Thursday, 19 February 2015
It is a pity that NICE (the National Institute for Health and Care Excellence) can’t see that its job is to support an organisation, the NHS, whose purpose is to keep millions and millions of unique individual human beings as healthy as it possibly can. Yet for me NICE always seems to judge people as being the quotient of a huge long division calculation. We’re not. We are all different.
Each one of us who has been prescribed an antibiotic as a medication for an illness will each have a different experience of it. For my own part, whether or not NICE states that antibiotics are less effective than they were, I have confidence that they work. About eighteen months ago a doctor put me on a course of antibiotics because I had a very worrying - for me at least - chest infection. My infection was clear within two days and I was feeling better and so as a patient I still have a great deal of confidence in antibiotics. It seems to me that NICE should take into account the confidence I am sure many, many people other than me may have in the efficacy of particular drugs and understand that they will ask their doctors to prescribe them if they are ill. Even if their effectiveness is found to be related to a positive placebo effect (which in my case I am certain it did not) rather than a bio-chemical one, I am sure sensitive and sensible doctors would in many cases decide to prescribe such a drug.
NICE’s impersonal approach is evident in other ways. Take for instance the case of a friend of mine who has an unrelenting and increasingly debilitating illness, and who was fortunate to find with the help of his doctor a drug which both slowed down the development of his symptoms, and, on a day to day basis made his life more tolerable. After a year of his taking this drug NICE decided that it could no longer be purchased from the manufacturer who produced it and insisted on the purchase of a drug which contained the same constituents in the same proportion as the previous one, the only difference being that this drug was made by a different manufacturer at a cheaper cost. My friend found that the replica drug was not effective and since he has been taking it, his condition has deteriorated rapidly. His doctor is no longer allowed to prescribe the original drug because NICE insists that my friend is being given exactly the same drug. I don’t think my friend is a liar, I don’t think his doctor thinks he is a liar and my guess is that something in the manufacturing process of the new duplicate drug causes the different physical reaction my friend is experiencing.
As does NICE's anti antibiotics propaganda I think my friend’s experience illustrates how NICE fails to understand that it is dealing with individual human beings and not some notional “normative” clone.
Wednesday, 18 February 2015
Everyday some government ministry, some national body or some kind of pressure group tells us how important, nay, imperative it is for us or someone else to take a particular action. "Don’t give medical treatment to people who are a little more than chubby or they'll just get fatter", "don’t help poor people or they won’t want to go to work", "don’t cut bankers pay and bonuses or they’ll all want to go to another country", "criticise and financially starve our state education system because investment companies will then put their money into places like free schools and the new academies", "don’t let children have a childhood or they’ll not want to be a part of a hard working British family or worse still they might not worship the capitalist system".
When all these and so many other pronouncements are clarioned, they are so fervently expressed, it can seem as if the whole of the universe will fall in if the latest edict is not acted upon.
Today it was the not particularly fragrant NICE's turn to pronounce. The National Institute for Health and Care Excellence is directing GPs who don’t prescribe antibiotics to set upon those of their colleagues who do. There may well be a good enough medical reason to reduce the usage of antibiotics but let's carry out the discussion in a considered, civilised way.
I don’t often go to my local surgery but when I do I don't like to see the doctors having a punch up in the waiting room. Divide and rule may be one form of governance but it does not make for a peaceful, kindly, caring community.