Monday, 17 November 2008

Socialized medicine not only sucks but also lets you die early

Here in Australia we are lucky to have what seems to be a pretty good balance between socialized and private health.

While waiting times to see specialists can be up to six months it's more typically 4-8 weeks and in the circumstances in which you are diagnosed with a life threatening illness then it's almost immediate.

There are medicines and procedures that are fully funded by the state with the others being covered by health insurance up to around 85% leaving the balance to be picked up by the patient.

We do have long waiting times in hospital emergency wards and there are chronic shortages of doctors and nurses, which is a direct result of government controls on salaries but all in all it's OK.

I have never heard of a situation, though they might exist, in which our health system has refused life saving or life extending medication to a patient.

That's what happens in that bastion of socialized health care - the United Kingdom - which inevitably leads to faceless bureaucrats making decisions about whether patients should be given medicine when they're going to die anyway.
Jack Rosser's doctor says taking Pfizer Inc.'s Sutent cancer drug may keep him alive long enough to see his 1-year-old daughter, Emma, enter primary school. The U.K.'s National Health Service says that's not worth the expense.

Rosser, 57, was told the cost of Sutent, 3,140 pounds ($4,650) per treatment for his advanced kidney cancer, was too high for the NHS -- the government agency that funds the nation's health care. The resident of the town of Kingswood, in southwest England, has appealed the decision twice, and next month may find out if his second plea is successful.

``It's immoral,'' Rosser's wife, Jenny, said. ``They are sentencing him to die.''

The NHS, which provides health care to all Britons and is funded by tax revenue, is spending about 100 billion pounds this fiscal year, or more than double what it spent a decade ago, as the cost of treatments increase and the population ages. The higher costs are forcing the NHS to choose between buying expensive drugs for terminal patients and providing more services for a wider number of people.

About 800 of 3,000 cancer patients lose their appeals for regulator-approved drugs each year because of cost, Canterbury- based charity Rarer Cancers Forum said. The U.K. is considering whether to make permanent a preliminary ruling that four medicines, including Sutent, are too expensive to be part of the government-funded treatment of advanced kidney cancer.

`It's Outrageous'

``It's outrageous,'' said Kate Spall, a full-time activist who has helped about 100 patients appeal NHS denials of cancer medicines. ``We are not asking for anything new or exciting or novel. We are asking for what the rest of the western world is getting.''

To help curb expenses, the government created the National Institute for Health and Clinical Excellence, known as NICE, in 1999 to review medicines and recommend whether the NHS should fund them.

``There is a view that all treatments should be available. Unfortunately, that's not possible,'' said Peter Littlejohns, NICE's clinical and public health director. ``There is a limited pot of money.''

He said the four cancer drugs provide a ``marginal benefit at quite often an extreme cost'' and that the agency had to keep in mind that funds spent on the medicines could be used elsewhere to help others at a greater value. ``Those are the hidden patients, the ones who benefit from the things the NHS does spend money on,'' Littlejohns said.

NICE Review

NICE is reviewing its Aug. 7 preliminary recommendation that Sutent, Roche Holding AG and Genentech Inc.'s Avastin, Bayer AG and Onyx Pharmaceuticals Inc.'s Nexavar, and Wyeth's Torisel shouldn't be funded in light of their cost of 20,000 pounds to 39,000 pounds a year per patient. All four medicines have been approved by European and U.S. regulators and are sold in other countries as well. A final ruling is expected in March.

While a drug is under review, the decision whether to pay for a therapy falls to the NHS's 156 local organizations, called trusts.

Of the 3,000 applications for exceptional funding for cancer patients a year, the most-requested drug was Sutent, said the Rarer Cancers Forum, which focuses on cancer cases that fall outside the more common ones such as colon, breast, lung and prostate.

Sutent, which stops cancer cells from dividing and chokes off a tumor's blood supply, was first approved for European use in July 2006. Kidney cancer sufferers taking the drug had a median survival rate of 26.4 months, according to a study presented at the American Society of Clinical Oncology in May.

Five Years to Live

New York-based Pfizer provided NICE with Sutent cancer- survival data that were released after its review began to try to persuade the agency to reverse its decision, and has offered to make the first treatment free, company spokeswoman Emily Bone said.

On Nov. 4, the government proposed giving NICE more flexibility in approving higher-cost drugs and allowing patients to buy the medicines themselves without losing access to government-funded health care. Final recommendations on the proposals aren't due until early next year and Rosser can't wait that long for his medicine, Spall said.

Rosser, of Kingswood, England, was diagnosed with cancer four days after Emma was born in July 2007. After operations in August and March to remove a kidney, adrenal glands and bone tumors, he was told he might live two to five years. In July, he was told by doctors that Sutent would help, but the South Gloucestershire Primary Care Trust said it wouldn't pay for the treatment.

`Very Expensive'

``I read the letter and I burst into tears,'' said Rosser, who was forced to retire from his air-conditioning and sheet- metal company because of the illness.

South Gloucestershire, the trust that includes Rosser's home, accepts applications for Sutent funding only for exceptional cases, said Ann Jarvis, director of commissioning at the trust, in an e-mail. ``Unfortunately for very expensive drugs, if they are proven to only provide a small benefit we have to prioritize other treatments.''

The trust plans to review its Sutent policy at a meeting next month, spokeswoman Sue Pratt said today.

Kidney cancer patient Kathleen Devonport, a 65-year-old retired factory worker, called it ``heartbreaking'' to have to beg her local health officials to provide her with Sutent. The County Durham Primary Care Trust, in northern England, initially turned her down in March 2007, then agreed to supply the Sutent seven months later only after she responded to a cheaper medicine paid for by an anonymous donation.

Offer Vetoed

Jenny Rosser, 41, said she is looking into getting her husband into a clinical trial for Sutent, but so far she has been told that his cancer would need to advance further to qualify.

Meanwhile, he is surviving on painkillers coupled with steroids for inflammation after vetoing his wife's offer of selling the house to pay for his treatments. In late October, he had another operation to remove growths on his spine and neck.

Jenny Rosser said the policies seem aimed more at saving cash than treating people.

``It seems like a money-saving exercise,'' she said. ``If a patient dies, tough.''
(Nothing Follows)

3 comments:

neko said...

"To help curb expenses, the government created the National Institute for Health and Clinical Excellence, known as NICE, in 1999 to review medicines and recommend whether the NHS should fund them."


Why is that whenver a government wants to spend less money, they invariably create more beurocracy? (Which usually ends up eating more money than they would have saved in the first place.)

sfw said...

It's a difficult problem. While I am not a fan of the NHS it like all health providers must continually assess whether money (which is limited) could be spent elsewhere to greater effect. The American HMO's do this and so do most Australian health services. Maybe the money that would keep Jack alive for another year could give 20 other people new hips which could last for years. In Africa that money could save the sight or lives of thousands. You do need to look at the big picture, that said I believe that the English system will eventually send the country broke.

Kevo said...

Yup

Medical technology can keep even the most marginal cases going for years - at vast expense.

And as a dad - I would probably emulate the Rossers and battle for every extra day too out of sheer familial self interest.

Not necessarily in the greater public interest to throw unlimited resources at one individual - but again, who is to say the worth of one individual at a point in time ....a sick potential Albert Einstein versus a sick potential Joseph Stalin ?

Huge ethical dilemma, no easy answers. Would not like to be sitting in the chair of those folk handling the files.