UK’s NICE Spends On Spin, But What About Meds?
12 CommentsBy Ed Silverman // September 10th, 2008 // 8:21 am
The health-rationing watchdog has come under attack for spending more money on spin than on evaluating drugs which could save patients’ lives, The Daily Mail reports.
The National Institute for Health and Clinical Excellence, which is widely criticized for banning drugs from NHS use over cost, squandered about $9 million on ‘communications’ last year. And this was $2.2 million more than the $6.8 million the controversial organization spent on assessing new meds, the paper writes.
The money forked out on press officers, marketing execs and consultants included $50,000 on top public relations firm Weber Shandwick to defend NICE’s ban on Alzheimer’s drugs. It could have paid for 5,000 Alzheimer’s sufferers to get $5-a-day drugs for a year, or funded nearly 200 patients with advanced kidney cancer to have a drug for 12 months that would double their life expectancy.
Tens of thousands of people across the country are waiting for NICE to assess drugs that could extend their lives or alleviate conditions such as rheumatoid arthritis and thinning bones. Government officials, patient groups and medical organizations called the spending a ’scandalous waste of money.’
Myeloma sufferer Jacky Pickles, one of the ‘Velcade Three’ - three mothers who launched a campaign after being denied anti-cancer drugs - tells the paper: “It is disgraceful that money which could provide drugs that make the difference between someone living and dying is being spent on communications.”
Mrs Pickles, 46, of Keighley, West Yorkshire, adds: “‘NICE should either use the money to improve their evaluation process, or give it back to the NHS to spend on people who are ill.”
And Shadow Health Minister Mark Simmonds, who uncovered the spending in NICE’s annual report, says: “These figures typify New Labour’s approach to Britain’s health service. Thousands of patients across the country who are still waiting for NICE to evaluate new medicines will rightly be asking why Labour insists on spending more on spin than on speeding up people’s access to lifesaving drugs.”
NICE has an annual budget of $78 million, and spends $1 of every $8 on communications. In contrast, $1 in every $10 is spent on evaluating new drugs. The rest is spent on such things as salaries - NICE’s annual report for 2006-07 revealed that wages accounted for almost 37 per cent of the budget - accommodation (8 per cent) and external contracts. Almost 300 full-time staff are employed in London and Manchester.
Here’s the complete story…
Michael D. Miller, MD
This is very interesting. Since NICE’s job is to provide analysis and information to the UK’s National Health System, they should be able to do that via email or with printed documents. It should then be up to the NHS to defend their actions.
This article/study shows that NICE is involved in much more than just analysis and information providing to the NHS. They clearly have a larger/broader agenda about health reform in the UK. And from all the attention NICE is receiving in the US, they might be influenced by actions here as well.
Christopher
This abuse of spending power underscores the ineptitude of NICE which has failed to deliver any meaningful value it its entire lifespan. A government agency, NICE is hamstrung by short-sighted policies which have gradually, relentlessly but hopefuly not irreversibly savaged the UK pharma industry. As the article illustrates there are inequities within British Healthcare. These have had profound consequences for many patients who have been prevented from receiving treatment which could otherwiase have helped them. At the same time the industry has been beaten up with punitive pricing restrictions: A bad mix for the prognosis of public (and private) health in the UK.
Matthew Holford
Christopher, NICE is operating with one hand tied behind its back. It is required to assess drugs for use on the NHS without being able to demand a full data set to scrutinize (the Worshipful Company routinely withholds negative trials data, as you may be aware, on the grounds that it contains trade secrets). At the same time, NICE is pressured into passing drugs, because to refuse to pass a drug on any grounds other than cost, when that drug has already been passed as “safe and efficacious” by the MHRA, would most likely result in legal action by the industry.
We might also bear in mind that the MHRA, which is permitted to demand a full data set, tends not to scrutinize original data, and apparently takes the word of the manufacturer. The loser in this scenario? The patient, every time.
Fuck the industry. The whole things so fucking crooked that it doesn’t bear thinking about.
Matt
Christopher
Matthew
I was with you until the last paragraph. That’s where we disagree on the value of the industry as an innovator, employer and generator of income on all sorts of levels which flows back into the economy.
But anyway, NICE isn’t helping.
Matthew Holford
Christopher wrote:
“…NICE isn’t helping.”
I’ve been over this ground too many times to bother to discuss the shady ethics, the statistical jiggery poker, the bullying of whistleblowers, the payola, the withholding (even hiding?), of negative data, etc, in any kind of detail. It’s irrelevant as to how many people the industry employs, frankly. Does the product work? The answer is a resounding “no,” certainly in the mental health field, where placebo performs as creditably. And if you judge the system based upon how much cash it generates, then frankly you are looking to the wrong indicator, because you will continue to justify the industry’s actions, long after it has been demonstrated to be useless.
NICE is not there to help the industry. The industry has the Department of Health looking after its interests (officially); and it has the ABPI, as a lobbyist. No, NICE is there to ensure that the NHS gets value for money. If a drug doesn’t fulfil the criteria, it doesn’t get on the NHS list. Extremely inconvenient for the industry, given the size of the (captive), audience that the NHS commands.
The motivation for attacking NICE (and the ABPI has attacked NICE), has nothing to do with value to patients, you may be sure of that.
Matt
Matthew Holford
Michael D Miller, MD wrote:
“…This article/study shows that NICE is involved in much more than just analysis and information providing to the NHS…
NICE has a bunch of functions.
1. It assesses drugs for use on the NHS;
2. It drafts best practice guidance for the benefit of clinicians;
3. It drafts guidance on the administration of treatments;
4. It formulates advice for the promotion of good health and the avoidance of illness.
What it’s not is a policymaker.
Matt
Christopher
Matt
I understand your perspective but I think you’re missing mine. The industry (like it or not) is - or was - a major employer, source of exports, generator of tax income and attracted inward investment much of which was recycled via taxation. NICE and other govt groups have hamstrung the industry to the point that, as you know, much of it is leaving Britain. That’s not good for the economy nor for innovation. Whether I support the industry is immaterial to the point I was trying to make.
Chris
Matthew Holford
Chris, I understand your perspective, I think, but I think if one places bias (and I use the word in its non-pejorative sense), in favour of any particular element, then one ends up making decisions that always lean towards that bias. I’m assuming that money impacts a lot of the decision-making, in the industry, as per the rather unpleasant litany in my previous response to you.
The product isn’t great, it really isn’t, and it seems to need a great deal of assistance to retain its pre-eminent status in the treatment of mental illness, which is a big earner for it. In fact, I think that the industry stifles innovation, because there are talk therapies that work better than drugs on a range of stuff (anxiety, phobias, depression, etc). But they’re not being promoted, even though NICE recommends them, ahead of drugs, in the treatment of mild depression (in fact, the majority of SSRIs are prescribed for mild depression, when the advice is that they should only be the last resort).
I dunno. I’m not benefting from the Worshipful Company’s activities, so I don’t give a shit if they fuck off, to be honest.
Matt
Christopher
Matt,
I think I understand your focus on SSRIs and the like and also, I think, why this is. That really wasn’t my theme but I appreciate learning a bit more from your perspective. Pity you can’t benefit from WC activities (sic) but I was thinking about the economic impact of a diminished pharma industry on the UK in general.
Chris
Matthew Holford
Well, if there are therapies that are more valuable (in terms of positive results), than pharmaceuticals, then they ought to take the place of pharmaceuticals. Isn’t that how “The Market” operates, or are you arguing for protectionism?
It would be a straight swap, and quite seemless. Patients would benefit and money would still be flowing through the system. Just not in the direction of the Worshipful Company. And jobs would still need to be filled. Just not in the pharmaceutical industry. I don’t see a problem with that. Let investors take the fall, for a change.
Matt
Jack2
I don’t think this is actually true. See the paragraph I posted below from this article:
UK Opposition Urges Payment Only For Drugs That Work
Another of the Conservatives’ attempts to score political points over medicines access backfired this week. Charges that NICE spends more on communications - described as spin doctoring - than on evaluating medicines were quickly refuted by the institute. No trace of the original complaint remains on the party’s website and senior party officials have not associated themselves with it.
Matthew Holford
I’m having a little exchange with the Mail’s Managingeditor, just now (I complained that the Mail’s piece was so fantastically biased and incomplete that it was effectively wholly inaccurate). He told me that it was a political piece, and reflected the views of the shadow minister, which is about the poorest excuse for shoddy journalism that I’ve ever heard - on that basis, the Mail is now Mark Simmonds’ fucking personal publicity organ!
Matt