Naughty and NICE

In the week that saw the wrecking of the Conservative party headquarters by student demonstrators the Coalition Government continued, more quietly, in its ongoing project of vandalism against the machinery of the British state.

This time it’s the National Institute of Health and Clinical Excellence (NICE) facing the axe. There have been many cruel and callous acts by this government during the six and a bit months it has been in office and it’s difficult to know where to begin when writing about them because cruelty and callousness often defy rational analysis.

Sheer stupidity, on the other hand, is easier to get a handle of and this move is profoundly and irredeemably stupid.

NICE was one of Labour’s more successful creations. It was designed to provide uniformity of access to innovative treatments and to control costs within the NHS by assessing every new treatment by a single standard. Treatments judged to be cost-effective would be offered to all NHS patients, whereas treatments judged too expensive would be rejected.

This idea was so simple and so effective that it soon began to attract international attention attention, as this New York Times article shows, with many other countries talking of introducing similar policies. Dr. Donald Berwick, the Administrator of the Centers for Medicare & Medicaid Services (CMS), in the US, described NICE as an “extremely effective, … conscientious, valuable and- importantly- knowledge building- system.”

The importance of NICE was that it tackled one of the major problems facing all advanced healthcare systems. The fundamental aims of healthcare – the treatment of ill health and the extension of lifespan – are goals without any natural limit. The ultimate logical aim, of immortality and perfect health, are forever out of reach and a country could very well expend all its resources in the effort.

This is particularly true given an intellectual property based model of healthcare innovation that means that drug developers can pretty much charge whatever they want and the end of the era of rapid advances in medical technology meaning that vast amounts of money could be spent on incremental improvements in outcome. NICE proved very effective at containing drugs costs by providing a clear non-negotiable cap on what the NHS would pay for treatments. It also helped to shield British patients from over-hyped and ineffective treatments.

Naturally, the pharmaceutical industry didn’t take this challenge to its control over drugs pricing lying down, whipping patients into a frenzy over “life-saving” treatments that were being denied, and creating fake patient advocacy groups. The tabloids relentlessly pushed this narrative, carrying multiple, emotive articles highlighting patients stories, and blaming NICE relatively poor cancer outcomes in the UK; a claim that makes no sense – the months of survival benefit these drugs have shown in clinical trials does not translate into years of advantage on a population level.

This campaign has often led to NICE being steadily undermined, a process that began with the Labour government intervening to ensure the approval of Herceptin for breast cancer in 2006, and continues with the coalition, first creating a separate fund to pay for refused cancer treatments, effectively neutering NICE in price negotiations, before removing its powers to approve or refuse new drugs altogether.

Health Secretary, Andrew Lansley, wants to replace this function with what he calls “value based pricing”. This will mean companies negotiating directly with the Department of Health over prices, and drugs being approved or refused directly by local GP consortia.

This plan is riddled with potential problems.

The DoH will be subject to extensive lobbying by industry and political pressure not to be seen to be denying drugs to needy patients – the ball will be entirely in the drug companies’ court and they know it.

GPs have neither the time, objectivity nor clout to handle these negotiations. Dr Ben Goldacre has written that it would take GPs 600 hours a month to read all the studies relevant to primary care alone, and that drugs companies are adept at massaging the data to favour their products, for example by failing to publish negative data and using positive data in multiple studies in different journals. These are tricks that are difficult to spot by all but the most careful reader, and certainly to busy GPs, themselves subject to corporate marketing and “hospitality.”

This plan effectively removes the ability of the NHS to force the pharmaceutical companies to lower prices, the GPs don’t have the clout to stand up to big multinational corporations and the government certainly doesn’t have the political will. It’s safe to say that the champagne corks will be popping in the boardrooms of those companies and their lobbyists (lobbyists such as the one wheeled out to defend the changes in the Guardian editorial linked to at the top of this paragraph) at the news.

Further to the reforms of the funding of the new medical treatments, we hear the news that many of the regulatory functions of the Food Standards Agency (FSA) with ”food networks” including representatives of the food companies to discuss “voluntary not regulatory approaches.”

We can see very clearly where Lansley’s political sympathies lie. He cannot plead ignorance, certainly on the issue of healthcare. He has spoken about the issue many times with Private Eye’s “MD” columnist (aka Phil Hammond), who has christened him “la-la Lansley,” assuring him that he has fully understood the need for rationing in the NHS.

These moves completely contradict the Conservative portion of the Coalition’s stated raison d’etre of fiscal responsibility- in an era of tightening health budgets, diverting precious resources to a small and vocal group of patients, to little end, and to pay to patch up an increasingly unhealthy public. This cuts away the myths of Conservative principles, exposing their core values of deference to business, deference to wealth and pathological hatred of the state.