Wednesday, December 3, 2008

Inside Look at the NHS's NICE--Heartless Rationing, or Heartless Price Gouging?

Gardiner Harris, in today's New York Times, offers a somewhat rare inside look at the workings of Britain's National Institute for Health and Clinical Excellence (NICE):

I have objections, much of the time, to the media's present fetish with always including a "personal interest" anecdote in any news story about medicine. In this case, however, the personal angle is essential, so it's highly appropriate that Harris begins with the story of Bruce Hardy of Ruislip, UK, who has metastatic kidney cancer and who might get an average of 6 months' extra survival with Pfizer's new drug, Sutent--at a cost of $54,000.

NICE has decreed that as a general policy matter, Britain's publicly funded National Health Service cannot afford more than about $22,750 to prolong life for 6 months. (We assume that Mr. Hardy does not have the resources to go into Britain's private medical system where he could get whatever he wanted, so long as he paid for it himself or through private insurance.) After stormy protests NICE is reconsidering this policy.

Harris nicely (no pun intended) lays out the dilemma. According to NICE's detractors, this is heartless policymaking. How can you niggle over a few pounds with human lives hanging in the balance? According to NICE's defenders, the problem is not heartless bureaucrats deciding who lives and who dies, or how medicine is practiced--it is heartless drug companies that price their drugs out of reach. (Indeed, now that it's widely known what price limits NICE is willing to work within, drug companies have suddenly discovered that they can price their drugs for the British market lower than they used to.) You can read both sides of the story in this article.

As this blog is not about health policy generally and not about drug pricing, except as it bears on the ethics of medicine's relationship with the drug industry, I'll say no more about NICE, except to agree in passing with those who argue that the US is in deep doo-doo managing health care costs unless we somehow figure a politically viable way to invent our own version of NICE. All I want to comment for purposes of this blog is to note a small gap in Harris's otherwise comprehensive account. He describes the protests from angry oncologists and their patients that are forcing NICE to reconsider the limits they have set on cancer drugs. But he fails to follow the money trail to study how much drug company money is behind these protests. The industry is masterful in using patient advocacy organizations and other supposedly neutral bodies as PR fronts. Just as with the highly publicized controversy when NICE refused to pay for largely ineffective Alzheimer's drugs several years ago, I'd be willing to bet that the supposedly grass-roots protest was largely industry-funded "astroturf."

And, if you want to explore the ethics of NICE's approach to health care rationing, I must recommend the forthcoming book of my long-time colleague, Leonard Fleck of Michigan State University, Just Caring: Health Care Rationing and Democratic Deliberation, due out from Oxford University Press in March 2009.


Marilyn Mann said...

Interesting post by Roy Poses on British astroturf groups:

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