Comments on: UK’s NICE Spends On Spin, But What About Meds? http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/ News, Comment and Conversation Fri, 10 Feb 2012 20:48:32 +0000 http://wordpress.org/?v=2.6.2 By: Matthew Holford http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-373713 Matthew Holford Tue, 16 Sep 2008 20:37:50 +0000 http://www.pharmalot.com/?p=15372#comment-373713 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 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

]]> By: Jack2 http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-373431 Jack2 Mon, 15 Sep 2008 14:23:50 +0000 http://www.pharmalot.com/?p=15372#comment-373431 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. 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.

]]> By: Matthew Holford http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372651 Matthew Holford Fri, 12 Sep 2008 09:03:35 +0000 http://www.pharmalot.com/?p=15372#comment-372651 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 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

]]> By: Christopher http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372567 Christopher Fri, 12 Sep 2008 02:50:16 +0000 http://www.pharmalot.com/?p=15372#comment-372567 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 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

]]> By: Matthew Holford http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372543 Matthew Holford Thu, 11 Sep 2008 23:22:19 +0000 http://www.pharmalot.com/?p=15372#comment-372543 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 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

]]> By: Christopher http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372510 Christopher Thu, 11 Sep 2008 21:32:43 +0000 http://www.pharmalot.com/?p=15372#comment-372510 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 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

]]> By: Matthew Holford http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372447 Matthew Holford Thu, 11 Sep 2008 16:22:16 +0000 http://www.pharmalot.com/?p=15372#comment-372447 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 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

]]> By: Matthew Holford http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372444 Matthew Holford Thu, 11 Sep 2008 16:15:48 +0000 http://www.pharmalot.com/?p=15372#comment-372444 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 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

]]> By: Christopher http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372390 Christopher Thu, 11 Sep 2008 11:37:37 +0000 http://www.pharmalot.com/?p=15372#comment-372390 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
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.

]]> By: Matthew Holford http://www.pharmalot.com/2008/09/uks-nice-spends-on-spin-but-not-reviewing-meds/#comment-372364 Matthew Holford Thu, 11 Sep 2008 09:07:29 +0000 http://www.pharmalot.com/?p=15372#comment-372364 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, 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

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