Protect and improve
That the processes undertaken by the National Institute for Health and Clinical Excellence in reaching its decision over treatment for early symptoms of Alzheimer's disease are likely to be scrutinised in a judicial review may be welcomed by patients and their carers. Whatever the outcome, it must not be used to undermine the NICE process in its totality which, although far from perfect, is preferable to the free-for-all that existed before the institute was founded.
Theoretical support for NICE, however, does not mean that its processes
cannot be improved. And ways to enable patients denied expensive treatment
by NICE need to be explored. In the coming years new drugs that target
disease more effectively but help fewer patients are likely to become
the norm and, almost by definition, be more expensive.
Peter West, from the Healthcare Commission, speaking at the British Pharmaceutical
Conference in September, made a powerful point that, although drugs costing £50,000
or £60,000 per year are routinely denied to patients, there are
thousands of patients all over the country (the frail elderly who suffer
from dementia) whose care may cost health and social services well over £100,000
and up to £250,000 per annum.
While we are not advocating withdrawing this level of care, a system
will have to be developed to finance effective new medicines when their
use is limited by cost. One way might be to have a central fund to which
clinicians can apply, if they believe their patients are eligible and
would benefit from an expensive medicine, without skewing the local health
economy. There is a danger, otherwise, that a future NHS will be supporting
increasing numbers of old and sick people but denying similar care to
younger patients.
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Duping innocent patients for profit
A report published this week by academics at the University of London School of Pharmacy and supported by Pfizer suggests, among many other points, that parallel importing could be a route for counterfeit medicines to enter the supply chain (p638).
Counterfeit medicines are not yet a huge problem in the UK or other developed
countries — certainly not compared with Latin America, Asia and Africa.
World Health Organization statistics indicate that 30 per cent of medicines supplied
in these areas are fake. It is a global problem — without any question — and
global solutions need to be sought. Nevertheless, matters could easily be tightened
up at home. There is, for example, no offence of counterfeiting under the Medicines
Act 1968. Dealers in illicit drugs are treated much more harshly than those who
set out to dupe innocent patients for profit: the latter are treated in the same
way as counterfeiters of Rolex watches and Prada bags, whose crimes certainly
harm manufacturers’ profits but cannot be considered to endanger public
health.
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