Avastin or not.

Sometimes personal experience makes logic difficult to accept. This is how I feel about last week's decision by NICE (National Institute of Clinical Excellence) to recommend that the NHS should not make the drug, Avastin available to bowel cancer sufferers. If I'd not been away on holiday in the US, I would have done some media interview work on this decision, accepting that it would not have been easy to challenge the NICE judgement. But I would have tried. Dr. Spock wasn't always right.

I've always thought of NICE as standing for 'national institute of control of expenditure'. And actually, there's nothing wrong with that. When Professor Mike Rawlins, Chair of NICE says "The question is not whether care is rationed, but how" he is being no more than honest and logical - unless you happen to be a bowel cancer sufferer or know someone whose life has been extended by years as a consequence of using Avastin.

Anyway, the purpose of this post is to highlight Alastair Palmer's article in yesterday's Sunday Telegraph which is more about the 'supposed' freedom of people to buy Avastin with money from their own wallets (£21,000 for a year's course of treatment) to 'top up' the care that the NHS will pay for. Until last year the rule was that patients who 'topped up' NHS care from their own pockets sacrificed the right to any NHS care at all. There was a ban on what were referred to as co-payments. Following some high profile cases the then Labour Government supposedly changed the position to allow co-payments. Palmer's article suggests that this change might not have taken place in practice - because of a rule that the private treatment must be carried out separately from the NHS treatment. This is not always practically possible. It depends whether the particular hospital has 'separate facilities'. In my opinion, any ban on co-payments, or any device to make co-payments more difficult is egalitarian stupidity. If an NHS patient decides to enhance treatment by paying for Avastin, it makes not a jot of difference to anyone else, or to the NHS's finances. Its just cruel and spiteful. I shall be writing to the hospitals that serve Montgomeryshire tomorrow to ask what the position is on this issue.