Polly on Top Ups

Polly addresses the "problem" of people topping up their NHS treatment with their own money and thereby risking being denied any further NHS treatment.

There\’s a glaring hole in her reasoning:

The National Institute for Clinical Excellence (Nice), one of Labour\’s best inventions, scrutinises all available evidence to decide what the NHS should provide once new drugs have EU licences. But Nice has been under siege from the drug companies, claiming their products are turned down because of cost. However, Nice is independent, and not primarily a rationing mechanism: it sanctions any drug with good evidence for effectiveness. It has only refused 5% of drugs – those that offer perhaps a few weeks\’ more painful end of life at huge cost. It makes the same decisions any wise family should make before paying privately, if only they knew the evidence.

Now, perhaps a tad unfashionably, I\’m a supporter of the essential idea of NICE. At root it\’s a form of cost benefit analysis . From taxpayers\’ dosh, we should only provide those drugs and services which are indeed cost effective. This is true whether we\’re talking about cancer drugs and it\’s also true out there in the wider world. We should only invest in, say, train safety up to the point where the costs of doing so are balanced by the benefits done. Similarly with the environment and climate change: we should only pay to mitigate climate change to the extent that such mitigation is cheaper than adaptation.

Cost benefit analysis is good for society, certainly. However, the error comes here:

same decisions any wise family should make

Ah, no. We\’re all well aware that there are things which benefit individuals but which do not benefit the wider society: all too aware. But we also need to understand that there are things which might make sense at a societal level which do not, necessarily, at an individual level.

The cost benefit analysis which society faces over the funding of drugs is rather different from the one an individual does. For society is asking the question "how much of other peoples\’ money should be spent to save or extend this life?" The individual is asking a very different question. "How much of my money should I spend to extend my life?"

The two are entirely different questions. By analogy: we do indeed have a welfare safety net, rightly so. There is an amount which it is righteous that I pay into society that the poor do not starve (leave aside whether it is State driven or charitable here). But the diet that the poor receives from that zakat? A reasonable and nutritious one? Or filet steak and caviar? And would it be immoral that the societal minimum diet guaranteed to all would be less sumptuous than the one that I might purchase for myself out of my own remaining resources?

There are those who would and have argued that yes, such would be immoral. Old JC got nailed to a cross for, amongst other things, suggesting that the correct reaction to a cold beggar was to divide your cloak into two and to bed down with him, asking if you might share his cold.

You might have noticed that we don\’t in fact run society along such lines and that we have in fact rejected this idea that the spending of our collective resources "should" be the same as we spend our private ones.

In other words, Nice is not refusing drugs any doctor should be suggesting it\’s wise for individuals to buy.

The NHS makes the same cost decisions individuals should make,

And there again is the mistake. The cost benefit analysis of how society deploys its limited resources is an entirely different one to that of an individual facing the same situation. And that is the problem with Polly\’s analysis. She\’s insisting that the micro and the macro are the same, when they clearly are not.

 

9 thoughts on “Polly on Top Ups”

  1. Polly’s simply wrong.

    I’ve just been diagnosed with Rheumatoid Arthritis. The best medical evidence is that early and aggressive combination therapy of a a DMARD such as Methotrexate plus an anti-TNF alpha drug is preferred.

    My consultant has admitted this is the case.

    NICE only allows payment for Methotrexate to begin with and, if that proves ineffective, another DMARD and, if that proves ineffective, then and anti TNF-alpha.

    My consultant agreed when I mentioned the combination therapy, but asked me if I had an extra £10,000 per year to spend.

    I understand why the decision’s made – although there’s an argument that I’ll ber less of a burden on the State in future years if an early effective treatment is followed now – but I can’t stand Polly’s downright lies.

  2. I understand why the decision’s made – although there’s an argument that I’ll ber less of a burden on the State in future years if an early effective treatment is followed now

    NICE is supposed to take that into account in its B/CA, though.

  3. Oh good. I was a bit worried about top-ups when I read about people being left to die by the NHS because they had dared to spend a few pennies of their own money on their own health, but now that Polly has explained that NICE is actually a, well, nice organisation that takes decisions for us so that we don’t have to, and even makes the decisions the way we should make them, well, I feel much better now.

    Not.

  4. As the partner of someone who has battled for the right to buy a drug (Avastin) alongside her NHS treatment I wish to say I fully respect Ms Toynbee’s opinion, BUT ONLY IF:

    – She publicly declares and promises that in the event of her being told that she has a disease that will kill her within three months, she will ONLY request the use of existing NICE-approved treatments.

    – She will not ask for medicines that might be available in Scotland but not England.

    – If she is told at initial diagnosis that *without treatment* she probably has only six weeks to live so the doctor needs to have her scanned in order to properly plan her treatment, but the waiting time for NHS scanners is… six weeks, she will NOT book a private scan on the SAME scanner

    – She will not travel abroad for treatment.

    With these provisos I am happy to respect her opinion.

  5. I think I need to slightly adjust one of my sentences:

    – She publicly declares and promises that in the event of her being told that she has a disease that will kill her within three months, but newer unapproved treatments can extend her life to many more MONTHS (not weeks) she will ONLY request the use of existing NICE-approved treatments.

  6. Tim,

    Toynbee states that,

    “Desperate patients are easily beguiled by doctors who are cavalier with the research in recommending a drug Nice has refused. ”

    This is a pretty full-on attack on the professionalism and expertise of doctors. She better have verifiable examples of where this has happened, otherwise she whacks another nail in her credibility’s coffin.

  7. “Desperate patients are easily beguiled by doctors who are cavalier with the research in recommending a drug Nice has refused. ”

    Doctors are experts in doctoring. NICE are experts in assessing the effectiveness of drugs. If you don’t trust the latters’ judgement over the former, then you are unwise.

    Tim adds: No, NICE are experts in the cost effectiveness of drugs for taxpayer’s money. As the above post shows, that’s not the same as the cost effectiveness of my money spent on treating me.

  8. Does the Guardian offer private medicine to its staff? BUPA, on-site GP, dentist, that sort of thing? Perhaps an “option benefits package” where medicine is one of the things you can choose to spend the bawbees on? Idle curiosity on my part: I don’t know the answer. Of course, when I say “staff”, perhaps I mean “senior staff”.

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