Healthy Skepticism Library item: 18814
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Toynbee P
Forget patients. Andrew Lansley is the servant of big pharma
The Guardian 2010 Nov 1
http://www.guardian.co.uk/commentisfree/2010/nov/01/andrew-lansley-servant-big-pharma
Abstract:
Nice was one of Labour’s best inventions. Its demise will probably mean more ineffective drugs, and higher prices
Full text:
Every health system is rationed, always was, always will be. In the US Tea Partiers protest that Obama’s health plan means “death panels” to decide who lives and dies at what price. But every private health insurance plan was always rationed too, according to price of policy. Without rationing treatments, any system would go bust. That is the law of healthcare, whoever pays.
In taking away the power of the National Institute of Health and Clinical Excellence (Nice) to select only cost-effective treatments, Andrew Lansley appears to be offering a health service without limits just when the NHS is to be cut back as never before. Oppositions always promise the NHS everything, so in the pre-election heat of a tabloid furore about drugs Lansley pledged a £200m fund for new cancer drugs, a puny sum that won’t begin to pay for the floodgates of demand it opens (when he finally decides how to distribute it.)
But now he is in the driving seat, it is extraordinary that he is removing Nice’s authority, the one outfit designed to protect him from having to take responsibility for unbearable rationing decisions. As the Guardian reported on Saturday, his health minister Lord Howe says Nice will become “somewhat redundant”. David Willetts said as much to a recent science conference. So now the Daily Mail crows a victory for its campaign with the headline: “Penny-pinching Nice stripped of its powers” as “the scandal of patients being denied drugs just because the NHS rationing body decides they are too expensive will end”. Really?
Here is yet another sign that Lansley’s plans for the NHS inhabit a realm of unreality that is at last starting to alarm the Treasury, some in the cabinet and, it seems, Stephen Dorrell, former health secretary and now chair of the Commons health select committee. More worrying than the ideology or the direction of travel are questions about his competence. With an air of willful naivety, he seizes on the eccentric enthusiasms of one or two NHS players and pursues them with an ear-blocking stubbornness as wiser, more experienced heads warn of a car crash ahead.
The Nice saga is just one telling example of Lansley folly. This time he seems to have been bowled over by a toxic combination of Daily Mail anecdotes of dying patients desperate for a few more months of life and intense lobbying by a pharmaceutical industry that has campaigned long and hard against the one body that kept NHS drug costs under a modicum of control.
Nice is one of Labour’s best inventions – which makes it politically vulnerable to this government. With appraisal committees of top clinical experts in each field sitting alongside lay people, Nice decides nationally which treatments and which drugs are effective and good value. It benchmarks price against “QALYs” – quality adjusted life years – a system devised jointly by US and York University health economists, evaluating how many years of good life a treatment offers per pound spent. Nice has refused only 5% of drugs – mostly those offering a few painful end-of-life weeks at huge cost: for those treatments, £30,000 per QALY is the usual limit.
For the first time Nice made NHS rationing explicit and transparent, publishing the best available evidence. It is not always right: occasionally it revises its first opinion. But making rationing public was bound to make Nice the hated target of every tabloid with a heart-tugging cancer-patient story.
For politicians the worst decisions were removed to where they belong – with independent experts. But Lansley is bringing in something instead called value-based pricing, where the pharmaceutical industry and government officials negotiate over the price of drugs. Lansley claims the price will fall: the enthusiasm of the industry suggests otherwise. Nice will stay on as an advisory body, but each separate GP consortium will have to decide which drugs it wishes to offer its patients within its budget. They will be the rationers now and they will take the blame – or try to pass it back up to Lansley.
Professor Alan Maynard, one of the first devisers of QALYs, fears the lid will be off both the prices charged and the number of ineffective drugs prescribed. If one GP consortium offers an expensive but doubtful drug, the patients’ group for that disease will make sure all other patients demand it from their consortiums. This is not a postcode lottery, but a one-way escalator: whatever one offers, all must offer soon. Eyecatching diseases beloved of the media – cancer mostly – will steal the budgets for mental health or less emotive ailments.
GPs struggling with the new tensions of distributing a shrinking budget between all patients and conditions will now find it impossible to refuse monumentally expensive drugs that preserve one person’s painful last few weeks at the cost of many other lives that could be greatly improved. Bad UK cancer survival results improved in the last decade because of money spent on early diagnosis and treatment, not these marginal high-cost drugs. Will GPs take the flak in their local press if they spend where it works – or cave in to public pressure?
NHS drug prices have been set since the early days to guarantee British-based companies a 20% profit, to encourage a successful industry. Many have long thought this cost should be borne by the business and not the health secretary. Nice was the first coherent check on runaway drug costs, but value-based pricing will re-open it all, to the industry’s delight. Nice, says the government, will no longer be “making decisions on whether patients should access drugs that their doctors want to prescribe”.
Any doctor can prescribe anything? A glance at the history of how well drug companies manipulate, bribe and bamboozle busy doctors into prescribing their most expensive products instead of cheaper and equally effective ones tells why the pharmaceutical industry is throwing its hats in the air at Lansley’s infinite gullibility. Big pharma has run a ferocious campaign against Nice because it has become the trusted international standard by which other countries agree to buy drugs in their health services; some firms refuse to offer drugs for inspection in Britain, for fear of Nice scrutiny.
Avastin, for colorectal cancer, has been an ongoing struggle, heralded in tabloid stories as a denied “wonder-drug”: Nice has held the line, its chairman saying that it might give two months more life if taken for a year, at a cost of £100,000. It will be interesting to see how long after the new system begins in 2013 it takes its manufacturers to find a way into the NHS through one of the 150 GP consortiums.
