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No death pannels here in the UK, we do have NICE that refuses to pay for cancer drugs that extend life for a few months because the price is exorbitant. The "death pannel" ruse was invented by American Republicans at the same time they said that Stephen Hawking wouldn't be alive if he lived in the UK (he was, and he did.) https://www.nice.org.uk/News/A... http://www.telegraph.co.uk/new...

The unasked question here is why was the Sepsis not managed in first place. It is well understood condition and early intervention is the key to successful outcomes, was he denied early healthcare cover, people should be told.

https://www.nice.org.uk/guidan...

There are NICE guidelines which provide lots of treatment pathways and set standards on what must be available+funded and, on the other end, what cannot be provided without the patient being expected to contribute (though strawmen frequently argue that a socialised health service is unacceptable because it won't pay $1,000,000s/year for treatment which has little or no proven benefit). The guidelines usually provide or admit alternatives, but it's worth noting that there are so many routine conditions where you're fooling yourself if you think medicine provides a selection of equally useful alternatives.

NICE is a bit of an oddity, though. Thatcher tried to break up the health service by getting it competing within itself ("internal market"), creating a postcode lottery with varying opportunities for treatment depending on where you live. The aim was to restore national standards. Lansley's now done a similar divide-and-conquer thing with the Health & Social Care Act, and I am not sure how the NHS will get through that one, but I hope it will. It's not that the Tories hate the NHS so much as that they like to milk it by introducing middlemen everywhere - Lansley himself received generous donations from people who stood to benefit from his "reforms".

Second... Oh... where to start...

For a prominent one, Terry Pratchett has early onset Alzheimer's but can't be put on medications for it because he's too young. That's bureaucrats overriding medical science. Socialized health care isn't interested in improving the quality of life. As a consequence, he will likely be taking his own life soon-- amusingly, in Switzerland. I guess assisted suicide isn't covered in the UK.

How about that the said drug is now actually recommended?
Or the fact that actually there were no limitations to the availability of the drug to anyone, as you could still pay for it yourself (only you'd have to pay the whole thing out of your pocket, or your private insurance's pocket), and particularly not to Pratchett who is a bloody millionaire.

http://en.wikipedia.org/wiki/NICE#Cost_per_quality-adjusted_life_year_gained

He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider. If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment. About 8% of the population has some private health insurance from an employer or trade association and 2% pay from their own resources.

So that bullshit about him thinking of hopping over to Switzerland to kill himself BECAUSE the ebil soil-she-lized gubermint won't let him have his life saving pill... nice troll.
No... really. Lovely.
Not quite on the holocaust denier level, but close. And it has more charm.

Now... Unlike you, Pratchett is not in it for trolling.
He made the comments about the drug as he is concerned that, unlike him, there are actually people out there who can't afford the extra 2.5 pounds per day cost.
Interestingly, while the Aricept/Donepezil's "cash-and-carry" price is 800-1000 pounds per year in the UK (about 1500$), up until recently it cost twice as much in the USA.
While the high price has primarily to do with patents, I'll leave it to you to ponder how the same drug could cost twice as much in a country which has SIX times greater population (higher demand, ergo - should cost less) and only ~1.4 times greater purchasing parity GDP per capita.

Socialized health care isn't interested in improving the quality of life.

Funny you should phrase it like that.

See... the ACTUAL issue that caused Pratchett to speak out about the NHS policy on the said drug has EVERYTHING to do with improving the quality of life.

Problem is... How do you quantify something as immaterial as "quality of life"?
And remember, you must take in account that different people value different things differently.
And before you ask "Why should you quantify it at all? Isn't all life sacred and precious?" - take a million dollars and threat 100 people with that money. For a year.
But you have to give each one of them the same quality of life, regardless of the fact that they will be chosen completely randomly, just as their age, living conditions and illnesses will be completely random.
And you don't get to know in advance who's the next person coming through the door, or what is their illness, but all of them ARE life-threatening.

Oh and, since you love hyperbole so much - all the people you don't get to help will be considered murders.
Done by you. Personally.
As if you've taken an axe to each and everyone of them.
You sick fuck.

Marketing drugs shouldn't be expensive because it shouldn't be allowed. In the UK you cannot advertise drugs to patients, the only advertising allowed is to doctors. But doctors are provided with NICE guidelines which recommend which drugs should be used as first and second line treatment for each illness. NICE also seems to do admirably well at resisting the lobbying of the drugs companies. There are constantly stories in the right wing press bemoaning NICE not allowing some new and expensive drug to be prescribed instead of the cheap generic that it replaces.

You get adequate care and treatment.

One can hope so.

Of course, some agency like NICE will decide for you what is cost effective. They decided that a "quality adjusted life year" was worth something like $45,500 in 2008 (the quality adjustment is to place less value on a year of life which is diminished by pain or the like). Attempts to do this in the US are met with screams of protest. Although, government agencies in the US, such as the EPA and state highway agencies, do regularly put a financial value on a year of life when making decisions and oddly this doesn't invoke much outrage (perhaps because in the case of the EPA it's generally impossible to prove that the lack of a regulation caused a particular disease or death and in the case of the highway agencies, one assumes they won't be the one to run off the cliff because there's no guardrail). However, Medicare is currently not allowed to consider price in determining what treatments will be covered.

Some of the "overkill" resulting in higher costs in the US system is the result of the lack of rationing.

Similarly, some of the "poorer outcomes" are the result of lack of such rationing - for example because sicker people in the US patients sometimes get treatment which would be denied in some single payer systems (this is true, for example, in end stage renal disease and may be true in the case of extremely premature babies).

The differences in attitudes between the general populace in the US with regards to medical care and some other "first world" countries is quite surprising. For example, a middle class person in the US who would benefit from hip replacement to reduce pain would expect to have the surgery (assuming they are in a condition to have it) in weeks while it's typical to wait for many months in Canada -- few middle class Americans I know would find this acceptable. When talking to someone from Canada not too long ago, I was quite surprised they were fine with the notion of living in unnecessary pain for six extra months. Some years ago I was in the UK talking to a vendor rep over dinner and she mentioned that she would be unavailable for a couple weeks due to upcoming surgery (I gathered it was some sort of abdominal surgery and was elective in its timing -- I can only guess what it might have been but I suspect 1/2 the population couldn't even have had this surgery because they lack the necessary parts) and I commented something like "Well, at least you don't have to pay for it due to your government healthcare system" and she gave me a look of shock and said something like "Oh, no - no one who can avoid it has this done in the government system -- I carry private insurance for things like this". She was a very "middle class" person who was on the marketing/sales side and the company she represented was obviously not a "big bucks" vendor. I don't know if this was common or still is, but it surprised me quite a bit.

Here in the UK there's a Government body, the National Institute of Health and Clinical Excellence, which makes judgements on how cost-effective treatments are. According to their website if it costs more than £20 000 - £30 000 to provide an extra year of healthy life, then the treatment is likely to be held not to be cost-effective and won't be offered via the National Health System.

Before anyone piles in, it's a bit more complicated than that (different parts of the UK follow different rules, for instance) but that's the essence of it. Private insurance of course isn't affected.

Anyone doing this should get put in jail for a long, long time. It may not be fraud in the sense that they're publishing fraudulent results, but by not publishing results they're creating fraudulent overall data, with possibly deadly results. This needs to stop.

That's a bit simplistic - often nobody is directly responsible for not publishing results, it comes about because major medical journals are not interested in pubishing negative findings. There are of course exceptions, when the negative findings come as a big surprise or there is a lot of anticipation about them, like the reports of the Alzheimer's disease vaccination not working earlier this year.

The medical journals themselves know this is a problem, but they aren't sure what to do about it. One suggestion has been the journals should make a 'commitment to publish' for a trial based on its design and importance, and then publish the findings whatever they are, but that would of course mean they'd be publishing a lot less interesting stuff.

Also scientists can't be bothered to write up negative findings, because there are proportionally so many more of them than positive ones.

There is a problem of pharma companies suppressing bad findings or writing misleading journal articles, but that's a wholly independant issue and should be dealt with by the schemes in develpment for enforcing results to be left in public databases after the trials are finishsed. The problem with that is that not many GPs will be searching through these databases

The real solution is probably for doctors not to rely on scientific journals for information (which they often don't really understand), but to wait for advice from bodies like the National Institute for Clinical Excellence or the Cochrane Collaboration who do very thorough searches and synthesis.

Weird case, they apparently couldn't use his inner ear, so they connected it to his brain. It works!

I might write a letter to NICE, I think.

Justin.