This is going to be fun

Thousands of elderly people are dying unnecessarily early because ‘despicable’ age discrimination in the NHS is denying them treatment for cancer, a charity has warned.

Yes, obviously. For the system is set up to do this.

Indeed, I\’ve seen Polly commending the NHS for taking such a robust attitude to expense control. Why spend fortunes on the last few months of the elderly when we could be eradicating child inequality?

According to research published in the journal Cancer Epidemiology, there would be 14,000 fewer deaths from cancer in those aged over 75 per year if if mortality rates from cancer matched those in America.

It\’s generally accepted that that\’s one of the reasons that makes the US system so expensive and the NHS so cheap. Because the NHS does a fairly brutal triage on who it will bother to treat aggressively and who it will offer simple palliative care to based upon the crude measure of age.

Now, whether it should be this way or not is one matter (one I\’m really not sure about myself). But the amusement might come from reactions to this report. I can see the usual suspects clamouring that this just proves how the Tories are bastards while ignoring their own previous stance that this shows how wonderful the NHS is because it doesn\’t waste resources.

15 comments on “This is going to be fun

  1. It’s also the case that people have paid for the NHS all their lives and are therefore entitled to get something out of it. If that is end-of-life care, then so be it.

    What we need is the option for people to make hard choices for themselves. For example, I have decided that if I end up with a stroke, or senile, or something of the sort, no one is going to spend 12 years wiping my shitty arse in a nursing home as I gradually get worse. My end-of-life care costs will amount to one 9mm cartridge and subsequent cleaning/repainting of one wall.

    I don’t see why I cannot make this decision now, be relieved of 40% of my mandatory healthcare/nursing care contributions, and be made to stick to this decision when I do actually start going senile.

  2. ‘be made to stick to this decision’
    state enforced suicide?

    the article doesnt really go into the nuts and bolts of the treatment vs quality of life decision.

    is another years treatment with the latest biologic really ‘worth it’ if the patient is still bed -ridden with pain and a plethora of side effects?

  3. It’s also the case that people have paid for the NHS all their lives and are therefore entitled to get something out of it. If that is end-of-life care, then so be it.

    Oh dear, not this again! It’s the “I’ve paid my insurance premiums so now I’m entitled to a little fraud” argument.

    Old people have indeed paid at the required level for the NHS all their working lives, and they have had the benefits. They’ve had an NHS A&E available to put them back together if they’ve had an accident. They’ve had their kids born in NHS hospitals, etc.

    If you want the NHS to pay for aggressive cancer therapy for the over-75s, that’s fine. Propose the tax increases required to pay for that, and we’ll see how it goes down.

    Are those 14,000 fewer deaths from cancer 14,000 people who continue to lead happy productive lives, or is that 14,000 more deaths from heart failure and pneumonia? If we’re extending someone’s life by 3 months, is this the most effective use of our money, or would it be better used providing artificial limbs for amputees, more police on the beat or more duck houses for politicians?

  4. According to research published in the journal Cancer Epidemiology, there would be 14,000 fewer deaths from cancer in those aged over 75 per year if if mortality rates from cancer matched those in America.

    The question I would ask is how many QALYs are they going to get at the age of 75? It is often said that half of all medical expenditure goes on people in the last six months of their lives. New cancer drugs are expensive – some go for millions a pop, although a lot more go for hundreds of thousands and even more for tens of thousands. You don’t have to take many before you’re ringing up a serious bill.

    What does NICE say about costs? There is a cost per QALY they won’t go over. At 75, you may have what? Five more years until you hit the average life expectancy?

    This doesn’t look like discrimination but actual NICE policy.

  5. JamesV – “It’s also the case that people have paid for the NHS all their lives and are therefore entitled to get something out of it. If that is end-of-life care, then so be it.”

    No it isn’t. It is not a defined contribution scheme. If you die quickly and early, you are not entitled to a refund.

    “What we need is the option for people to make hard choices for themselves. … I don’t see why I cannot make this decision now, be relieved of 40% of my mandatory healthcare/nursing care contributions, and be made to stick to this decision when I do actually start going senile.”

    You can make that decision now. Or could if anyone let you buy a gun. But of course what you mean is not that you should be allowed to shoot yourself, but that some doctor should be allowed to kill you. That is a very different matter and there are good reasons why we do not allow this.

  6. ‘the crude measure of age’ is a little crude. Chronological age plays only a small part in my treatment decisions (I’m an oncologist). Biological age/’organ fitness’ is much more relevant, and has meant I have treated 65 year olds more intensively than 45 year olds. Geographic variation in quality of care is a much bigger problem in the NHS

  7. *It’s also the case that people have paid for the NHS all their lives and are therefore entitled to get something out of it. If that is end-of-life care, then so be it. *

    A counter argument would be “I paid my AA subscription for 30 years, doesn’t mean they will fix my car if I stop paying it now.

    /heartless

  8. My first instinct now is to disbelieve anything published by a charity. Sad: it wasn’t all that long ago that I set up deeds to fund some of them. When did they fall, so often, into the hands of lying bastards?

  9. It’s a triage based on more than age. Once the first and second line therapies have been exhausted then it’s pretty much into palliative mode no matter how old. Forget the US, even in continental Europe patients are treated more aggressively than they are here.

  10. Matthew L – “What determines the rate at which you age biologically?”

    Well I bet it is probably a good idea not to smoke.

  11. dearieme – “When did they fall, so often, into the hands of lying bastards?”

    When they fell into the thrall of the State, dear chap.

  12. And when will a geriatric invoke the ‘eye for an eye’ law on the person denying treatment.
    After all even if sent to prison -things are not all that bad there. They have to look after their customers.

  13. This research was published last June: someone must have put out a press release this week. I’m sceptical of anything epidemiological that analyses cause of death, because there are all sorts of biases in the way it’s recorded.

    I don’t recognise the description of “brutal triage” from the practice I know. I suppose not all oncologists are the same.

  14. JamesV said (#1): “people have paid for the NHS all their lives and are therefore entitled to get something out of it”

    That would be true if the NHS were a properly funded long-term healthcare system.

    But it isn’t. It’s a short-term annual service.

    If you paid for the NHS in 1978, you were entitled to healthcare in 1978. If the system’s different now, the system’s different now.

    That’s what you get for leaving these important matters to short-term politicians, rather than long-term businesses.

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