nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Monday, November 1, 2010

Britain To Give Patient Treatment Decisions Back To Doctors

Britain's National Institute for Health and Clinical Excellence has been the "rationing" arm of their National Health Service.  After mutiple scandals, that role has been taken away.

The Institute, called NICE (what a name for a body that decides not to cover some expensive treatments for its citizens), has over the years made calculations using cost and quality-adjusted life years (QALY) as a way to decide that certain treatments are not justified by the cost involved.  I've talked about how faulty these calculations can be in previous posts; just search for QALY on Nostrums.

There's something inhuman about saying someone's life is worth only a certain amount of dollars.  The second half of the calculation, involving "quality" of life, depends on somebody's idea of how to judge the value of being alive.  And, lastly, just because an expensive treatment only adds six months on average to life, ignores the fact that "average" means that half live longer...some a lot longer.

The President's new Medicare chief, Dr.Donald Berwick, has professed to "love" the NICE system.

However, NICE made the decision not to fund drug-eluting cardiac stents for several years and delayed acceptance of Herceptin, a drug shown to improve survival in non-metastatic breast cancer.  I doubt whether the British government is going to do a study of how many died needlessly from those delays.

But it saved money, I'm sure.

So, the news now is that GB has finally woken up (BBC News, 1 Nov):
A Department of Health spokesperson said: "We will introduce a new system of value-based pricing which will make effective treatments affordable to the NHS. Our plans will ensure licensed and effective drugs are available to NHS clinicians and patients.  "We will focus NICE's role on what matters most - advising clinicians on effective treatments and quality standards - rather than making decisions on whether patients should access drugs that their doctors want to prescribe."
And guess where the authority to approve drugs and other treatments will go?  To groups of doctors who are seeing the patients in their locale.

What a concept.  Doctors deciding, with their patients, what best meets their needs.

Doc D

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