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?