Fickle Patients

Earlier this week I wrote for UK Uncut an article about how I think that the government's Any Qualified Provider policy will be the main driver to privatise the NHS. My argument was that the policy will create thousands of new providers who will appear on the Choose and Book system, and when a patient chooses a non-NHS provider that will mean money for their care will go to the new provider (most likely profit making) and not to their local NHS hospital. The result will be that the service in the NHS hospital will close (through lack of patients), and this may well have a knock-on effect of closing other, more complicated, services in the hospital that are cross-subsidised by the simpler services. (Poly Toynbee takes up this theme in her column in the Guardian today. An article that deserves a read.)

My message in my UK Uncut article was this. It's our NHS: Choose it, or lose it.

The problem is that this depends on patient choice, and patients are fickle. Let me give you an example. A few years ago I attended the AGM of the hospital local to me and there was a talk by their consultant eye surgeon. The talk was about Age-related macular degeneration. Until recently this was an untreatable condition: if you suffered the condition then you would go blind. Then it was discovered that people with one version of the condition (the so-called "wet" version) who were treated for bowel cancer found that the macular degeneration was halted. These patients were treated with an expensive drug called Avastin. Studies showed that when tiny doses of Avastin are used, the "wet" macular degeneration can be halted.

The surgeon told the AGM that such a dose of Avastin cost £1. The problem is that the drug company realised that patients were desperate to save their sight and would pay accordingly. The drug company chemically altered Avastin to remove the cancer treating property, but keeping the macular degeneration properties, and called this drug Lucentis. For no other reason than the fact that it would make them loads of money, the drug company priced Lucentis at £1000 per treatment. The surgeon told us that on average ten treatments were needed.

Avastin or Lucentis: £10 or £10,000? The surgeon said that all evidence showed that there was no difference between the two drugs other than the price. However, the drug company only applied for a licence for Lucentis to be used to treat "wet" age-related macular degeneration. Remember that we are told by the government that the NHS is horribly "wasteful"? It isn't. The surgeon told the AGM that when a patient is referred to his clinic it is explained to them that the licenced drug and the unlicenced drug are the same clinically, but there is a factor of a thousand in the cost of the drug. The hospital has to get the patient agreement to use the unlicenced drug and save the NHS (on average) £9,990 when saving their sight.

Half of patients choose the expensive drug even though it gave them no extra benefits.

Patients are fickle. Even when they are given all of the facts, there are some patients who think "if it costs a thousand times more, it must be better". I am sure the hospital did not mention rationing because they are professional. However, the half of patients who chose Lucentis also chose to deny another patient of a treatment that could improve their life, since there is a limited amount of money and money wasted on a drug that is priced to be a cash-cow is money that cannot be spent on other treatments.

In the future, when patients are given an AQP choice between a private hospital and an NHS hospital there will be some patients who will say (without any evidence to support their view): "the private hospital must be better". I want patients to defend our NHS, but I fear that too many will be enticed by irrational arguments to use non-NHS providers and this will result in our NHS hospitals closing.

Patients are fickle. This is why we will lose our NHS.

Update:
My thanks to @DrPanik on Twitter for this link to the New York Times describing the Avastin/Lucentis issue in the US.