Last Monday it was announced that the National Institute of Clinical Excellence was being relegated to the position of mere advisory body – with comparable clout one imagines to the Monster Raving Loony party or the Drugs Advisory Committee led by a Nutt. The body responsible for deciding how the NHS spends its cash on drugs has had its balls lopped of. No longer will it have the power to decree who has access to which miracle lifesaving cancer drugs, no longer will it be able to say how many rounds of the little blue pill your GP can prescribe you. And a good thing too you might say.
But, you may not know, that despite the endless stories the Daily Mail, and the BBC, publish about poor Mary Smith being denied access to the drugs that would have definitely definitely saved her life, NICE actually did quite a good job. They had the resources and the man-power to make decisions that a GP or hospital doctor just doesn’t have time to make. Doctors are simply too busy saving people to make intricate analyses of research papers. NICE however were not; they read the clinical trials – (very very dull, incomprehensible documents with lots of statistics and odd incomprehensible terms like “bladder satisfaction scale”) – all of them, scrutinised them, picked holes in them, found all the stuff the companies making the drugs ("Pharma") didn’t want them to find. And they also had the know-how to make the infamous coast-benefit analyses – in layman’s, making judgements on the benefit of a drug weighed against its cost; the test that many (new) cancer drugs tend to fail.
And now doctors, already busy, overtired, overworked, are expected to make these decisions. As said above, they don’t have the time to access all the relevant information, never mind critically analyse it. Add to this, the amount of propaganda doctors are still subject too (even with the recent clampdowns on merchandising by Pharma) is quite impressive. If they are not told otherwise busy people will prescribe the first drug that comes to mind, quite likely to be the one that’s written on the free pen that rep gave you.
But with regards to cancer drugs (and the million odd cancer drug fund created by the Tories on top) the story is much more chilling. New cancer drugs are expensive (a years cost of one in particular lung cancer drug is ~£30000) , and as is clearly shown in the data, don’t average extend average life expectancy by more than a few weeks. And so often fell foul of NICE’s cost-benefit analyses.
But if you were dying you would want those weeks, even if they do cost thousands, you may cry. And you would be right to. Absolutely. Even if that money could be spent of several life saving operations for the sickest, most angelic children’s. You are a human being, entitled to life. This is as fundamental a right as they come. The problem is that most patients wouldn’t get it. The new generation of cancer drugs are by nature selectively more helpful to some patients then others – often for a patient minority sub-group they can be very helpful indeed. But the pharmaceutical companies have no incentive to run expensive clinical trials identifying which groups of cancer patients their drug works for; better to have a license for sort of working in all lung cancer patients when you even it out, assuming that 50% of doctors will try the drug, then have a drug that works really well, but only in 5% of patients – its just better business. And pharma is a business. Just like Tesco and WHS Smith. You can’t blame pharma for this; they have shareholders just like everybody else. But certainly don’t blame NICE. So what will happen now is over prescribing of expensive, potentially life-saving (but only in 1/20 people) drugs take money away form the prescribing of expensive, certainly life saving drugs. We needed NICE to tell us no.
But their competency, and as far as Mr Ant is concerned marvellous stiff-upper-lippedness to do one of the most thankless jobs short of kitten murderer and being Nick Clegg, the importance of NICE was much more than administrative; office managers denying you access to the stationary cupboard they were not.
NICE was important, because unlike the single GP who is now going to making the majority of the calls on which drugs can be prescribed, NICE had bargaining power. If NICE said no, the drug didn’t make it onto the NHS, and a drug company would lose almost the entire UK market. The bargaining power of one GP (maximum, a few patients) is negligible. They could drive down drug prices, like no single doctor or even hospital could – they made one pharma company cover the cost for a cripplingly expensive cancer drug after one years treatment, another company contribute towards the cost for sight-saving injections – which hey y’all means more money for other cancer sufferers and less blind people over all. This was a good thing.
But NICE also, in representing the whole UK market, had the power to demand better from pharma. It could demand superior trials, more comprehensive data, and studies that actually found out who would actually benefit form the drugs. This is good for the NHS’s purse, and bloody excellent for the patient. False hope and unnecessary chemo side effects are quite certainly a bad thing.
