Archives for the 'Healthcare Reform' Category
Going Blind Waiting for the National Health Service–So Sorry!
Sorry about that! That’s the British government’s reaction to the two-year delay in approving a drug that combats blindness. Too expensive, dear chap … anyway, keeping your sight is so 20th century!
The head of the NHS rationing watchdog has said he is ‘genuinely sorry’ for a delay in approving a new treatment for blindness.
But campaigners said Andrew Dillon’s comments would be of little consolation to the thousands of Britons who have lost their sight in the two years it took NICE to make its final decision.
The watchdog has now approved Lucentis, which is used to treat wet age-related macular degeneration, a condition which affects 26,000 new sufferers every year.
NICE’s original recommendation was that patients had to wait until they went blind in one eye before they would be given treatment to save the sight in the other.
The proposal caused a huge public outcry from doctors and campaigners, prompting a U-turn in December last year before further consultation resulted in the final decision today.
Mr Dillon, the chief executive of NICE, seemed to blame these protests for slowing the decision to make Lucentis more widely available.
He claimed that because NICE’s rulings were not made behind ‘closed doors’ and were open to being challenged, lengthy delays often occurred.
But campaigners said the procrastination, which potentially cost the sight of 50 patients a day, was not their fault.
The Royal College of Ophthalmologists said the latest guidance was nearly identical to the suggestions it made two years ago and campaign groups pointed out that without their intervention, NICE might never have overturned its original decision.
Another great argument for socializing medicine in America!
Anna Tomalis, R.I.P.
Last Friday, I attended the funeral of a remarkable 13-year-old girl named Anna Tomalis. For the past three years, Anna had been battling terminal cancer and, more recently, trying to get the Food and Drug Administration to grant a “compassionate use” exemption so she could try an experimental cancer drug now being jointly developed by the pharmaceutical companies ARIAD and Merck. Unfortunately, FDA rarely grants exemptions. If too many exemptions are granted, it would become harder to enroll patients in clinical trials, where they have as much as a 50-50 chance of getting a placebo. Anna was too young and too sick to be admitted to any of the clinical trials, so that wasn’t at issue here. But, of course, the whole point of FDA is to keep individuals from making their own decisions about which drugs to take. So, eventually, after months of delay, FDA finally approved Anna’s exemption, but it came too late. She died just three weeks after beginning treatment — too little time for the drug to have worked.
I got to meet Anna and her mother Liz a few months ago, through a patient advocacy organization called the Abigail Alliance For Better Access To Developmental Drugs, with which CEI works occasionally. And, I continued to correspond with them both by e-mail ever since. Though I certainly did not know Anna very well, the service was quite moving. Her father, Ron, for example, explained that Anna realized all along that her chances of survival weren’t good. But, keeping a good attitude about the whole thing, Anna insisted that she be buried in a hot pink casket. Since no one actually makes a hot pink casket, her parents had to buy a non-descript one and take it to an auto body shop to have it painted pink.
Anna also tried to use her impending death in order to promote a change in the law that would make it easier for critically ill patients to get compassionate use exemptions. Even though she realized she wouldn’t last long enough to benefit personally from such a change, she visited Washington several times in order to advocate for such a policy. My op-ed on the subject appeared in this past weekend edition of The Wall Street Journal, and can be read here.
Stop the Presses: More Private Health Care in Canada?
It can’t be true. Canada, that paragon of health equality, the place where all health shortages are shared and shared alike, might have more private health care in the future. At least, that’s what Robert Ouellet, head of the Canadian Medical Association, wants.
The natural next step for Canada’s health system is allowing more private delivery, which will give patients more choice, and better access to care, the new president of the Canadian Medical Association says.
“My whole career has been about resolving access issues. This is my battle horse,” said Robert Ouellet, who takes over today as president of the CMA.
“Private delivery is an accepted practice everywhere in the world and it’s time Canada accepted this reality.”
A radiologist by training, Dr. Ouellet, 62, owns and operates five medical imaging clinics in suburban Montreal. He is an unabashed promoter of private-sector delivery of medical care and keen to introduce more competition into Canada’s health-care system, and he knows this will make him a lightning rod for criticism.
Hasn’t anyone told Dr. Ouellet that Canadians are supposed to be proud of their lengthy waiting lists?
Want an Operation in Great Britain?
You’d better keep two or three dates open. It seems that the National Health Service likes to cancel operations even after they are scheduled. A third of the 124 NHS “trusts” canceled an operation at least twice for patients.
More than 7,000 patients had an NHS operation cancelled more than once in the past year, figures from the Conservatives reveal today.
One patient had an operation cancelled 21 times and around a third (34 per cent) of trusts cancelled an operation for the same patient three times or more.
The figures were calculated from 124 NHS trusts across England and referred to operations cancelled for non-clinical reasons, including a shortage of beds, missing patient records, staffing problems and a lack of equipment.
According to the statistics, 77,302 operations in total were cancelled for non-clinical reasons. Another patient took precedence in 5,968 cases; 10,714 cases related to a shortage of beds; 16,614 were due to problems relating to the operating theatre and 2,635 were down to administrative problems. Another 3,946 were due to difficulties with equipment, 11,370 related to staffing, 404 operations were cancelled because the patient’s notes were missing and 11,585 were due to patient-related problems.
it turns out “cheap” health care is, well, cheap. That’s something we should keep in mind as politicians promise to “fix” American health care by increasing government control over the system.
“Jackpot Justice Gets New Meaning”
Ted Frank has an entertaining and disturbing column in the Washington Examiner about how a compulsive gambler blamed his medication for his irresponsibility. A jury not only believed him, it awarded him more than $8 million dollars, most of it punitive damages! As Frank notes, the jury’s verdict gives new meaning to the term “jackpot justice.” Drug-makers want the Supreme Court to preempt such lawsuits when the drug has been carefully vetted and approved by the FDA, asking it to do so in the pending case of Wyeth v. Levine. By contrast, liberal lawmakers like Henry Waxman support such lawsuits, claiming that preemption is just a tool to enrich business.
Leaving Patients to Die–Literally
The next time you hear someone complain about Americans who don’t get needed health care, think of Great Britain, where the government has decided that cancer patients are not worth saving. Since the government controls the health care system, that means the patients, unless they are lucky enough to be wealthy, will die. Reports the Daily Mail:
Thousands of kidney cancer patients have been handed an ‘early death sentence’ under plans to ban life-extending new drugs.
Four drugs which can offer patients extra years with their loved ones have been rejected by the Government’s rationing body because they cost too much.
The National Institute for Health and Clinical Excellence admits the drugs work, but says that if they are approved, patients with other diseases will have to go without.
Campaigners claim the Health Service is being plunged into the Dark Ages, as other western European countries use the drugs as standard.
Instead, NICE has limited treatment to a drug called interferon that doctors claim is ineffective for 75 per cent of patients.
Kidney specialist Tim Eisen, professor of medical oncology at the Cambridge Research Institute, said: ‘Patients here are receiving medieval treatment.
‘Together these drugs are the single greatest advance for kidney cancer patients in the last 20 years, yet I and my colleagues face the prospect of being unable to offer treatment that is absolutely standard in every other western European country.’
‘This decision will mean that the UK will have the poorest survival figures in Europe.’
The ban is the latest controversial move by NICE, which has already seen its decision-making process in restrictions on Alzheimer’s drugs successfully challenged in the High Court.
Hope: Cancer patient Jean Murphy now has access to the drug thanks to an anonymous donation
Instead doctors will be forced to offer interferon - a medication of such limited use that it is prescribed for just one in ten patients in some cancer units.
Trade-offs have to be made in every system, but in a nationalized system the bottom line is determined politically. With very negative results for most people–especially cancer patients in Great Britain.
Socialized Medicine Says: Let ‘Em Die
There are trade-offs every where, we all know, including for health care. How much do you spend to provide how much treatment to which payments? These decisions often are not easy. But at least in a decentralized, private system lots of people are making those decisions. Nationalized systems centralize the decisions over life and death, and hand them to politicians and bureaucrats.
The National Health System in Great Britain is refreshingly honest. If we don’t think it’s worth the money to save your life, tough. It’s the public interest, you know!
Patients cannot rely on the NHS to save their lives if the cost of doing so is too great, the Government’s medicines watchdog has ruled for the first time.
The National Institute for Clinical Excellence (Nice) has said the natural impulse to go to the aid of individuals in trouble – as when vast resources are used to save a sailor lost at sea – should not apply to the NHS.
The disclosure follows last week’s controversial decision by Nice to reject four new drugs for kidney cancer even though they have been shown to extend life by five to six months.
Nice has been under pressure from the drug industry to apply the so-called “rule of rescue” to such cases, setting aside costs in instances where treatment is necessary to save life. But the institute has decided that if drugs are too expensive they should not be prescribed even if they prolong life, because the money could be better spent elsewhere. The judgement overrules advice from Nice’s own citizen’s council, which recommended two years ago that it should adopt a “rule of rescue” as an essential mark of a humane society.
Give me the messy U.S. system, with all of its many flaws, anytime, compared to the NHS.
Ending the HIV Travel Ban
The federal government is finally in the process of lifting the travel ban on individuals who are HIV positive. For many years, one of the blogosphere’s most vocal critics of the ban has been U.S.-resident Brit Andrew Sullivan. Last month he was already predicting the eventual success of the legislation that ended the ban, known as President’s Emergency Plan for AIDS Relief (PEPFAR):
Obviously, the bigger achievement in PEPFAR is the funding for continued help for those with HIV and AIDS in the developing world - people whose plight is unimaginably worse than mine or so many others trapped by this HIV law. Bush’s legacy in this is one for which he is rightly proud. But for those of us who have long dreamed of becoming Americans, and have been prevented by 1993 law from even being able to enter or leave the US without waivers or fear or humiliation, this is a massive burden lifted.
I’m not exaggerating when I say that it’s one of the happiest days of my whole life. For two and a half decades, I have longed to be a citizen of the country I love and have made my home. I now can. There is no greater feeling.
Andrew made it through the years that the ban was in place, but the San Antonio Express-News’ Hernán Rozemberg reminds us that not everyone was so lucky:
Howard Wallen of New York tried to get papers to bring his wife into the country from Ethiopia, where he met her in 2002, later marrying her and having a daughter. They soon found out Abeba’s HIV status prevented her from coming to the United States with him.
She eventually died from AIDS — an outcome that might have been different had she received therapy in the United States, Wallen said.
“She deserved the dignity of that chance,” he said.
Don’t Get Kidney Cancer in Great Britain
There are drugs to treat the disease, and they are available in America. But the National Health Service won’t pay for them. Writes Jonathan Waxman in the Times of London:
But there are areas of healthcare where things have gone badly wrong, where wrong meets bad, becomes worse, and then spirals to appalling, and these areas are approached through the bloodstained portals of the National Institute for Health and Clinical Excellence (NICE).
This week’s NICE announcement on treating kidney cancer, a preliminary opinion about the value of new drugs, has sent doctors into apoplexy. Kidney cancer affects approximately 7,500 people in the UK each year, and there are 2,500 deaths. We have recently begun to understand the molecular biology of kidney cancer, and to know of its specific characteristics. Understanding these characteristics allows us to design treatments that exploit the differences between kidney cancer cells and normal cells. As a result, we have wonderful new treatments that double life expectancy in this condition.
NICE has evaluated these four new drugs for kidney cancer and indicated that these drugs will not be recommended for use in patients. This is against all sense, and contrary to the situation in the rest of Europe and in the United States, where these drugs are available. NICE has made its decision on the basis of an arcane and extraordinarily complex calculation which relates the benefit of treatment with these new drugs to a treatment that is comparatively ineffective.
But at least all Britons are equal. Everyone is at risk of being denied necessary, life-saving treatment!
Want New Medicines? Stay Away from Great Britain
Explains Peter Pitts of the Center for Medicine in the Public Interest:
Experimental cures are often the last hope for dying patients in the U. K. health system. Thanks to the British government, however, many sick Britons will soon have their last hopes dashed.
Why? Pharmaceutical companies from around the world have been scaling back clinical research in the United Kingdom, largely because of government parsimony. And British citizens have paid the price.
Britain’s National Health Service seems to have made Britain inhospitable to new drug research. By covering only the lowest-cost treatment options and denying patients access to more expensive breakthrough drugs, the NHS has erected serious roadblocks for companies trying to develop new cures.
The main culprit is Britain’s National Institute for Health and Clinical Excellence, the government agency responsible for comparing the effectiveness of different treatment options. Using the institute’s studies, the British government determines which treatments to cover and which ones aren’t worth the cost.
When the NHS decides not to cover a drug — as happened recently with the new macular degeneration drug Avastin — it hinders the ability of drug companies to recoup research and development expenses. That means less money for research into tomorrow’s cures.
Such practices don’t just fleece pharmaceutical research firms; they also make British patients less-than-appealing subjects for clinical trials.
Think about it. You wouldn’t want to conduct a taste-test of a new soft drink by giving one test group the new beverage and another group a warm glass of tap water. Obviously those who tasted the soda would react better. Similarly, comparing an experimental cancer drug to the low-quality treatments that many in Britain receive won’t reveal how effective the new drug is.
America has its own set of problems with health care, but the failings of socialized systems are far more grievous and fundamental.
Government Service with an Oops!
Remember stories about the horrors of the American medical system? Operations performed on the wrong leg and such? Guess what: it’s also a problem in Great Britain, with its wonderful, equal, fair National Health Service. Reports the Independent:
The cases of 14 brain surgery patients who were the victims of catastrophic errors when neurosurgeons operated on the wrong side of the head are to spearhead a government drive to make operations safer.
Sir Liam Donaldson, the Government’s chief medical officer, will highlight the cases at the launch of his annual report today when he will announce the establishment of a new clinical board for surgical safety to reduce errors and eliminate “wrong site” mistakes.
About 7.9 million operations are performed in Britain each year, nearly 10 times the number of births, yet surgical safety attracts far less attention than the safety of maternity care.
In 2007 more than one operation a month – 16 in all – was done on the wrong site. Examples include knee replacements on the wrong (healthy) knee, cochlear implants – surgically implanted hearing aids – in the wrong ear, removing bone from the wrong foot and wrong incisions to gain access to organs in the abdomen.
One patient a day was listed for the wrong operation in 2007, and there were 1,136 errors involving operating lists, including mistaken surgery, wrongly identified patients or operations performed in the wrong place.
The 14 brain surgery patients had suffered head injuries causing bleeding in the brain leading to increased pressure in the head. The standard treatment is to drill holes in the skull to release the pressure, but in the 14 cases the “burr-holes”, were drilled on the wrong side. A second set of burr-holes then had to be drilled on the correct side. The 14 cases, all in the UK, were reported to the National Patient Safety Agency over the past three years.
That’s a pleasant thought. Wake up from brain surgery and find they’ve punched holes all over your head! People just might want to keep Britain’s experience in mind before pushing to collective our medical system.
The HSA Revolution That’s Already Here
The new book America’s Health Care Crisis Solved has been praised as providing a detailed, free-market solution for healthcare’s future. This it does, but what’s almost as fascinating about the book is its description of what is going on in the present, with consumer-driven health savings accounts (HSAs). Almost without notice, HSAs have grown dramatically and have solved for millions of Americans the problem of healthcare’s lack of portability.
First, some background. In the 2003 law that was rightly derided for massively expanding Medicare with a new prescription drug benefit was a separate section that let many more working-age people to take advantage of HSAs. This provision allowed any adult under 65 to open a savings account for medical expenses that receives much of the same special tax treatment as employer-based health care.
As a result of this change, you can qualify for an HSA by getting health insurance with at least an $1100 deductible for individuals or a $2100 deductible for families. So long as you don’t have another insurance policy, you can get a tax deduction for contributing up to $2900 for an individual or $5800 for a family to an HSA. Or your employer can contribute some or all of that amount. In either case, the money grows untaxed and can be withdrawn tax-free for health-care expenses.
And unlike the old flexible spending accounts, which you have to “use or lose” by the end of the year, an HSA can accumulate interest, dividends and capital gains year after year for 20, 30, or even 40 years until you reach the age of 65. And the same insurance policy remains in your hands regardless of whether you change jobs or become self-employed.
The book’s authors — insurance entrepreneur J. Patrick Rooney and longtime HSA advocate Dan Perrin — marshal impressive statistics to shatter critics’ myths that HSAs are only used by the young, wealthy and healthy. Citing statistics from eHealthInsurance.com, the authors note that more than 40 percent of HSA buyers had incomes lower than $50,000 a year, more than 50 percent were age 40 and older, and one-third had been previously uninsured.
And there has been a seven-fold increase to 3.2 million people with HSAs since just after the program began in 2004. In an interview with Open Market, co-author Perrin notes that, by contrast, it took several years to get to just one million individual retirement accounts after those were created.
In the interview, Perrin also credited HSAs with widespread innovations in the health care market. He says that the “minute clinics” that offer cheap and convenient medical services at Wal-Mart and other stores came about in part because of cost-conscious consumers with HSAs. When the government levels the health insurance playing field and consumers are spending their own health care dollars, market innovations arrive that make health care cheaper and better, just as other technologies and services have become cheaper and better when the consumer is in charge.
Much more could be done, Rooney and Perrin write, by the government, employers and insurance companies to make HSAs more accessible. HSA insurance premiums should be made tax-deductible, just as employer-provided insurance premiums are. But HSA have proven themselves as a way of dealing with the costs of U.S. healthcare by empowering patients, rather than empowering governments and limiting choices as socialized medicine does.
Surprise, Surprise: America is Tops in Treating Cancer
No one ever wants to get cancer, but if you do get it, America is the place to get treated. As Sen. Ted Kennedy doubtless realizes, but will never admit, if he was in Canada both diagnosis and treatment would be slower and inferior, reducing his survival chances.
David Gratzer explains in the Wall Street Journal:
“Your accomplishment of [universal access] is the envy of every U.S. citizen who understands what you’ve done,” Sen. Edward Kennedy (D., Mass.) told a Canadian audience in 1996. This week, a major international study confirms that Mr. Kennedy is right to stay at home for his own cancer care: U.S. medicine bests the cancer treatment available to people in 30 other countries.
The Concord study compares five-year cancer survival rates for several malignancies: breast cancer in women; prostate cancer; colon and rectal cancer in women and men. Combining the efforts of some 100 researchers, drawing data from almost two million cancer patients in 31 countries, the study, to be published in the August issue of The Lancet, is groundbreaking.
Who’s on top? Arguably Cuba, which records the best overall outcomes for breast cancer and colorectal cancer (in women), and seems to beat U.S. health care in three out of the four categories. The study’s authors — who apparently hold higher standards than filmmaker Michael Moore — disregard these results owing to data quality issues.
The study finds that the U.S. leads in the field of breast and prostate cancer. France excelled in women’s colorectal cancer and Japan in men’s colorectal cancer. The news isn’t all good here: great discrepancies exist between white and African-Americans. That said, the United States clearly leads other nations in overall survival.
Remind me again why we are all supposed to want the government to take over America’s health care system.
Is Britain Selling Health Care to Foreigners?
A British hospital says no. But a suspicious number of foreign liver transplants have been done at one hospital. Reports the BBC:
A London hospital has been referred to health watchdogs after concerns that too many liver transplants are being given to foreign patients.
The Healthcare Commission was alerted after 72 non-British EU nationals were given new livers in four years at King’s College Hospital.
Of those, 37 were given to Greek and Cypriot nationals in what were classed as “private” operations.
But the hospital said non-UK patients could not “buy” a transplant.
It said the figures were an anomaly caused because the Greek and Cypriot governments operate a different funding arrangement with the Department of Health than other states.
Most countries pay the Government a block fee to cover their citizens’ treatment in the UK. However, Greece and Cyprus pay hospitals directly on a patient-by-patient basis and so the procedures are classed as “private”.
I though the National Health System meant equal access for all, and not just for those whose governments will send a check.
Don’t Go to the Dentist in Great Britain
It’s long been obvious that you don’t want to get cancer in Great Britain. (Obviously, you don’t want to get it anywhere, but especially in a country which will take your money to provide health care but then won’t provide the drugs necessary to save your life.) You don’t want to have kidney disease there. Or suffer most any other ailment.
You also don’t want to have to go to the dentist there.
Changes in the way dentists are paid mean they effectively have no financial incentive to give appropriate treatment, the Commons Health Select Committee said.
Under the new contract, dentists receive an agreed annual sum rather than being paid for each individual treatment.
The committee found the number of dentists extracting a decaying tooth rather than carrying out a more complicated procedure had increased.
As a result, the volume of more complex work like crowns, bridges and dentures has fallen by 57%.
Evidence presented to the committee also suggested that patients were being pushed unnecessarily into the hospital system.
A survey carried out by the British Dental Association in 2007 found 78% of clinical directors had seen an increase in referrals from general dentists.
“We are concerned about the increase in referrals of patients requiring complex treatment to dental hospitals and community dentists,” the MPs said.
“This can be bad for those patients who would prefer to be treated by their general dental practitioner and can also have adverse effects on patients who are traditionally treated in these settings and have to wait longer for treatment.”
The report said it was “extraordinary” that the Department of Health did not carry out pilot studies on the new system before introducing it across England.
And it said that, despite assurances from the Government that the new arrangements would work if Primary Care Trusts and dentists acted more flexibly and used common sense and goodwill, the Committee “saw little evidence this will happen”.
Figures released last month showed that almost a million fewer people are now seeing an NHS dentist than before the Government’s reforms.
Well, why worry about the quality of your care? You’re equal with everyone else, who also is not receiving proper medical attention. So there’s no cause for complaint, right!?
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