http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/nh=
s-should-not-save-patients-lives-if-it-costs-too-much-says-watchdog-891501.=
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NHS should not save patients' lives if it costs too much, says
watchdog
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 =96 as when
vast resources are used to save a sailor lost at sea =96 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.
Nice describes the rule of rescue as "the powerful human impulse to
help an identifiable person whose life is in danger, no matter how
much it costs". But it says in a re****t that spending too much on one
patient may deny others. "When there are limited resources, applying
the 'rule of rescue' may mean other people will not have the care or
treatment they need," it says.
This contradicts the position of Nice's citizen's council, which
concluded that individuals in "desperate and exceptional
cir***stances" should sometimes receive greater help than can be
justified by a "purely utilitarian approach." The council, 27 members
of the public chosen to be representative of lay opinion, backed the
idea by 21 to 6. Most agreed the NHS could not be expected to save
life at any cost, but felt there were cases where, if the NHS did not
intervene, society would be diminished. "It is human nature to help in
an emergency," said one member.
Another said helping those in imminent danger had a wider impact, as
when the response to the Asian tsunami created a feelingwhere: "We
felt better about ourselves as a society".
Professor Peter Littlejohn, clinical and public health director at
Nice, said: "We shouldn't have a formal rule of rescue because our
general guidance took into account provision for exceptional cases.
That can allow [the institute] to recommend treatment above our normal
cost threshold."
The move was criticised by the British Medical Association, which said
doctors had a duty to do their best for patients. Tony Calland,
chairman of the ethics committee, said: "We would be opposed to
ignoring a rule of rescue when it introduces a degree of flexibility
around extreme cases. So what if you waste a few pounds if you are
doing your best for humanity?"
The Nice re****t, Social Value Judgements, was placed on its website
last month but was not publicised. The re****t also includes advice on
the treatment of smokers, drinkers and the obese. It rejects arguments
that people whose illnesses are self-inflicted should get less or no
treatment. But it says treatment may be withheld where behaviour cuts
the chances of success, unless patients agree to change. The alcoholic
who will not quit drinking could be denied a liver transplant.
Treatment may also be refused to elderly patients if the benefits are
deemed too low or the risks too high.
'Billions go into research then we deny people the benefits'
Kate Spall successfully campaigned for her mother, Pamela Northcott,
58, to get the drug she needed for her kidney cancer. Though she won
her battle with her local health trust in north Wales, her mother died
soon after starting treatment.
The drug, Nexavar, costs =A332,000 per patient per year =96 more than the
average salary of around =A324,000. Nice declined to recommend its use
on the NHS in draft guidance published last week because it was not
cost effective. Ms Spall said: "We plough billions into cancer
research but the benefits of that research =96 some remarkable drug
treatments =96 are not available to all who need them. Patients are
disregarded and given up on because they cannot get the drugs they
need."
Ms Spall now campaigns on behalf of other patients and has scores of
appeal applications, many of them for patients with kidney cancer.
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