The article shows that NICE is the world's leading teacher about the ethical imperative for societies to set health care limits. I've quoted some excerpts from the article (in italics) followed by my comments.
"'Everybody should be allowed to have as much life as they can,' Joy Hardy [wife of Michael Hardy, who has kidney cancer] said...'It's hard to know that there is something out there that could help but they're saying you can't have it because of cost...What price is life?'"Mrs. Hardy is profoundly right - deciding not to cover Sutent is a tragic choice. In terms of Albert Schweitzer's concept of reverence for life, the answer to the question "what price is life?" is - "it's priceless." But in economic terms, it's not.
Some years ago, Lester Thurow, then Dean of MIT's Sloan School of Management, suggested that we think about this kind of decision in terms of how much human labor the cost represents. $54,000 is a bit more than the average annual wage in the U.K. Asking "is it right to require John Doe to turn over his entire year's earnings to give Mr. Hardy a chance to live 6 more months?" feels significantly different than asking "should we allow a bureaucrat to sacrifice Mr. Hardy for $54,000?" Money isn't paper - it's ultimately human labor. We should have reverence for John Doe's life as well as Mr. Hardy's.
"Even in the United States, rising costs have led some in Congress to propose an institute that would compare the effectiveness of new medical technologies, although the proposals so far would not allow for price considerations...the idea of using price to determine which drugs or devices Medicare or Medicaid provides has provoked fierce protests."The idea that we would forbid our government to consider cost - in other words, say that even if 100 or 1,000 John Does had to sacrifice their entire annual income they would have to do so to provide a chance for 6 more months of life - is so preposterous that it calls to mind Schopenhauer's famous comment about a philosophical assertion he found equally preposterous: "As a serious conviction it could be found only in a madhouse; as such it would then need not so much a refutation as a cure."
With regard to our public discourse about health policy, the U.S. is indeed a madhouse!
Robert Goldberg, vice president of the Center for Medicine in the Public Interest, an advocacy group financed by drug makers, likened Dr. Rawlins (director of NICE) and his institute to terrorists..."This kind of Karl Rove take-no-prisoners rhetoric from a well paid PhRMA shill shows what NICE and its leadership is up against. I hope Michael Rawlins has a thick skin and a good sense of humor.
"Dr. Rawlins said he was frustrated that his institute had been censured instead of the drug company executives who set sky-high prices."He's right to be frustrated!
Anyone who has brought up children knows how difficult it is to teach about limits and sharing. It takes patience, firmness, love and understanding the cost to the child of not learning. Children don't thank us. Like the hypocritically named "Center for Medicine in the Public Interest" they call us the equivalent of terrorists.
NICE is the kind of teacher the developed world - especially the U.S. - needs. Let's hope Michael Rawlins and his colleagues can keep up the good work!
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