Friday, June 30, 2006

Fat-buster not for NHS patients

A fat-busting drug that not only reduces bodyweight by up to 10 per cent but also helps to tackle other health problems such as diabetes and even smoking has been introduced in Britain. Rimonabant, also known as Acomplia, is the first drug to target a natural body system that governs a host of factors controlling appetite, weight, metabolism and energy use. Research suggests that it has the capacity to combat a smoker’s craving for nicotine.

Britain is the first country to receive Rimonabant, after the decision by drug regulators last week to grant it a licence throughout the European Union. Experts say that 20 per cent of Britain’s population could be eligible for treatment. However, the drug is unlikely to be widely available until it is approved by the National Institute for Health and Clinical Excellence. The institute, which advises on NHS best practice, is not expected to issue guidance on Rimonabant for two years. At a cost of 55.20 pounds per patient per month, or 1.97 per tablet, even treating a fraction of the group eligible could cost the NHS billions.

The drug’s manufacturers, Sanofi Aventis, argues that the drug represents good value for money when set against the 7 billion-per-year cost of tackling the problems connected with obesity and being overweight. Anthony Barnett, a diabetes specialist from the University of Birmingham who took part in yesterday’s launch at the Science Museum in West London, said that it would be a “great shame” if use of the drug was limited by funding issues. “The real question is, can we afford not to treat?” he said.

In a series of trials involving more than 6,000 patients in America and Europe, about a quarter of those taking Rimonabant lost more than 10 per cent of their initial body weight after a year. About a half lost more than 5 per cent of body weight. Waist circumference, seen by many experts as a more important measurement, was reduced by between six and seven centimetres. Significant improvements in measures of glucose control, cholesterol and triglyceride blood fats were also seen. These went far beyond what might be expected simply by losing weight. For example, levels of high-density lipoprotein “good” cholesterol, which reduce heart disease risk, showed an 8 to 9 per cent increase, but only half of this was because of weight loss. There is also trial data suggesting that the drug can help people to give up smoking by overcoming their cravings. However, it is being marketed only to tackle obesity.



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?

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