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This health care
'reform' will kill thousands. --Karol
Sikora, Tuesday, May. 12, 2009
One of the more
unproductive elements of President Obama's stimulus bill is the $1.1
billion allotted for "comparative effectiveness research" to
assess all new health treatments to determine whether they are
cost-effective. It sounds great, but in Britain we have had a similar
system since 1999, and it has cost lives and kept the country in a kind
of medical time warp. As a
practicing oncologist, I am forced to give patients older, cheaper
medicines. The real cost of this penny-pinching is premature death for
thousands of patients - and higher overall health costs than if they
had been treated properly: Sick people are expensive. It is easy to see the
superficial attraction for the United States. Health-care costs are
rising as an aging population consumes ever-greater quantities of new
medical technologies, particularly for long-term, chronic conditions,
such as cancer.
As the government takes
increasing control of the health sector with schemes such as Medicare
and SCHIP (State Children's Health-care Insurance Program), it is under
pressure to control expenditures. Some American health-policy experts
have looked favorably at Britain, which uses its National Institute for
Clinical Excellence (NICE) to appraise the cost-benefit of new
treatments before they can be used in the public system.
If NICE concludes that
a new drug gives insufficient bang for the buck, it will not be
available through our public National Health Service, which provides
care for the majority of Britons.
There is a good reason NICE has attracted interest from U.S.
policymakers: It has proved highly effective at keeping expensive new
medicines out of the state formulary. Recent research by Sweden's
Karolinska Institute shows that Britain uses far fewer innovative
cancer drugs than its European neighbors. Compared to France, Britain
only uses a tenth of the drugs marketed in the last two years.
Partly as a result of
these restrictions on new medicines, British patients die earlier. In
Sweden, 60.3 percent of men and 61.7 percent of women survive a cancer
diagnosis. In Britain the figure ranges between 40.2 to 48.1 percent
for men and 48 to 54.1 percent for women. We are stuck with
Soviet-quality care, in spite of the government massively increasing
health spending since 2000 to bring the United Kingdom into line with
other European countries. Having
a centralized "comparative effectiveness research" agency
would also hand politicians inappropriate levels of control over
clinical decisions, a fact which should alarm Americans as government
takes ever more responsibility for delivering health care - already 45
cents in every health-care dollar. In Britain, NICE is nominally
independent of government, but politicians frequently intervene when
they are faced with negative headlines generated by dissenting terminal
patients.
For years, NICE tried
to block the approval of the breast cancer drug Herceptin. Outraged
patient groups, including many terminally ill women, took to the
streets to demonstrate. In 2006, the then-health minister suddenly
announced the drug would be available to women with early stages of the
disease, even though it had not fully gone through the NICE approval
process. A more recent example was the refusal to allow the use of Sutent
for kidney cancer. In January, NICE made a U-turn because of pressure
on politicians from patients and doctors. Twenty-six professors of
cancer medicine signed a protest letter to a national newspaper - a
unique event. And yet this
drug has been available in all Western European countries for nearly
two years. In Britain, the reality is that life-and-death decisions are
driven by electoral politics rather than clinical need. Diseases with
less vocal lobby groups, such as strokes and mental health, get
neglected at the expense of those that can shout louder. This is a
principle that could soon be exported to America.
Ironically, rationing
medicines doesn't help the government's finances in the long run. We
are entering a period of rapid scientific progress that will convert
previous killers such as heart disease, stroke and cancer into chronic,
controllable conditions. In cancer treatment, my specialty, the next
generation of medicines could eliminate the need for time-consuming,
expensive and unpleasant chemo and radiotherapy. These treatments mean
less would have to be spent later on expensive hospitalization and
surgery.
The risks of America's
move toward British-style drug evaluation are clear: In Britain it has
harmed patients. This is one British import Americans should refuse.
Karol Sikora, a practicing oncologist, is
professor of cancer medicine at Imperial College School of Medicine, London, and former
head of cancer control at the World Health Organization
Read the entire article and the Blog
responses . . .
The NHS does not give timely access
to modern health care, it only gives access to a waiting list.
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