11 July 2009

How mad can you get

Emeritus Professor Joe Collier
Mad at fast track drugs proposal

The British are quite an innovative lot. The UK has contributed in no small way to some major advances in medicine ranging from DNA and test tube babies to CT and MRI scanners. Yet the NHS is said not be be innovative. Dr Grumble is not so sure that this is entirely true. Certainly we were slow to get the scanners we invented but that was at a time when the NHS was very much underfunded. And not all innovative treatments are worth having. We are said to be conservative when it comes to new drugs but that is not necessarily a bad thing. Many new chemical entities are not quite as marvellous as they at first seem and it is not unusual for serious, though rare, adverse drug reactions to become apparent after marketing rather than in the clinical trials. Some drugs just do not live up to the marketing hype and some drugs cost so much for such a minuscule benefit that it is just not reasonable to expect the taxpayer to foot the bill. And it is in dealing with this problem that the NHS has been innovative in requiring NICE to evaluate the value for money of treatments.

According to the Guardian:

The pharmaceutical industry has been fiercely critical of Nice since its inception in 1999 because it blocks sales of expensive drugs to the NHS that are of only limited benefit.

How can you be critical of curbing unreasonable spending on medicines? Surely expensive drugs that are of very limited benefit should never have been developed? If the pharmaceutical industry cannot produce drugs that are reasonably cost effective that is their problem and not the taxpayers'.

So, after all the effort put to developing NICE, why is the Office for Life Sciences proposing a system which bypasses current NHS procedures for safeguarding taxpayers money? See if you can work it out. There are clues in the Guardian article.


the a&e charge nurse said...

"Critics will say the proposal threatens to undermine NICE by allowing into the NHS costly drugs that may offer no real health gain".

But ...........
"Lord Mandelson, whose business department oversees the OLS, believes pharmaceuticals are key to the revival of the economy".

"The proposal comes from OLS, run by Drayson, a former drug company boss. His remit is the promotion of the life sciences as potential big earners for Britain".

Am I getting warm, Dr Grumble?

Adam Wishart's film, 'The Price of Life' (aired on Beeb2) delved into the machination's of NICE and it was a real treat, not to mention an education, watching it.

For one thing, I learnt QALYs (quality adjusted life year) has been priced at £30k by the NHS - the same cost for keeping an average prisoner incarcerated for a year.

Up until recently if a drug cost more than £30k (p.a.) and did not offer longer than a year of life then NICE would have deemed it not cost effective so would have been unlikely to approve it.

Now Mandy's exciting plan for the economy trumps medical ethics it seems?

Dr Grumble said...

Dr Grumble is not privy to the thinking behind this but he has had the very same thoughts.

Grumble has always been suspicious that one of the reasons why drug companies have tended to thrive in the UK is that the NHS has provided them with a hidden subsidy (but he has no evidence for this). If that is right then reining in NHS spending on ludicrously expensive drugs would have a damaging effect on one of our key industries.

And he is also appalled at the enormous cost of locking people up (and the numbers we lock up). There are better ways to spend taxpayers’ money. Many of Dr Grumble's patients have been in prison. It hasn't done them any good. It hasn't done society any good. It's just cost us a lot of money. Few of these people are bad enough to have to be locked away. But most middle class people don't meet people who have been in prison. They just read the Daily Mail which frightens them into thinking that prison works which it clearly does not.

Andy Cowper said...

ah, the dear old Mail. Did you see their recent comedy piece about an HSJ journalist and a wicked conspiracy against Andrew Lansley, Dr G? See here for more.

Hope you're well, Dr G. And a big yes to the previous post - much too little time to read books. But do read this excellent piece on US health reform by Atul Gawande from the New Yorker if you get a minute

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