For decades, Dr Logan McLennan served Porirua as a beloved family doctor. He now needs hundreds of thousands of dollars for medication to stay alive, following a shock blood cancer (myeloma) diagnosis and without Pharmac funding. Nicholas Jones reports.
Dr Logan McLennan spent more than 40 years working to plug holes in New Zealand’s health system, but after retirement fell into one himself.
McLennan worked at the Waitangirua Health Centre in Porirua East, choosing the area because it had great health needs but lacked family doctors.
In the following 43 years of practice, he cared for countless patients and delivered more than 1000 babies.
McLennan also mentored doctors through the postgraduate GP training scheme and successfully fought off government cuts to keep the vital programme going.
That contribution was recognised with a Queen’s Service Medal in 2013.
About a year after his 2019 retirement he was diagnosed with multiple myeloma, the second most common blood cancer in New Zealand, with about 450 new cases a year.
Currently incurable, it can be kept below detectable levels (remission) for years by treatment and medicines.
Each combination of drugs eventually stops working and myeloma returns, more aggressively. A patient must then try another option.
These lines of defence have deepened over the past 10 years. Newer medicines have greatly increased life expectancy and more are being released and developed.
New Zealanders haven’t benefited from that progress, however, because no new myeloma drugs have been funded since 2014.
A number of proven myeloma medicines are on Pharmac’s “options for investment” list, meaning the government drug-buying agency wants to fund them but doesn’t have the budget.
Myeloma affects plasma cells, which are a type of white blood cell that multiply in bone marrow and help fight infection.
Testing found McLennan’s cancer was particularly aggressive.
One treatment is a stem cell transplant, where healthy stem cells (special cells that can make copies of themselves) are removed from bone marrow.
The patient then receives high-dose chemotherapy, before the stored cells are returned to regenerate the healthy cells killed along with the cancer.
McLennan wasn’t eligible, because of his age (he is now 76) and a kidney issue.
Instead, the grandfather of six began on three drugs including the chemotherapy lenalidomide.
That is funded by Pharmac but because McLennan hadn’t had a stem cell transplant he didn’t qualify.
He paid $26,000, the point at which an access agreement with the drug’s maker kicked in, making future supply free.
In November last year, a blood test measuring levels of a protein associated with myeloma showed his cancer was on the march - the drugs had stopped working, and it was time to try a new combination.
The best option was daratumumab and pomalidomide, both routine and effective treatments that are funded in most of the developed world, including Australia, the United Kingdom and Canada.
Pharmac has both on its “want to fund” list. The private cost for daratumumab is about $220,000 a year (this halves in subsequent years, because the drug is given more frequently at first), without including administration and other fees.
Pomalidomide is a generic version (created after the patents on the original drugs expire), costing $706 a month.
McLennan and his wife Robin, a retired practice nurse who has been recently diagnosed with Parkinson’s disease, are preparing to sell the family home in Plimmerton to help meet the cost.
Medsafe has approved his drugs, but not in combination (it hasn’t been asked to by daratumumab’s maker, Janssen) - a technicality that means his health insurance won’t contribute.
A friend insisted on a Givealittle page, and his daughter, Jaime McLennan, a copy-writer retraining as a counsellor, was enlisted to summarise the situation.
“Sadly, after decades of helping other people through the gaps in the public health system, Dad’s treatment is now in one of those gaps,” she wrote.
More than 150 people have given almost $50,000 in a few weeks. The accompanying messages - from former patients, and colleagues he trained and mentored - have boosted the family.
“He treated thousands of us all. But he did it all as individuals and with amazing respect,” one former patient wrote. “He certified my father and mother’s passing, with such humility and utmost respect. He brought in new babies as treasures into our lives. For me and my siblings.”
“Dr McLennan was our doctor for three generations,” Teresa wrote alongside one donation. “We always left his office feeling a little smarter after each visit because he always took the time to explain things.”
Another donor thanked McLennan for being an “amazing” doctor to their parents: “You gave them confidence to see a doctor. A side note, thank you for sitting with dad the length of time you did, [when] he passed. He would have enjoyed your company.”
“Delivered two of my babies, and I remember him saying that he was delivering the babies of babies he’d delivered,” Erica wrote. “That made him a Grand-Doctor! He is a wonderful man, and a truly wonderful doctor.”
One family remembered McLennan rushing from a party to deliver one of their children, with his dinner suit under his scrubs and boots.
“He was ahead of his time and we never found another GP like him. No doubt he couldn’t have achieved what he did without his wife by his side. His meds have to be made available to all who need them.”
Pharmac and blood cancer drugs: a shortfall costing lives
McLennan has had more than two months’ of daratumumab, and protein levels in his blood have dropped sharply.
He also enjoys quality of life, something that would be much less likely if he was on the handful of decades-old, government-funded drugs for myeloma, which cause debilitating side effects including nausea and fatigue.
Those outdated drugs include thalidomide, developed in the 1950s and the cause of birth defects before it was banned for use during pregnancy.
“I can still go kayaking, I can go biking,” McLennan says.
“If people can’t afford [unfunded drugs] they go on to older chemotherapy, and the chance of that producing a deep remission is very low.
“They get a partial remission, which wouldn’t last as long, and they’d have to take time off work due to the side effects.”
Pharmac first received an application from Janssen to fund daratumumab in July 2017. Its expert cancer treatment subcommittee recommended it with high priority in November 2021.
About 270 to 290 New Zealanders could need the drug each year. Negotiations over price are confidential, but the amount paid by Pharmac would be a fraction of the price charged to patients like McLennan.
A recent review of Pharmac estimated funding the entirety of its “options for investment” list - the more than 130 medicines and therapies it wants to fund - would cost more than $400 million annually.
Pharmac is running a procurement process for pomalidomide (the other drug McLennan is on) and to widen access to the chemotherapy lenalidomide (which he previously had to pay for).
In terms of daratumumab, the agency says it is “continually engaging” with Janssen “to discuss commercial proposals and provide an update on the progress of the funding applications”.
McLennan wrote to Pharmac in October 2022.
“Better myeloma treatments will enable patients to regain control of the disease as early as possible in its course, maintaining quality of life and giving patients a chance to survive until the next new breakthrough line of therapy becomes available.
“Māori and Pasifika (already over-represented in the myeloma population) are less likely to have a stem cell transplant and their overall survival is worse.
“New Zealand used to be famous for its egalitarian approach to its citizens but when it comes to cancer treatment there is a large gulf between rich and poor.”
The Herald was made aware of his story by Myeloma NZ, a group run by volunteers including Nichola Oakenfull, who was diagnosed with myeloma in 2020, aged 41.
Some patients move to Australia or the UK to access daratumumab, she says. Others take desperate measures - last month the Herald reported on Simon Clark’s family, who collect aluminium cans to sell as scrap to fundraise.
Most families cannot raise enough money, says Oakenfull.
“These are sick patients. It’s not that their families aren’t caring for them - it’s that the caring, taking them to appointments etcetera takes time and effort, and they don’t have the time for fundraising on top.”
Her son was 6 when she was diagnosed.
She had a stem cell transplant and eight months of chemotherapy. It’s been physically tough - one effect of myeloma is calcium loss in bones, and Oakenfull broke her back after sneezing in March 2020.
“I used to be so active but now I can’t even go for a run because of the pain and risk of more fractures,” she told the Herald.
“I have no idea if I will even see my son get to college let alone university, work or get married. I can accept for myself that I am going to die, but I don’t want him to have his mum die when he is so young and he needs me. You need your mum, don’t you?
“We all deserve to have our family for as long as we can. The government needs to value our lives and see us as the assets we are.”
McLennan himself isn’t critical of Pharmac.
“It is an agency that has served New Zealand well by constraining pharmaceutical costs in the way it deals with pharmaceutical companies.
“The problem is that central Government is not able to fund them sufficiently for Pharmac to pay for expensive new cancer treatments.”
Ahead of the election, National pledged to introduce ring-fenced funding for 13 cancer treatments that are available in Australia.
Blood cancer medicines weren’t included. Health Minister Shane Reti previously said that omission was because analysis is needed by the Cancer Control Agency, which should be done by the end of the year.
Following the Herald article on Simon Clark, he said that would happen by the end of June, at the latest.
“We can then consider the Government’s response to the findings. I do recognise the frustration of people and whānau trying to access the best possible treatment for their loved ones.”
Pharmac last month announced it will fund a new medicine for some people with acute myeloid leukaemia, another type of blood cancer.
Leukaemia and Blood Cancer Foundation chief executive Tim Edmonds says the step “takes New Zealand a step closer to providing people with what is considered ‘standard of care’ internationally”.
“We hope that similar gaps in access to life-saving medicines can be bridged for a wider group of blood cancer people in the near future.”
A life of service
McLennan grew up on a farm and decided on medicine when his sister, 10 years older, married a medical student who became the local doctor in Lumsden, Southland.
As a final year medical student in 1970 McLennan worked in Harlem Hospital, New York, and was dismayed by the lack of primary medical services for the low-income, mostly black population.
When he returned home he found similar medical deserts and chose to work in the heart of one.
He and Robin balanced work with raising Jaime, now 46, Ana, 44 and Willy, 40.
“I was always aware that he wanted to help people less fortunate,” Jaime says.
“Those are values that we have all taken on.”
She was already planning on moving home from Melbourne with her young family when in 2021 she pulled to the roadside to take his call and learn he had cancer.
Robin fell sick with Parkinson’s last Christmas.
Asking for financial help is difficult, Jaime says. The support is more than money.
“What’s been especially touching is that some people have given $5, and they might be former patients and people without a lot of money. There’s something beautiful about them wanting to give back to dad.
“He has been very emotional and very grateful. But we recognise that other people might be in the same situation without that ability to reach out and call on the community.”
Nicholas Jones is an investigative reporter at the Herald. He won the best individual investigation and best social issues reporter categories at the 2023 Voyager Media Awards.