Polly Today

The first half of this is very good. Woo Woo medicine shouldn\’t be paid for by the taxpayer, nor should spurious governing councils for charlatans. She then, as is her wont goes slightly off the rails.

Only challenged once to a judicial review, Nice won the case for limiting Aricept to only the moderate stages of Alzheimer\’s – and won it with the strength of solid evidence.

That\’s not in fact how I recall (insert Alzheimer\’s joke here) the matter.

The recommendations issued today state that donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon) should not be used as a treatment of mild to moderate Alzheimer\’s disease.

Aricept should only be used to treat severe Alzheimer\’s on cost benefit grounds. The unfortunate thing about this being that the drug delays the worsening of symptoms: so they won\’t pay for it to stop you losing your mind but will to keep you alive once you have done so.

This week patients are suing their primary care trusts for the right to Avastin for stages of cancer not yet recommended by Nice – or at least, their right to buy the drug privately to top up their NHS care, which if they won, would destroy the NHS.

Ánd that\’s the loopy part. Allowing people to spend their own money on their own treatment will not destroy the NHS: it\’ll destroy a particular vision of it, for sure, but that vision of it is one in which you get only what the Government thinks you should, not what you might actually want.

Nice makes the hardest, most public decisions on NHS rationing – it was designed to draw the flak. If a drug costs more than £20,000-£30,000 for a quality-adjusted life year, a year of reasonably good life – they scrutinise it thoroughly. They tend to judge £50,000 too much for a few months longer in end-stage cancer. Naturally people protest, but no health system – certainly not US private insurance – is ever open-ended.

The survival of the health service depends on people trusting the science of these decisions. If they think they can buy better privately, the NHS will fall into the hands of those who think it should be dismantled – Professor Karol Sikora and the Reform Group, close to the Conservative leadership, who want a two-tier system where some people pay for better extras of their choice.

Quite. Now it\’s worth pointing out what actually happens in the NHS currently. If you decide to go for a top up treatment, paid for out of your own money, then you lose your NHS treatment for that same condition. You don\’t just pay the top up of £20,000 a year for Herceptin (or whatever it is) you also have to go private for the entirety of your treatment for breast cancer. Treatment which, you will note, you have already paid for through your taxes.

Now, the basic idea of rationing by cost, by QUALY, is an obvious and sensible one. But the measurement of that cost is not actually what your life, or a year of it, is worth to you. It is a measurement of what impositions it is right to put upon your countrymen, through taxation, for a year of your life. Which is, I think you\’ll agree, a vastly different question.

Think of what impositions upon the rest of us we think valid for someone who has lost their job (and assume away all the jibes about the workshy etc). It\’s something like £100 isn\’t it? (whether per week or fortnight I\’m not sure….rather out of touch). But we do not then go on to insist that someone who does work hard at a job can only be allowed that same £100, do we? Social housing for those who need it is OK but we\’re not exactly fitting jaccuzis into it: but we don\’t then say that those who want to spend their own money on such cannot, do we?

So it is with health care. What might be the right level of help I am able to call on from my fellow taxpayers (when we\’re talking about cancer and other expensive treatments the NHS does become a social insurance policy, not simply a pre-paid health service via taxation) when in need might be, indeed can be, very different from the amount of my own resources that I am willing to spend on an extra year of life. After all, I\’m rather likely to find my life more valuable to me than my life is to you.

So why shouldn\’t I be allowed, even encouraged, to top up my treatment from my own money?

Well, except for the point that it is better that we be dead and equal than alive and unequal?


5 thoughts on “Polly Today”

  1. Reminds me of the CND “Better Red than Dead” campaign in the ’80s. I wonder how many ex-CND folk would agree with “Better unequal than dead.”

  2. An interesting point comparing NHS treatment with welfare. The NHS is, in the mindset of the New Labour, and particularly in the mind of the founding politicians, an integral cog in the welfare system. A handout, to be given by a paternalistic Government with conditions and strings.

    It’s no wonder that the system is not responsive to patients’ needs when it has these roots.

  3. It really takes a wonderfully warped worldview to see the [i]limiting [/i] of access to a therapeutic drug as a ‘win’. Only in the NHS, I guess, is the denial of therapy a positive thing and the continuation of the system more important than the fate of the people it is intended to serve.

    Why in the world should people not ‘top up’ their healthcare out of their own pockets, if they so desire? Isn’t this the very basis of some of the more-successful Continental healthcare systems that are forever being lauded in the pages of The Grauniad and elsewhere? That everyone gets the basic, no-frills system and you can buy as much additional healthcare as you choose?

    Scratch a modern UK ‘liberal ‘and the old class hatreds that were the backbone of the Labour party for so many years are just below the surface. It’s not about the NHS or the millions of people who suffer under its rationing and sub-standard care – what gets them all upset is that well-off middle-class people can afford more than the ‘government stroke’.

    A person more cycnical than I would get to thinking that a drug like Aricept – which may slow or delay the onset of Alzheimers in some patients – is an active threat to the institutional well-being of the NHS and is therefore resisted on that account. After all, a drug that may keep patients out of long-term assisted- and nursing-home-care is a drug that reduces the need for the most densely-staffed NHS services. Not surpising, perhaps, that the institution would resist supplying such a drug, and hail limitations on its provision as a ‘win’.



  4. It’s even worse than that isn’t it Lllamas. Patients whose condition deteriorates to a point where they can no longer live independantly at home, end up having their home, and most of their money, confiscated to pay for their “care”, at unjustifiably high rates.
    Patients who maintain their independance, and ultimately die at home, get to pass on their estates to their horrible middle class families. And we can’t have that, can we. Won’t do at all.

    NICE could be renamed the National Institute of Cost Effectiveness without changing its initials. And that would be more honest.

    It is time the welfare state was radically overhauled and turned back into a safety net, instead of a glass ceiling.

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