest, Hadassah was released, stating that "The Hadassah Pathology Institute is the third outside the US and the first in the Middle East to receive the certificate of recognition for producing the diagnostic test-enabled DNA. And tailoring targeted personal care for cancer patients. " This is the first phase of the test, and later the samples will be sent to the company labs in Europe.

Private pocket financing

On the eve of the opening of the basket committee discussions, Prof. Rothstein was interviewed by Israel Today to refer to the genetic paving tests, and announced that in light of last year's opposition to the inclusion of tests in the drug basket - he will fight for their introduction. All this, just a moment before signing the agreement with Roche to perform Hadassah Foundation tests. "No situation in the current basket committee will pass a decision that basically prevents citizen information about his illness," says Rothstein. "I have no problem that the issue will reach the door of the High Court as well."

Today, many cancer patients are privately funding the genetic testing, which costs about NIS 18,000. The specimen is taken from the tumor undergoing genetic flooring in the laboratory. Depending on the results, patients can find tailored treatment. This year, five types of genetic flooring tests were submitted to the drug basket: Foundation, Oncommine DX, Transite 50, Kanser Select and Archer.

Discussion of necessity

The health ministry has asked the trade unions to rate the tests so that the basket committee members can discuss them, as they usually discuss every drug and technology on its body.

However, during the hearing, last week, in an unusual move, members of the committee were told that they would hold a general hearing about the need to include the test in the drug basket, and not to discuss the five genetic paving tests themselves.

Following the hearing, the Israel Pathologists Association sent a letter to the members of the Hessel Committee, expressing concern over the selection of criteria that might result in one test preference, and in particular a foundation test, part of which is being decoded abroad.

"It is appropriate to bring in the technology of genetic pavement to the health basket, but it is important to include all technologies that have clinical use approvals and allow pathologists and oncologists the ability to choose from these technologies based on the professional considerations of each case," write all hospital pathology managers Israel's largest and middle class.

The managers of the pathological laboratories note that they can carry out all the tests in the country's hospitals except for their decoded work abroad, "There is no reason to send these tests, which are now routine tests in modern pathology institutes, to overseas laboratories. Monopoly to force all tests abroad Will not allow institutes in the country to continue to develop in the field of molecular pathology. "

"Such a move, which has no professional advantage, will cause harm to patients and the level of pathology and medicine in the country. Sending these tests to outsiders abroad will hurt patients because of extending waiting times for repentance."

Rabbi Yuval Sherlo, head of ethics at the Rabbi Zahar organization, formerly a member of the Medicines Committee and currently a member of the Helsinki Committee for Human Experiments in the Ministry of Health, who was asked to address the issue, said: "There is a clear conflict of interest and Prof. Rothstein must say that Hadassah is negotiating Opening such a lab. "

"Many treatments"

"Hadassah performs many treatments that are not in the basket and are paid through the funds of the health insurance companies and insurance companies. This includes genetic flooring, carried out by two hospitals and one health fund itself and referred patients. If the flooring goes into the basket - like any other treatment, Hadassah will think In the case of Prof. Rothstein, he or she must disqualify himself, the legal and all the legal representatives of the HMOs who treat the patients, in the treatments applied to the basket. ISA. It is also possible to vote for committee members who sit on behalf of the Treasury who are in conflict with their goals to reduce the budget, thus piling the committee on journalists only - of course there is no conflict of interest. "

Prof. Rothstein of the Public Health Basket Expansion Committee for 2020 said: "As long as this is not a concrete and personal conflict or personal connection between a committee member and a pharmaceutical or technology company, there is no problem."

Regarding the molecular testing technology, the public committee said that "when there are technologies that are changing and renewable and not all commercial products, the Ministry of Health broadly incorporates the technology, which allows it to be updated for the benefit of patients in Israel. Restriction to specific tests may impair the ability to perform in the future. This is the case in the past, when drugs requiring molecular diagnosis (mutation detection, for example) were included in the tumor tissue. "

"Eligibility is included in the basket"

The eligibility to perform the test was included in the basket, but the basket committee did not discuss the laboratory method by which the test would be performed. Naturally, the laboratory methods are modified and refined, and the tests included in the basket are not detailed up to the level of the laboratory method. ".