Wednesday, 3 November 2010

Letting emotion rule the roost.

Sometimes in Medicine people let their hearts overrule their heads, and it inevitably ends up hurting patients. I have a feeling that this is exactly what's happened with the decision to take away the power from NICE to decide which drugs should be paid for on the NHS. Instead we'll have a postcode lottery, with a real probability of money being wasted on popularist treatments that aren't actually as effective at what they do and drain money away from where it is really needed.

I've written before about how NICE gets undeserved scorn from some areas of the press, and perhaps that's inevitable given that their job involves denying the funding of drugs to patients. But the fact of the matter that while people might not think it in good taste to look at aspects of health care from a cost-effectiveness point of view, that is what you have to do when there isn't a limitless budget. You have to prioritise treatments, and that means that some people will inevitably lose out. All you can do is make sure the smallest amount of people lose the smallest amount possible. In fact, despite it's reputation for negative decisions, NICE has approved 83% of all new treatments it's had to consider funding.

You don't have to look far to see that people won't always be able to see what the best treatments will be for themselves. The very fact that the NHS spends £4 million a year on Homeopathy, a treatment which has been thoroughly debunked and shown to have no positive effect beyond that of a placebo, is proof enough that people will happily shell out hard cash for worthless treatments.

That is why NICE is so essential, it takes out the political and business influence from something that should be purely based on rigorous clinical assessment of its cost/benefit. Of course government's are going to want to provide the drugs that give the most positive headlines, and the pharmaceutical companies are going to want to claim every drug they produce is worth spending fortunes on, but we can't let those vested interests get in the way of giving patients the best care we can with the funds available.

We shouldn't give in to the powerful lobbying of the big pharma companies, who will benefit massively from this new supposed 'value-based pricing' which will take out the ability of an independent body to just say no to these companies. When you have a body that can simply say no, this isn't worth the price you're charging, it forces pharma to up their game and provide value for money.

Of course, this isn't the only time I've suggested reform of pharmaceutical companies, and it's not that I want to damage them, but I think reform is needed so that they serve he patients interests before they serve their stockholders.

If you want to see what happens when pharma holds all the cards and claims that this is in the interests of the patients, then look to the USA. Admittedly, their problems run deeper than simply the drugs companies, but they are a major reason why their health care costs have increased exponentially since the 1980's, to the point they pay the most per capita anywhere in the world. Yet, for all this money being spent on the top drugs, they have some of the worst health outcomes of any developed country. Lots of money spent on health care is only beneficial if it's targeted in the right areas.

Andrew Lansley is playing political games with the NHS, and so far its fallen on unsympathetic ears from all areas of health care. This is the latest in a long line of failures. Let's keep providing money for treatments that are shown to work, and provide the best care possible. Let's keep NICE.

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