CHEAP MEDICATIONS ONLY FOR NHS PATIENTS

A row over a “breakthrough” treatment for diabetes broke out yesterday as it was rejected for NHS use by the Government’s drug watchdog on the grounds that it was not cost effective. The new product, insulin that is inhaled, could transform the lives of sufferers, who have to inject insulin up to five times a day. However, it costs about £500 a year more per patient. This latest example of “drug rationing” came as Tony Blair insisted that the NHS was not facing disaster despite thousands of job losses and cutbacks in expensive treatments as a result of a financial squeeze. Mr Blair also defended soaring pay rises for doctors that will see some earn more than £250,000 this year. The Prime Minister admitted that the NHS was at a “crunch point” but insisted he was still on course for an historic “end to traditional waiting” by 2008.

About 800,000 people in Britain use insulin injections to control symptoms of diabetes, a disease that can have very serious effects. Health experts are giving warning of an explosion in type 2 diabetes of 10 per cent of cases a year as the population becomes fatter and takes less exercise. Inhaled insulin has been heralded as the greatest potential advance in treatment for 80 years. Simon O’Neill, director of care and policy at Diabetes UK, said: “The Government has put patient choice on the NHS agenda. Diabetes UK is disappointed that the guidance on inhaled insulin does not reflect this as we believe it could offer an alternative treatment in improving the lives of some people with diabetes. “We believe that new treatments should not be restricted because of costs and greater emphasis should be placed on patient choices and preferences.”

The draft guidance, from the National Institute for Health and Clinical Excellence (NICE) was “perverse and short-sighted”, said Pfizer, the drug company that markets Exubera, the first form of insulin that can be inhaled rather than injected. “NICE must not be allowed to undermine clinicians’ ability to work with their patients to improve management of this debilitating long-term condition,” it said.

Diabetes UK also urged NICE to reconsider the guidance, which is now up for consultation before a final decision is taken. “This is a medical breakthrough and it is the potential first step to improving the lives of some people with diabetes,” the charity said. “It will be unfortunate if people in England have limited access while it becomes available in other countries.”

Ever since the 1920s, diabetic patients have had to inject themselves with insulin, sometimes as often as five times a day, to control the disease. Exubera represents an alternative approach in which insulin in a fine, dry powder form is taken from an inhaler. Pfizer argues that its trials show inhaled insulin to be as effective as injected insulin, and that many people who are developing diabetes are too slow to acknowledge and control it. They do not want to start injecting insulin, but are willing to start inhaling it. “The choice here is quite simple,” Pfizer said. “Force patients to keep enduring the burden of multiple daily injections, or give them an alternative. In a clinical trial, three times as many patients chose to start on insulin therapy when the inhaled option was made available.”

Kate Lloyd, Medical Director of Pfizer UK, said: “This is a terrible decision. It could deprive clinicians of the opportunity to benefit patients by starting insulin much earlier and cutting future costs of diabetes and its complications including heart disease, amputation, blindness and kidney failure. “NICE has rejected Exubera on the grounds of cost-effectiveness. But if people aren’t willing to inject, injected insulin can’t be cost-effective either. “They accept that inhaled insulin might be effective for some patients, but say it is difficult to identify them. We find that desperately concerning. NICE takes the view that because they can’t identify suitable patients, nobody else can.”

In its draft guidance, NICE says that using injected insulin is “not usually a concern for the majority of people with diabetes, given the availability of patient support and education, modern small needle types and insulin pens.” It adds that inhaled insulin would not fully replace the injected form and that people would still need to use needles for measuring glucose levels in the blood. It accepts that inhaled insulin is as effective as the injected form, and says it would cost just over £1,100 per patient per year, about twice the average cost of injected insulin. Patients might prefer it, but patient preferences were only relevant if they translated into real health benefits. The fact that patients who need insulin are more likely to take it if they can get inhalers “is insufficient to provide support for a cost-effective use of this therapy”.

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Canada's Socialized Health Care Is Not the Model to Follow

American politicians on the stump are fond of citing Canada's socialized health care system as a superior alternative to the mixture of public and private health spending in the United States. Such rhetoric may attract votes, but we Canadians, trapped in a broken and deteriorating system, have reasons to disagree. In 1967, when Canada adopted the British socialist model, our country was near the top of international rankings for the effectiveness of our medical spending. The U.N.'s World Health Organization now places Canada about 30th on that list.

Vancouver's Fraser Institute recently released a comprehensive study that measured Canadian Medicare's performance. Called How Good Is Canadian Health Care? An International Comparison of Health Care Systems, the report included only countries that have publicly funded systems with universal access. It excluded the United States and Mexico, which do not.

Of the countries in the Organisation for Economic Cooperation and Development, only Iceland spends more on an age-adjusted basis than Canada does on health care. No other countries follow Canada's model of monopolistic public provision of health insurance. Canada is the only OECD country that outlaws privately funded purchases of basic medical services.

* With respect to hard indicators of performance, Canada's record is alarming for a prosperous country:

* How many doctors per capita does Canada have? We rank 16th out of 23 OECD countries.

* What about access to high-tech diagnostic tools? We rank 15th for MRIs, 17th for CT scanners and eighth for radiation machines. We are tied for last for lithotripters (devices that destroy stones in the urinary system).

* What percentage of our total life expectancy will we live free of disability? We rank 14th.

* What are the rates for infant and perinatal mortality? We rank 16th and 12th.

* What about potential years of life lost to disease? We rank ninth.

* What is our incidence of breast cancer mortality? We rank sixth.

By only one measure is Canada's performance commensurate with its rate of spending: It has the lowest incidence of mortality from colorectal cancer per dollar spent. Ultimately, the researchers conclude that the Canadian health care model is inferior: "It produces inferior age-adjusted access to physicians and technology, produces longer waiting times, is less successful in preventing deaths from preventable causes and costs more than any of the other systems that have comparable objectives."

The problem is progressive. For 13 years, Fraser has been tracking waiting lists for common medical procedures. Its latest findings indicate that waiting times for surgical and other therapeutic treatments in Canada increased in 2003: "Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003."

The structure of Canada's system is dictated by the federal government, but most health services are delivered by the provinces. Waiting lists and spending levels therefore vary quite widely from province to province. Manitoba spends 12 percent more per capita than the Canadian average. Despite significantly higher spending levels, comparative data on the current state of hospital crowding, waiting lists, delays and denials of medical procedures indicate no significant difference in health care outcomes.

Although the average wait in Manitoba for a primary joint replacement is about nine months, many of the top surgeons have patients who wait for two years, according to the Winnipeg Free Press: "The longer they wait, the more trouble they have, partly because they are in worse condition when they have the surgery."

This dynamic is the unmeasur-able cost of Canada's socialized health care. Because timely treatment is routinely denied, people cannot work or lead normal lives. The costs in lost production - never mind the losses due to pain and suffering - are difficult to quantify. Economists have calculated the cost of adverse consequences for cardiac patients waiting for surgery. They broadly estimated it at from $1,100 to $5,600 annually per patient.

When you consider last year's average of 17.7 weeks of waiting for all treatments, the staggering hidden price Canadians pay for socialized medicine becomes clearer. This does not include the people who die while waiting for bypasses, radiation or chemotherapy, or because treatment was started too late.

When the results are considered, it is hard to understand why anyone would advocate the Canadian model. Americans should be more cautious when they extol its virtues. You may get what you ask for.

Source. The full Fraser Inst. report is here (Big PDF).

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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