The NHS using Cheaper Untested Drugs to Cut Costs and make their Limited Resources Stretch Further

Posted by PITHOCRATES - May 6th, 2012

Week in Review

Who is more evil?  The pharmaceutical that has spent time and money to develop a new drug?  And then further time and money going through a lengthy clinical testing process to guarantee (as best as possible) that the new drug is safe?  When proven ‘safe’ by the regulators to sell it at a patent-protected price?  To cover all of these costs.  All the costs for the 20 new pills that failed along the way?  And the inevitable lawsuits when a proven ‘safe’ drug proves NOT to be safe after all?  Or is the health service using a cheaper drug that appears to give similar results?  That hasn’t gone through that extensive clinical testing process?  But they use the cheaper drug because they can treat more patients than they can with the more expensive but clinically tested drug?

Oh, it’s a perplexing and vexing question.  For we want new super drugs to cure all that ails us.  But we want those drugs to be cheap.  And safe.  But if they end up hurting us we’ll sue the bejesus out of everyone who allowed that drug to get into our system.  Which brings us to a great catch-22.  Drugs cannot be both cheap and safe.  For even the expensive ones sometimes prove not to be safe.  Especially if we rush them to market to save lives.  Only to find that by rushing those drugs to market they’ve harmed the lives we were trying to save.

Sadly, they have to balance the quality of health care with the cost of that health care.  Which is a never ending struggle in the NHS (see Using Avastin for eye condition wet AMD ‘could save NHS £84m’ by Branwen Jeffreys posted 5/6/2012 on BBC News Health).

The NHS could save £84m [about $135 million US] a year by using a cheaper drug to treat a leading cause of blindness, research suggests.

NHS-funded research says both Lucentis and Avastin have a similar effect in preventing loss of sight when used for wet age-related macular degeneration.

Lucentis costs about £700 an injection, and Avastin £60 – but Avastin is not officially approved for eye conditions.

Novartis, which markets Lucentis in the UK, is taking legal action against four NHS trusts for using the cheaper drug.

The company says the use of Avastin – developed to treat cancer – is undermining patient safety…

Lucentis is officially approved for use in eyes, and is the treatment recommended in England and Wales by the watchdog NICE.

Roche, which owns the rights to the similar, but cheaper, Avastin, has never sought to have it approved for use in eyes, which would involve further clinical trials.

But many doctors have been using Avastin at their clinical discretion…

As they both target blood vessels, the IVAN researchers particularly looked at whether there was an increased risk of heart attack or stroke…

Novartis argues that Lucentis has a safety profile proven in clinical trials and approved by the regulators.

It says the US research, which has just published data from the second year, highlights what it describes as “serious safety concerns” about the use of Avastin in this unlicensed treatment of eyes.

It points, for example, to a higher rate of stomach and gut disorders in patients given Avastin…

Cost pressures on the NHS have led to an increased use of Avastin…

The financial stakes are high both for the NHS and the pharmaceutical company.

Perhaps the question should be which is more evil?  The pharmaceutical industry?  Or a national health care system that has put cost considerations before patient care?  For the use of the cheaper drug is driven by the cost of the drug.  Not by the effectiveness of the treatment.  They may determine that the cheaper drug may be as safe as the more expensive drug.  The drug that was specifically clinically tested and approved by regulators for that specific use.  But this points out another issue.  Is the drug approval process not necessary for all drugs?  And, if not, why have it?  If it is only delaying bringing more life-saving drugs to market at affordable prices?  And if this is all true then should there be a ban on all lawsuits against pharmaceuticals?  Who were only doing what everyone demanded of them.  Rushing new life-saving drugs to market.

Perplexing and vexing questions, indeed.  And ones that we will hotly debate as Obamacare comes on line.  For Obamacare will have greater cost constraints than the NHS.  For Obamacare will treat far more people than the NHS.  About 5 times as many as the UK based on population sizes.  Which means the debate under Obamacare will not be about saving $135 million.   But about $683 million.  Over half a trillion dollars.  Or about half of the 2011 budget deficit.  So you know Obamacare will consider these cost savings.  And use drugs that haven’t gone through the clinical testing process like they are in the UK.  And actively search for other savings.  And place incredible pressures on the pharmaceuticals.  Making it very difficult for them to make a profit.  Or to even cover their costs.  And when that happens they will drop out of the business of finding new super drugs to cure all that ails us.  Making what ails us really ail us.  Reducing the quality of our lives.  Perhaps even killing us.

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British Soldiers receive Better Treatment in Military Field Hospitals than in Britain’s NHS

Posted by PITHOCRATES - April 15th, 2012

Week in Review

Britain’s National Health Service (NHS) treats all Britons.  Even their military wounded in battle.  It doesn’t matter.  The NHS takes care of all Britons.  Where they put patients before profits.  And negligence before quality in some cases (see Wounded soldiers sue military hospital for medical negligence after receiving ‘poor treatment’ by Tom Gardner posted 4/15/2012 on the Daily Mail).

When they signed up to risk life and limb for their country, they expected in return to receive a decent level of care if they were wounded.

But new figures have revealed troops returning injured from the battlefields of Afghanistan and Iraq are suing a specialist hospital for medical negligence.

Over the past three years, 13 soldiers have launched compensation claims against the Royal Centre for Defence Medicine at Birmingham’s Queen Elizabeth hospital…

… experts say there is a gap between the world-class care frontline soldiers receive on the battlefield and the aftercare they receive when they are repatriated.

Clinical negligence specialist Philippa Tuckman said: ‘I think as far as Birmingham is concerned, there is a gap between the emergency care and what comes next.

‘The acute care is usually very good. The battlefield and emergency treatment is an example to others which has been picked up around the world.

‘What they are not so good at is the general practice and the day to day less dramatic care, which is just as important.

So in other words, the care they received when first airlifted from the battlefield to a field hospital is better than the care they received when they returned home.  And became a patient in the National Health Service.  It’s sort of like that in the U.S.  Where the VA hospitals were notorious for substandard care.  Things are better than they used to be.  But if a veteran has the option (money, spouse’s health insurance, etc.) they’ll go to a private hospital.  For better care.  At least, while they have that choice.

Obamacare will change all that.  And give our veterans the same choice British veterans have.  None.  And the overall quality of health care will decline.  For when you’re treating more patients with the same resources you can’t raise the VA up to the level of the private hospitals.  You’ll have to lower the level of health care everywhere to the level of the VA hospitals.

Britain doesn’t hate their wounded veterans when they return home.  It’s just that when they get home they enter a much larger health care system that spreads limited resources over more people.  Which can’t but decline the level of quality they receive.  As it will be under Obamacare in America.  As it will be everywhere when they try to spread limited resources to more people.  Sure, everyone will have access to health care under Obamacare.  It just won’t be as good as it used to be.  And more people will suffer medical negligence.  Like those British soldiers returning to Britain.

Mr Garthley was also ordered to take off his uniform at Selly Oak hospital – then home of the Royal Centre for Defence Medicine – in case it offended ethnic minority patients, sparking national outrage.

Imagine that.  A British soldier had to remove his British uniform for treatment in the British NHS.  You know, if anyone has earned the right to leave his clothes on you’d think it would be a British soldier wounded in battle.  Perhaps they should have removed the offended patients to another room.  Apologizing, of course, for their inconvenience.  But we’re treating national heroes here.  And, frankly, when it comes to heroes politics don’t enter into the discussion.

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Reforms in the National Health Service opposed by the BMA, Royal College of Nurses and the Royal College of Midwives

Posted by PITHOCRATES - January 28th, 2012

Week in Review

There is a struggle in Britain about power and money in the National Health Service (NHS).  Health care costs are rising.  Services are being rationed.  And the current government is trying to fix these problems by decentralizing the NHS.  By transferring budgets and decision making to the general practitioners (GPs) at the local level.  The front-line doctors.  Making the GPs responsible for their budgets.  And their patients’ care.  At the local level where doctors treat patients.  Making the practice of medicine once again an intimate relationship between doctor and patient.  But others see this as a heinous plot to introduce market forces into health care (see NHS ‘in peril’ if health reforms fail, warn GPs by Stephen Adams posted 1/27/2012 on The Telegraph).

In a letter to The Daily Telegraph, the heads of more than 50 new doctors’ groups argue that the British Medical Association’s policy of “blanket opposition” to the Health and Social Care Bill fails to represent GPs’ views.

They warn that previous reforms have not gone far enough and have consequently “paid the price of disengaging the frontline staff most needed to modernise the NHS”…

The letter has been signed by 56 GPs who are helping set up clinical commissioning groups (CCGs) across England. Under the Bill these will effectively replace primary care trusts (PCTs) and be handed their budgets.

Andrew Lansley, the Health Secretary, has consistently argued that the central thrust of the Bill is to give doctors a greater say, and key to this is giving them more responsibility for commissioning health services…

However, many believe the real motive is to open up the NHS for greater private sector involvement.

Last November the BMA moved to a position of total opposition to the Bill, and since the New Year the Royal College of Nurses and the Royal College of Midwives have followed suit. The Royal College of GPs is deeply sceptical, although not yet publicly in total opposition.

The inefficiencies of national health care have resulted in medical rationing.  Which has lowered the quality of health care for the patient.  So why would anyone oppose reforms to improve the quality of health care for the patient?  Because it will introduce market forces into health care.  Which will reduce costs and improve efficiency.  Which could also impact pay, benefits and pensions of health care providers.  The most expensive part of national health care.

This is the danger of national health care.  It destroys the quality of health care.  But it also creates a very vocal and powerful health care bureaucracy.  That takes on a life of its own.  And makes reform nearly impossible.  It’s happening in Britain.  And will happen in the U.S. if Obamacare is not repealed.

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