Healthy Skepticism Library item: 7067

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Publication type: Journal Article

Twisselmann B.
How much will Herceptin really cost?: Summary of other responses
BMJ 2006 December 9; (333):1219-1220
http://www.bmj.com/cgi/content/full/333/7580/1219-b

Abstract:

The 19 responses to the article by Barrett et al express concerns about the independence of the National Institute for Health and Clinical Excellence (NICE), its remit, and its role in relation to primary care trusts.1

People are divided on whether NICE should decide which services to cut to fund new technologies (opportunity costs). But without an implementing body it is unclear how to react to NICE’s recommendations. NICE’s remit is not the equitable distribution of a limited healthcare budget, but its guidance should provide healthcare professionals and political bodies with a means to make informed decisions and communicate these to the public. The public in turn needs to accept that health care is a finite resource, and that the decision is between rationing and paying higher taxes.

The role of primary care trusts as strong local commissioners is emphasised by several correspondents-postcode prescribing, rather than being a lottery, is their raison d‘être, and as such they are in the best position to judge local needs. They might also be expected to put their case for bigger budgets to the politicians who control national budgets and to the public. They are in a position to support clinicians in facing up to media, politicians, and pressure groups.

Two correspondents provide examples of how NICE guidance is already restricting treatment options-in palliative care and in chemotherapy. And one correspondent pragmatically suggests a budget split into “historical” and “innovative” treatments.

Yet others question whether cost effectiveness is the right prioritisation tool. And, given that breast cancer is not a disease of ageing any more, these kinds of prescribing dilemma may in future be avoided altogether if the focus were on health and prevention.

The role of the media is touched on by several correspondents, most notably a doctor and former patient with breast cancer, Jane Cooper. She got caught up in the media circus surrounding Herceptin and, after discussions with her oncologist, decided against taking it. Benjamin White, a senior house officer in critical care, sums it up nicely. Either “the profession lays itself open to blame for all deficiencies in service or we face the possibility of health care for those who shout loudest. Clearly the public needs to be properly informed about what to expect from their health service, but we cannot risk the debate being hijacked by those groups who are most vocal or well funded.”