Make the NHS one big clinical trial?
From last week:
Evil ways of the drug companies
This week health secretary Alan Johnson announced that he wasn’t going to stick by the pharmaceutical price regulation scheme that lines the pockets of the drugs industry.
They spent only 14% of that money on research and development, but 31% on marketing and administration. They are very careful not to let anyone see how much goes on marketing and on administration. Whenever you hear the drug companies explaining why they have to charge so much for their products – perhaps as they are denying their lifesaving Aids drugs to the 20 million HIV-positive people in Africa – the plea is that they need money to develop new drugs. That’s not true if they spend twice as much on marketing as on research and development. This unhappy collision of facts makes them look very evil indeed.
But what really interests me is what we do with our feelings about this evil, market-driven venality, which can be found in every market sector. But we find it uniquely distressing when we are sick and needing healthcare.
This moral discomfort and resentment leaks out in delusional anti-MMR beliefs, or bizarre acts of faith in the vitamin pill industry, as acts of misguided and wasteful political rebellion. Why? Because everybody is a socialist when it comes to healthcare, but nobody knows what to do with those feelings any more.
I included the last two paragraphs simply because I found them amusing. Yes, the news was that Alan Johnson (no, not that one) has declared done with the sort of price regulation that turns over tonnes of money to pharmaceutical companies.
Just to note: the context of this is not merely hacking away into PhRMA’s profitability, but is in response to them bilking the NHS out of millions of pounds. Which is not to say they couldn’t wear it – from the good folks at the Kaiser Family Foundation:
For every year from 1995 through 2002, the pharmaceutical industry was the most profitable industry in the U.S. Since 2002, however, its profitability has declined, with drug companies ranking as the third most profitable industry in 2004 (15.8%), with mining, crude-oil production the most profitable industry (22.1%). Drug companies were three times more profitable than the median for all Fortune 500 companies in 2004 (15.8% compared to 5.2%).
Notes: Percent is the median percent net profit after taxes as a percent of firm revenues for all firms in the industry. The second ranked industry for each year shown was commercial banks.
Their full report can be picked up here, if you’re inclined.
I have little sympathy for the bottom line of PhRMA members (I’m the wrong type of health economist), especially here in the US where the TV, when it is on, insists on trying to convince me that I have a syndrome for everything I used to think was just known as “being”. Even Chris Rock thinks so (warning: he swears. Lots):
On to today’s article (i.e. getting back to the point):
But if we ever had a scientist in charge of health, instead of tinkering with payments to big pharma, they would do one simple thing: move hell and high water to collect and collate the best and cheapest evidence on healthcare. First you would give huge amounts of money to the Cochrane Collaboration, which collects and collates data independently on all healthcare interventions, and is quietly one of the most subversive organisations ever to be created, because it blows the lid on false commercial claims.
Doctors waste money by irrational prescribing decisions, so give them clean, clear, accessible information, and that will stop.
But more than that, we are in a unique position to generate data: we have inherited an extraordinary information resource, in this vast monolith of the NHS.
Nobody knows what the best treatment for stroke is, but if we randomised every single new stroke patient in the UK, over one week, into a rough trial, we’d have our answers in a couple of years.
My word, Ben Goldacre does like kicking paragraphs off with the word “but”. He also makes a great crack about the wonder that is the Cochrane Collaboration – I love those guys. Talk about evidence-based medicine. They should have pamphlets in every doctor’s office.
A colleague of mine – a thousand times smarter than I am – has this manner of thing as a bit of a bug-bear. Not with relation to, say, stroke, but disease-states without treatment (or with only experimental treatment). Trials are a rather expensive and slow way of going about things, when most people with given conditions, properly informed, would probably be only too happy to give something new a shot.
With the NHS this might not be a bad idea – it certainly holds with most statements of medical ethics of which I know. In the US, not so much. Medicare, maybe (restricting, thereby, the sample considerably). Generally, though, “experimental” is probably the first port of call for insurers telling you to drop dead (pun intended).
Obviously I’m biased: Goldacre’s cynicism appeals to me greatly, and as an Australian I just don’t like Big Pharma, their profiteering and their thuggish attempts to turn our PBS into their money tree. The NHS still strikes me as a good setting for massively multicentre clinical trials.