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Millenial Humbug


While humbug may mean misleading behaviour (or talk) which is intended to win support or sympathy to some, to others it will always be a hard-boiled sweet. Rationing has to be, to maximise the health of the population served when resources are limited (as Bandolier has argued before in issues 2 and 8 ). The humbug comes in the process. Bandolier believed that closing mental hospitals was for the good of the patients ( Bandolier was 'humbugged'). NHS dentistry, for many at least, just disappeared. Care of the elderly quietly went from being covered by the state to not being covered. What happened to our involvement in these decisions, professional or as citizens? Were we just asleep, or were we humbugged by a process which passed us by?

The fourth hurdle for new drugs, the cost-effectiveness investigations by the National Institute of Clinical Excellence (NICE), is at least an attempt to make overt judgements about medical interventions, and we should welcome it. In Bandolier 69 we covered their studies of Relenza, the anti-flu symptom drug. Clearly the drug works: the argument is about how well it works, particularly in high-risk groups. But if an articulate patient arrives with flu in the surgery and demands Relenza what happens? By some quirk of the GP contract does the patient have the right to be prescribed the drug? Does the GP have the right to override NICE?

The MDU said yes (15/9/1999) "GPs will neither lose their clinical freedom nor be able to set aside their clinical judgement when NICE guidance comes into force. GPs have a legal, contractual and ethical duty to act in the best interests of the patient. This clearly involves taking into account national guidance on recommended treatment but, if a GP decides that a recommended treatment is not in a particular patient's best interests, then he must act as he thinks is right for that patient."

The last piece of New Year humbug is the claim that the NHS is cheap, with Britain spending less than 7% of GDP, much less than other developed countries. Bandolier worries that while in other countries the ramifications of chronic illness are overtly badged under the spending on health, here we badge them differently. Could it be that our actual health spend is not so very much lower than the other countries, that our quality may be lower than we would like, and that we need a radical re-think? It would be tragic if current media doctor-bashing (self-inflicted as it may be) allowed such a radical re-think without the profession's involvement. Protection from humbug is what we need.
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