September 30, 2008

Who’s Really Paying for Cancer Patients’ Free Medicines?

By Jeremy Laurance

Medical Life

Medicines are like money - they provoke strong emotions and no one is capable of being entirely rational about them. Do you know anyone who isn't either a spendthrift or a scrooge? No, neither do I.

It's the same with drugs (the medical kind). We can't get enough of them (postcode lotteries) or we can't get away from them (a pill for every ill). They are too expensive or too toxic, or we are taking too many or they are too hard to obtain.

An attack of sentiment is the only explanation for Gordon Brown's decision to remove prescription charges for cancer sufferers next year on the grounds that it is "unfair" to make them pay for their drugs. At some future point - unspecified - he will do the same for sufferers from other long-term conditions, such as diabetes, Parkinson's and multiple sclerosis.

So the existing unfairness, whereby cancer sufferers have to pay for drugs, will be replaced by the far more glaring unfairness of having cancer patients getting free drugs while Parkinson's sufferers have to pay.

Once the exemption is extended to them, where will that leave those with gently rotting teeth and failing eyesight who have to shell out hundreds of pounds for NHS treatment to enable them to continue eating and finding their way down the street?

Mr Brown's decision to help cancer patients is gesture politics - and the losers will be the very cancer patients now campaigning for access to new and expensive drugs, which the NHS will be less able to afford because it will have foregone upwards of 300m a year in prescription charges.

Those who have to pay can buy a season ticket for 102, covering their prescriptions for a year. So Gordon is taking cash out of the hard-pressed NHS's coffers and giving it away in bundles of fivers to those who least need it. Ministers have already done it in the people's republic of Wales, and Scotland will shortly follow suit.

No wonder, then, that Alan Johnson, the Health Secretary, is preparing to reverse existing policy and allow cancer patients who will save 100 a year on their prescription charge to pay tens of thousands of pounds to top up their NHS care with drugs rejected, or not yet approved, by Nice. Even an old cynic like me finds that pretty hard to swallow.

You may have read that Nice wants to curb the use of Ritalin and similar drugs in the treatment of hyperactive children, limiting it to those in whom other treatments have failed.

I was at the press conference for the new guidelines, widely reported, but that was not how I heard it. The message was drugs were being overused in some children but underused in others - those most severely affected - and it was wiser prescribing, not less prescribing, that was wanted.

Did this second half of the message get lost in translation - or is it another example of the irrational prejudice against drugs?

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