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IN TOUCH – Novartis appeal, Shane Warne

TX: Ìý16.10.2018Ìý 2040-2100

PRESENTER:Ìý ÌýÌýÌýÌýÌýÌýÌý PETER WHITE

PRODUCER:Ìý ÌýÌýÌýÌýÌýÌýÌýÌýÌý KEVIN CORE

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White

Good evening.Ìý Tonight:Ìý The battle over which treatments can be used to combat a major eye disease goes on, as drug companies seek to return to court.Ìý And how Shane Warne ruined our correspondent’s breakfast.

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Warne

The best sledges are always those little clever ones, so who ironed your pants today like Stevie Wonder or you know like they’ve got to be clever things.

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White

More from Shane later.

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But first, two drug companies are seeking leave to appeal against a decision which allowed the NHS to use a cheaper drug – Avastin – for the treatment of Wet Age-Related Macular Degeneration.Ìý The companies argued that Avastin wasn’t licensed for use in the eye and that its prescription, by 12 health authorities in the North East, put at risk the regulations which govern the safety of drugs.Ìý But a High Court judge ruled that the NHS could cite cost as a justification for Avastin’s use and also rely on the fact that NICE – that’s the National Institute for Health and Care Excellence – had said it was safe and effective.

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Well talking to In Touch after that decision Haseeb Ahmad, Managing Director of Novartis Pharmaceuticals UK, explained why they were contemplating an appeal.

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Ahmad

Regulation is there for a reason, what we’re seeing in this case is that potentially both hospital trusts, physicians and patients will be put under pressure to accept a medicine that hasn’t been through the same regulatory standards.

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White

Haseeb Ahmad of Novartis.

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Well David Hambleton is the CEO of South Tyneside Clinical Commissioning Group, one of the 12 authorities who went ahead and used the cheaper drug.Ìý How did he react to the company’s decision to appeal?

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Hambleton

Well I think, first of all, I’d say we were disappointed that both of the drug companies concerned haven’t been prepared to accept the judgement, which was really comprehensive and I think for us represented a very, very clear statement of the law.Ìý So, first of all, disappointment, given how clear that was.Ìý

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White

And what have been the immediate effects of the judgement about your use of Avastin because there have been some big claims about the difference it would make?

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Hambleton

Yeah, I think the judgement has really clarified things for our clinicians, in particular, because I think there have been, deliberately I suspect, a lot of misinformation around this area, probably going back for a decade.Ìý But now I think it’s really clear that this policy is legal and we can start using Avastin legally in this area of Wet Age-Related Macular Degeneration.Ìý So, our clinicians are now feeling much more confident to go ahead and implement the policy and offer choice, which I think for us is great news.

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White

So, does that mean that people already who perhaps were not getting Avastin are now receiving it?

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Hambleton

I think there are already some people who were receiving Avastin, because remember you can use Avastin when people’s visual acuity hasn’t deteriorated to the level that you have to wait before you use the other two drugs.Ìý And I think that we’re now about to see a real step change in that.Ìý So, I think clinicians are now gearing up to offer that choice much more widely to people.

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White

And are the human resources there – this is likely to speed up the treatment that people get – have you got enough people, as it were, to provide this treatment?

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Hambleton

Well I think it’s fair to say that firstly, of course, using Avastin doesn’t require people necessarily to have more injections, it just allows you to do it potentially earlier in people’s disease.Ìý So, for us, that can only be good news.Ìý So, we would love to have the challenge of saying actually there are more people for us to be able to treat and preserve even more of their eyesight.Ìý So, rather than that being a challenge, that’s an opportunity for us to say to our retinal specialists, for example, that actually your departments need to be really ready to make sure that they’re offering choice.

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White

So, if the law on this had been clearer earlier what impact would that have had on your clinical commissioning group?

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Hambleton

I think the impact would have been really very significant.Ìý We’ve calculated that it costs approximately £13 million every year in Cumbria and the North East for these treatments and that’s the type of order of savings that we could have been making every year.Ìý So, for us, the size of that price is really significant and that’s why we’ve gone to these lengths to prove that our policy was lawful in the first place.

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White

Novartis argued again, on In Touch a couple of weeks ago, that it’s in no one’s interest to see deregulation of the process to decide the safety of drugs.Ìý They’re right about that aren’t they?

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Hambleton

I listened to the piece which you broadcast, I have to say that’s not what the law says.Ìý But at the moment what I think we’ve had is two drug companies who have been trying really, really hard to protect their profits and let’s face it these judgements – the cases – have not been at all to do with whether these drugs are safe and effective.Ìý NICE have very, very clearly stated that all three drugs involved are equally safe and equally good.Ìý The questions that the drug companies have hidden behind is whether the current drug licensing regime supports that.Ìý As far as we’re concerned, it’s should these drugs be offered as a choice for our patients in the NHS and the law has very clearly said yes they should.

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White

But don’t companies also need to be able to protect how their intellectual property is used?Ìý The work to develop these drugs is costly, it takes time and it costs money.

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Hambleton

Listen, I think we’d all accept that the pharmaceutical industry makes a really positive contribution to the NHS and there is a good relation between our health services and the pharmaceutical companies.Ìý I think what we’ve seen, unfortunately, in this case the drug companies have put their profits and their shareholders’ interests above that of patients within the NHS. ÌýNo one’s denying the fact that commercial organisations should be able to make a fair profit, I think what we’ve seen is this is really going beyond the pale, to be quite frank, and therefore that’s why we’ve gone to these lengths.Ìý The price difference in these drugs is astronomical.

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White

Although, to be fair, the price of Lucentis, in certain circumstances, has gone down in recent years hasn’t it?

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Hambleton

Oh yes it has and there’s no doubt about that but I guess if you still compare even those prices to the price of one vial of Avastin at £27 the NHS could save a significant amount of money.

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White

Will you go on prescribing Avastin while this appeal is considered?

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Hambleton

Oh goodness yes, I mean the judgement is really clear, it’s a clear statement of the law, the appeal process obviously hasn’t even been agreed yet, so first of all the judge needs to grant leave to appeal and it remains to be seen whether that will be granted, given that there needs to be a reasonable prospect of success and to be frank we can’t see that.

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White

David Hambleton, CEO of South Tyneside Clinical Commissioning Group.

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And the relationship between cost and quality is also at the heart of our next story.Ìý Last week we heard about the long-delayed arrival on the market of a much cheaper machine to produce electronic braille – the Orbit.Ìý The development of the machine was backed financially by a number of a charities for visually impaired people around the world, including the RNIB.Ìý Their argument was that the commercial machines doing the job up to now have costs thousands of pounds, which made it impossible for many blind people to get their hands on them, literally.Ìý

Well Neil Jarvis has been a major player in the process.Ìý An experienced braillist himself, until recently Neil worked for the New Zealand equivalent of the RNIB.Ìý He’d anticipated Orbit’s appeal on the grounds of cost and as an educational tool but there was a third group of users he hadn’t foreseen.

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Jarvis

That was people who already had the existing kind of braille displays but were afraid to take them out to places where they might get damaged or even they may not be safe.Ìý And so, taking something like the Orbit allows them to take a device which is not something which has costs them thousands and thousands of pounds but is something which is easily used in the outdoors and easily used in strange places.

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White

And I think you come into that category don’t you, I don’t know if you’re surprised to have come into that category but you’ve actually done this yourself.

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Jarvis

Yeah, I took the Orbit to Russia for the 2018 FIFA World Cup.Ìý I’m a huge football fan and I took the Orbit on the road for that.Ìý The nice thing was of course when I got back to my hotel room it doubled up as a braille display for my computer, so when I was doing emails or for my iPhone I actually had braille to do it as well.

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White

You’re still a member of Transforming Braille but you’re not so much fully associated with organisations.Ìý Why was there such a long delay?

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Jarvis

When you design new technology, you’re going to have teething problems, so that’s why there was the delay that we found problems but we didn’t want to send devices out on to the market that weren’t ready for prime time.Ìý We’ve, as blind people, have become used to hearing other blind people complain rightly and bitterly that they’ve invested a lot of their own hard-earned money in new electronic braille devices only for them not to perform as advertised when they’ve got them home and we didn’t want to be in that situation.Ìý

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White

Just finally, the fear might be that although of course you welcome – you want to get braille into the hands of as many people as possible – the fear might be that some of the sophisticated high-end uses wouldn’t be possible and that might drive the companies who are doing that out of business.

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Jarvis

In most markets there are budget versions, mid-priced versions and higher priced versions – bells and whistles, if you like, of products.Ìý If you buy a car you can buy a Mini or you can buy a Ferrari and lots of things in between.Ìý And I don’t see any reason why braille or any kind of technology should be any different.

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White

Neil Jarvis.

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Well Humanware has been involved in the development of electronic braille for 30 years, so how do commercial companies like this react to the appearance of Orbit on the scene and this clear challenge to their pricing policy?Ìý Andrew Flatres is Humanware’s braille product manager.

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Flatres

You have to be openminded and make sure that customers and users are not misguided in the thought that this is the future of braille.Ìý Don’t get me wrong, manufacturers like ourselves are looking at different approaches to help reduce the costs of today’s prices in braille technology.Ìý However, the customer demands high quality and expects that high – same high spec technology as everyone else is using.

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White

So, is Orbit a threat to you would you say?

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Flatres

I wouldn’t say a threat, it’s something to – it’s a good thing that they are making braille affordable and available to those that cannot afford it.Ìý As I said, any type of technology people have different price points and different choices.Ìý Of course, the lower cost braille side of things there’s going to be compromises, whether it’s suitable for certain segments in the market like education etc.Ìý So, to answer your question, Peter, no I don’t think it’s so much a threat, I just think it’s really important to know what the difference in the technology is.

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White

But Orbit have said education is actually one of the areas that they’re really aiming at, you know, that they want to get into schools.Ìý Are you saying it’s not suitable for education?

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Flatres

I don’t think it is.Ìý People want to achieve the high quality or high stem science, maths, etc., assignments on a braille product that can achieve that kind of stuff and I don’t believe that the Orbit-20 is there at this stage.Ìý The main purpose of the Orbit is a reading machine.

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White

But has equipment not been overpriced in the past?Ìý I mean you tell people that this sort of equipment is two, three, four thousand pounds and they kind of gasp, they’re really surprised that it is that expensive.

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Flatres

I guess that people need to be aware of the technology that’s being used.Ìý The quick refresh rates, the quietness versus what’s happening now in the low-cost market – it’s becoming louder, it’s becoming slower.Ìý Is someone who’s in the high end in the school would they – do they find that acceptable?

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White

So, are you saying really that this bit of competition in the market will make no difference at all to you – how you price things, how you market things?

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Flatres

Well, I don’t think – I mean as said, as before, it’s certainly something to be aware of and we are looking at ways to make braille affordable but you’ve also got to take in the fact that support and support is one of the biggest things in the braille market, making sure that customer is comfortable, knowing what to do, what happens if something goes wrong, the aftercare.Ìý Humanware has been around for about 30 years in this industry now.Ìý With the Orbit Reader 20 only just sort of being established is it proven technology?Ìý That’s questionable.Ìý And what’s the support going to be like?Ìý Again, that is all things that we need to start thinking about that.

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White

But Andrew, some people do say that it’s the commercial companies who are very keen to talk to us and explain things to us when they’re trying to sell us something quite expensive, not quite so quick on the scene when things go wrong.Ìý Given that for blind people, in particular, if you don’t get hands on advice it is really difficult to sort it yourself.

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Flatres

Oh, I wouldn’t say it’s difficult to sort it yourself, it’s just knowing that – well who do I contact if something happens, I need someone on the other line just to speak to about the issues that I’m experiencing.Ìý Again, it’s really important to make sure that the aftercare is there as well.

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White

Andrew Flatres of Humanware.

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And finally, today, for years Shane Warne upset batsmen with his mysterious spin bowling but how come he’s now been upsetting the breakfast listening habits of In Touch columnists?Ìý Red Szell explains.

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Szell

Like many people I listen to the Today programme while I crunch my cornflakes.Ìý It’s a bit like sending my brain to the gym – it can be challenging, depressing, thought provoking and informative and sometimes I find myself shouting at the radio.Ìý But seldom do I get offended by what I hear.Ìý Then last Tuesday, as I was getting ready to leave the house, I stopped to listen to Michelle Hussain interviewing Shane Warne.Ìý As a cricket fan I was all ears.Ìý Michelle opened with a couple of easy deliveries and Warne was getting into his stride when Michelle bowled him a googly.Ìý

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Clip – Today programme

Hussain

Sledging – something that Australians are really famous for, you yourself have had some memorable one liners.Ìý When Moeen Ali wrote his autobiography he said an Australian player called him Osama – does that go too far?

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Warne

Absolutely, there’s no room for racism or anything like that in sport or in the world – in the workplace, anywhere.Ìý So that’s disappointing.Ìý Sledging, to me, you know people always say what’s the greatest sledge.Ìý The best sledge is always those little clever ones.Ìý Things like when someone comes out to bat and you go jeez who ironed your pants today – like Stevie Wonder?Ìý Or like it was – they’re little things, they’re just, they’ve got to be clever things.Ìý Like I thought I had time with Daryl Culligan where I read this double page spread about him saying he’d been to a psychiatrist to say that he’d been playing the man and not the ball.Ìý Putting that in a public domain when you’re about to play a Test Match is opening himself right up.Ìý So, I sort of took the lead with that and I remember when he came out to bat I just sort of whispered in his ear as I was walking past him – Were they hourly sessions, what colour was the couch?Ìý Now to me that’s funny.

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Szell

So, let’s review this using DRS – the disgusted Red system.Ìý Shane’s initial defence is good, he fends off the question with a straight bat, there is no room for racism or anything like that in sport or in the world.Ìý But his follow through is shocking – a Stevie Wonder gag!Ìý But according to Shane stereotyping and deriding blind people is clever, a prime example of the art of sledging, as is mocking those with mental health issues.Ìý But when he realises he’s on a sticky wicket he tries to cover up.Ìý However, he makes no attempt to defend his Stevie Wonder jibe.Ìý

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So, Shane Warne, I’m calling you out.Ìý Why does this matter?Ìý Well as a celebrity Shane Warne is both a role model and a brand, voted one of the top five cricketers of the 20th century he remains a role model for many young players and has a high media profile.Ìý Like any other commercial brand he has a responsibility not to display double standards, stereotype minorities or discriminate on the grounds of difference.Ìý Deriding disability is just as wrong as stigmatising people on the grounds of race, religion or sexuality.Ìý It’s not clever or funny, it’s offensive and it perpetuates prejudice.Ìý Alongside casual racism and sexism it too has no place in sport, in the world or on Radio 4.Ìý

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So, Shane, if you’re listening, show us that you’re someone to admire in the 21st century and admit you’ve overstepped the mark.

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White

Red Szell.Ìý Do you agree or is the boy just too sensitive?Ìý You can call our actionline for 24 hours after the programme with your comments and queries, that’s 0800 044 044.Ìý You can email intouch@bbc.co.uk or click on contact us on our website.Ìý From there you can also get downloads of tonight’s and many previous editions of In Touch.Ìý

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From me, Peter White, producer Kevin Core and the team, goodbye.