Thursday, 19 February 2015
It's not very NICE again, is it ?
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.