Monday, March 16, 2009

Mother of rugby suicide damns NHS

Slothful care left her son paralysed

JULIE JAMES, whose son Dan was paralysed in a rugby training accident and took his own life in a Swiss clinic last autumn, has spoken for the first time of her anger at the “disgraceful” care he received from the NHS in the hours after the accident. James believes the indifference with which her son was treated at two hospitals in the Midlands wasted 30 vital hours after the accident, in March 2007, which led to the 23-year-old becoming paralysed from the neck down. “If he had been treated differently perhaps Dan would have ended up with an injury he could have lived with,” she said.

When he was taken to hospital after a scrum collapsed on him, dislocating two vertebrae and trapping his spinal cord, James says “the terror on Dan’s face was apparent” but he still had the use of his arms and hands. Some 30 hours later, his hand function had disappeared after he had been moved unnecessarily, put last in the queue for an MRI scan and waited for four hours for an ambulance to transfer him to the spinal injuries unit at Stoke Mandeville hospital.

As she launched a fundraising drive in Dan’s memory, James, from Sinton Green, near Worcester, spoke about her “feelings of helplessness and despair” as she watched her son, who played rugby for England as a teenager, reduced to a state of “fear and loathing of his living existence”.



In state-run health care systems, cost pressures typically prompt governments to ration access to treatments for patients, often via waiting lists or low usage of medical technology. In order to provide a veneer of scientific rationale for these restrictions, governments often employ cost-benefit analyses, known as "health technology assessments" (HTAs), says the Fraser Institute.

Though these assessments may save money in the short term, they unleash a number of hidden economic consequences creating undue distress for dying patients. Many countries are increasingly turning to these types of "comparative effectiveness" reviews to restrict access to expensive new drugs, says Fraser:

* In 1988, Canada instituted a Health Technology Assessment program in Quebec; today, HTAs are widely used at the national and provincial level.

*Since 2004, Germany's Institute for Quality and Economic Efficiency in the Health Care Sector has provided "comparative effectiveness" information to health care insurers.

* Even the United States is poised to give more prominence to HTAs, as President Barack Obama has proposed to "establish an independent institute to guide reviews and research on comparative effectiveness."

But before marketing approval for a drug can occur, it must pass through 4 phases of clinical trials, says Fraser:

*( Less than 1 in 1,000 makes it past the first stage and the chance of a drug making it to approval are less than 0.03 percent.

* Moreover, every year, regulators add more mandatory tests; as a result, the average cost of bringing a new drug to market has risen from US$119 million (1975) to almost US$900 million (2003).

To solve the problem of high drug prices, it is necessary to radically overhaul the drug approval process. One solution is injecting a degree of competition. Bringing in competition could liberate innovation, speed up the development of new medicines, remove the need for expensive surgery and limit the need for costly in-patient care. This would be good for patients and health care funders alike, says Fraser.


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