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Is the cancer spreading? Treatment is reduced Israel today

2021-11-14T05:33:16.140Z


A new and unprecedented procedure of the Ministry of Health allows Clalit Health Fund to reduce the dose of drugs for lung and skin cancer patients, in contrast to the legal dose √ According to Clalit documents, the reason for the move is to "streamline spending on drugs", whose annual budget is estimated at 300 million shekels √ Senior oncologists: "Moral Bankruptcy That Has Not Been in the History of Israel"


Senior oncologists, including seniors and managers in hospital wards, senior officials in the Ministry of Health and hospital organizations, make serious claims that have not been heard until now, according to which a new and unprecedented approval by the director general of the Ministry of Health, Prof. Nachman Ash, for Clalit HMO allows it to reduce the dose The drug for lung and skin cancer patients - in contrast to the regular dose and the recommendations of a special committee set up in the Ministry of Health on the subject.

According to the new approval, doctors will be able to give patients with lung and skin cancer a reduced drug dose than that stipulated in the legal and official approval of the drugs in Israel, and in contrast to the dosage required by a significant number of senior doctors in the country. A special committee on the matter, set up by the Ministry of Health, also recommended that the HMO not allow doctors to prescribe the dose of medication.

In addition, there are harsh and unprecedented allegations, which are revealed here for the first time, which was raised before Prof. Ash in July this year, the chairman of the Israeli Oncology Association in the Medical Association, Prof. Gil Bar-Sela. Bar-Sela warned of Clalit's new policy Bar-Sela complained that the fund "refuses to give patients other drugs, despite the explanatory letters explaining the need for treatment," adding that he "wants to warn." "This conduct harms patients and the professional judgment of oncologists, and does not comply with the guidelines of the Ministry of Health."

In addition, Prof. Bar-Sela warned that the fund cancels the doctors' legal ability to choose the appropriate drug for the patient.

Another unprecedented claim he made concerns the fact that the fund did consult with doctors on the subject, but did so "while concealing the purpose of the consultation."

The new approval from the director general of the Ministry of Health has been issued in recent days as a draft of the doctors' responses in Israel. The fund ordered doctors to give them in a reduced dose according to the patient's body weight, while they are included in the drug basket according to the full dose - regardless of the patient's weight.The annual government budget for these drugs is estimated by health officials Cancer per year.According to the fund's documents, the new provisions are intended to "streamline spending on the most expensive drugs."

Special Committee of the National Council of Oncology: "The choice of dosing regimen should be left to the discretion of the attending physician, and the insurer should not be allowed to interfere with medical considerations."

The harsh criticism of senior doctors over Clalit's new instructions was exposed in June this year in "Israel Today", following which the Ministry of Health set up a special committee in the National Council for the Prevention, Diagnosis and Treatment of Malignant Diseases, which will examine the issue. "The committee was not persuaded that treatment guidelines should be dictated contrary to the doctor's discretion and contrary to the registration of the Ministry of Health," the committee argued. They added that "the choice of dosing regimen should be left to the discretion of the attending physician, and the insurer should not be allowed to interfere with the medical consideration, provided it is done in accordance with the physician's leaflet." Prof. Michal Lotem chaired the committee, and Prof. Ron Applebaum, Dr. Einat Shaham-Shmueli and Dr. Daniel Keisman served on the committee.

In addition to the special committee, complaints from patients at the Admissibility Commission to the National Health Insurance Act were investigated.

The commission is headed by Adv. Nili Hayun Dickman, and in two complaints from lung cancer patients, whose dose was supposed to be reduced according to Clalit's new directive, it ruled that the fund has a duty to fund and deliver the high dose according to the doctor's requirement, based on research and medical literature. And the only accepted registration in Israel and in the world.

Senior oncologist: "This is a robbery in the public trust in the State Health Insurance of the State of Israel. The move may be interpreted as a mass offense under the auspices of the Ministry of Health."

However, contrary to the recommendations of these sources, the director general of the ministry stated in an unprecedented circular that the fund "may dictate treatment policy in the dosage regimen of the drug for lung cancer and skin cancer", along with allowing doctors to request reasoned exemption requests. There is no impediment as a policy of the fund to treat a drug dose that is not listed in the drug leaflet. "

A senior oncologist told Israel Today that "this is a very dangerous and unprecedented move. For the first time in Israel, the Ministry of Health approves and backs the administration of a drug in complete violation of world-wide guidelines, out of HMO budgetary considerations, all when patients are unknowingly abandoned. "He will receive treatment that has not been tested in studies and in stark contrast to the registration, how can you tell if the disease has progressed due to the reduced dose? This is a treatment that in many cases leads to cure for cancer.

Senior oncologist: "This is a robbery of public trust in the State Health Insurance of the State of Israel, the Ministry of Health and the HMOs. This is a step that could be interpreted as an unprecedented mass violation of the law under the auspices of the Ministry of Health. Health in Israel. "

"Do not prevent patients from having the best treatment."

Sheila, Photo: Liron Moldoven

"The Helpless Patients"

Shani Shilo, founder and CEO of the Israeli Association for Lung Cancer, told Israel Today that "I am sorry that the Ministry of Health prioritizes economic considerations over medical considerations.

Patients with metastatic lung cancer are in a complex and sensitive medical condition, and any change in the physician's decisions about treatment may be fatal for them.

Although the decision can be appealed, this possibility is unlikely, as these are patients who may die, and every day for them is significant.

We urge the Ministry of Health to go against its own decisions in the drug basket and against the medical recommendations accepted in Israel and around the world, thereby undermining the chances of hope for patients and their families.

As an association, we will also consider initiating legal proceedings in order to stop the move. "

Sheila also wrote in recent days to the director general of the Ministry of Health that “Lung cancer is considered to be the number one cause of death among all cancers, when in the last decade there has been a revolution in the treatment of lung cancer with the introduction of drugs that work through the immune system.

Many patients have hope for life extension, and even recovery.

But despite the optimal access to these patients, many of Clalit's members are helpless.

We reiterate our desire not to severely prevent patients from receiving the best treatment they are entitled to, due to the economic interests of the funds and without any medical justification. "

General Health Insurance Fund

's response

: "The Ministry of Health and experts around the world support our policy"

Clalit Health Fund stated that "Following the intensive and thorough staff work of the heads of the Ministry of Health and the appointment of an independent expert committee, which determined that both methods should be permitted by weight and in a fixed dose, the ministry published a draft circular in favor of Clalit.

"The Ministry of Health states in the draft that the right and even the duty of the HMO, like any medical institution, to establish a medical treatment policy is binding on the medical staff treating it and on its behalf, including its right to prescribe drug treatment and dosage regimes, while establishing sound medical policies.

Clalit's position - as presented and even approved to the Ministry of Health and the Independent Committee of Experts - rests on policies pursued in various countries around the world such as Canada and Denmark, as well as the opinions of leading experts from the world, including the position of the World Health Organization. "Of senior oncologists from the major cancer treatment centers in Israel. We emphasize that Clalit will act in accordance with the proposed procedure and will seriously consider any reasoned request for an exception."

Clalit did not respond to a request for comment from the oncology association.

The Ministry of Health stated that "the draft circular was distributed for reference after it was formulated by the relevant professionals in the ministry and based on their opinion. Professional references received during the coming month will be considered in detail, and a decision will be made on the final wording."

The Ministry of Health did not respond to any allegations made by Clalit about the new regulations.

Prof. Gil Bar-Sela, chairman of the Oncology Association, said that "this is a draft of a circular from the CEO that has been submitted for comment, and the association as the professional authority on the subject of treating oncology patients will submit its comments."

He further stated in the letter of complaint he wrote that the issue of melanoma drugs had been sorted out, and regarding the drugs for colorectal cancer patients: "I do not know if the problem persists."

Source: israelhayom

All news articles on 2021-11-14

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