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Karol Sikora: This health care 'reform' will kill thousands
One of the more unproductive elements of President Obama's stimulus bill is the $1.1 billion allotted for "comparative effectiveness research" to assess all new health treatments to determine whether they are cost-effective. It sounds great, but in Britain we have had a similar system since 1999, and it has cost lives and kept the country in a kind of medical time warp.
As a practicing oncologist, I am forced to give patients older, cheaper medicines. The real cost of this penny-pinching is premature death for thousands of patients -- and higher overall health costs than if they had been treated properly: Sick people are expensive.
It is easy to see the superficial attraction for the United States. Health-care costs are rising as an aging population consumes ever-greater quantities of new medical technologies, particularly for long-term, chronic conditions, such as cancer.
As the government takes increasing control of the health sector with schemes such as Medicare and SCHIP (State Children's Health-care Insurance Program), it is under pressure to control expenditures. Some American health-policy experts have looked favorably at Britain, which uses its National Institute for Clinical Excellence (NICE) to appraise the cost-benefit of new treatments before they can be used in the public system.
If NICE concludes that a new drug gives insufficient bang for the buck, it will not be available through our public National Health Service, which provides care for the majority of Britons.
There is a good reason NICE has attracted interest from U.S. policymakers: It has proved highly effective at keeping expensive new medicines out of the state formulary. Recent research by Sweden's Karolinska Institute shows that Britain uses far fewer innovative cancer drugs than its European neighbors. Compared to France, Britain only uses a tenth of the drugs marketed in the last two years.
Partly as a result of these restrictions on new medicines, British patients die earlier. In Sweden, 60.3 percent of men and 61.7 percent of women survive a cancer diagnosis. In Britain the figure ranges between 40.2 to 48.1 percent for men and 48 to 54.1 percent for women. We are stuck with Soviet-quality care, in spite of the government massively increasing health spending since 2000 to bring the United Kingdom into line with other European countries.
Having a centralized "comparative effectiveness research" agency would also hand politicians inappropriate levels of control over clinical decisions, a fact which should alarm Americans as government takes ever more responsibility for delivering health care -- already 45 cents in every health-care dollar. In Britain, NICE is nominally independent of government, but politicians frequently intervene when they are faced with negative headlines generated by dissenting terminal patients.
For years, NICE tried to block the approval of the breast cancer drug Herceptin. Outraged patient groups, including many terminally ill women, took to the streets to demonstrate. In 2006, the then-health minister suddenly announced the drug would be available to women with early stages of the disease, even though it had not fully gone through the NICE approval process.
A more recent example was the refusal to allow the use of Sutent for kidney cancer. In January, NICE made a U-turn because of pressure on politicians from patients and doctors. Twenty-six professors of cancer medicine signed a protest letter to a national newspaper -- a unique event. And yet this drug has been available in all Western European countries for nearly two years.
In Britain, the reality is that life-and-death decisions are driven by electoral politics rather than clinical need. Diseases with less vocal lobby groups, such as strokes and mental health, get neglected at the expense of those that can shout louder. This is a principle that could soon be exported to America.
Ironically, rationing medicines doesn't help the government's finances in the long run. We are entering a period of rapid scientific progress that will convert previous killers such as heart disease, stroke and cancer into chronic, controllable conditions. In cancer treatment, my specialty, the next generation of medicines could eliminate the need for time-consuming, expensive and unpleasant chemo and radiotherapy. These treatments mean less would have to be spent later on expensive hospitalization and surgery.
The risks of America's move toward British-style drug evaluation are clear: In Britain it has harmed patients. This is one British import Americans should refuse.
Karol Sikora, a practicing oncologist, is professor of cancer medicine at Imperial College School of Medicine, London, and former head of cancer control at the World Health Organization.

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Andrew Cline has been editorial page editor of the New Hampshire Union Leader since October of 2001. His writing has appeared in more than 100 newspapers and magazines, including The Wall Street Journal, The Washington Post, and National Review.
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YOUR COMMENTS
The health care plan put forth by the Clintons in the early ninities did prohibit going to doctors outside the government sponsored plan. It would have been a crime punishiable by prison for the both the doctor and patient. THere was no private sector choices.
- Fred, Apopka, FL
It's scary that the people that are doing such a wonderful job running the post office, social security, and medicare will be making the health care decisions.
- Free Bird, Manchester
Ten or fifteen years ago there was a huge flood in Poland. The then Prime Min. arrived at the scene to supervise aid, but also asked the victims a basic question: "Why the hell haven't you taken even the cheapest insurance to cover the only place of living you had, and now you're vying for Treasury money to keep you afloat?" The question cost him his office.
After all these years, the same well-remembered question is likely to win him Presidency at the next election as people have got tired to death with constant sponsoring of the happy-go-luckies who believe that when push comes to shove, they'll always manage to suck in public money this way or other.
Now please don't try to persuade me that health is less important than a place to live... Some aid with the basics - yes. Paying to have ALL your needs met because you've simply never cared yourself - no, thank you.
- Iza, Poland
Interesting that the article compares a cancer outcome of a socialized medical system in the UK, with one that is even more socialized in Sweden, and decides the outcomes are better in the latter in an article opposed to socialized medicine adoption of any kind in the US.
- Mike Cobler, San Antonio, TX
It appears that everyone fails to understand that there is still private healthcare and private insurance in the UK, you just have to pay extra for it. Nobody is proposing that the government form a healthcare monopoly and ration out care. All we need to have happen is to provide a system in which everyone is provided with at least BASIC health insurance.
Right now we have millions of people who die because they can't get ANY regular medical treatment, let alone designer drugs and treatments. Why is it a problem that a potential government subsidized health insurance system (BTW you realize that one already exists called Medicare) won't provide Mayo Clinic care to everyone? Millions of people need basic care and the government should help provide basic care. If you want something more than basic go get a job and pay for it. Nobody will stop private insurance companies from offering insurance that covers items not on the government list.
Preventing families from going bankrupt from a routine medical problem is important for a good society. Extending life for cancer patients by 6 months should be on them. Trust me, nobody will take away your ability to pay for better medical care.
- Mike B., Hadddonfield, NJ
So if the NHS consigns thousands to death, why is life expectancy in the UK higher than that in the US?
- Lewis, Edinburgh, Scotland
Sadly, the advert is a misrepresentation of the true state of healthcare in the UK. It is still possible to buy private insurance - just like you are in the US - which means that you are not subject to what NICE decrees in the same way - but it also means that if you have no commercial insurance you still have a basic level of healthcare that you can rely on.
I don't see how this can be a bad thing...
- JRH, Brighton, UK
The problelm with Congress fixing the system is that they don't participate in the system. Their health policies are separate and better. Their pensions are not attached to Social Security either. They are separate and better. The people trying to reform the system have no real, life threatened, stake in the system. Scary to me.
- Michele, Toms River, NJ
What do you think money is? Its a system of indirect rationing! The COST of health-care has already excluded (aka rationed) people OUT of it! It IS being rationed, and people who cannot afford the enormous monthly premiums are being rationed right out of the doctor's office. The only care they get is the emergency room, which is 10X more expensive then the doctor, but at least the emergency room will see them. We need a system where preventative care is not withheld from the general population, and the only way to do that is "single payer".
- joe t, derry, nh
This is not Britain. Nice fishing expedition though.
- Ed, Concord
the real concept being proposed is rationed health care. rationed means the government,, not a doctor, decides if a particular medicine, device or procedure will extend your life or improve its quality in a cost effective manner. Sounds good doesn't it? Actually it sucks. As a healthcare professional who works in oncology I can not imagine making a decision whether a drug should be approved based on whether or not I think the money spent is worth it. if you have a rare disease you will NOT get medicine. it is your time to die. The nazis sicko doctor, joseph mengele has more compassion than our current regime.
Less government, More Freedom!
- Michael Layon, Derry
Jason, Londonderry
How else can I say this? You are an idiot, speaking about things you appear to have no clue about.
Here are some real numbers for you.
US Infant Mortality rate is 6 per 1000. African Infant Mortality rate ranges from 12 per 1000 up to 157 per 1000. Seems we are quite a bit better off than Africa.
US Life expectancy is 75 for men and 80 for women. UK is 76 men and 81 women; France is 77 men 84 women, Germany is 76 men and 82 women, Switzerland is 79 men and 84 women. Should I keep going? As for the health of Americans? Americans consume more calories and more protein per day than nearly any other country. US avg is over 3500 calories and 110 g of protein per day. Matched only by Portugal, Ireland, France, Italy, Austria, Greece and Isreal. Our diets are terrible. Perhaps that is at least a partial reason for our 'poor health'.
Our system is not broken, it is expensive. How can we reign in the costs? Mandating coverage is a great idea, if everyone is able to pay for it. Capping the value awarded in malpractice suits would be helpful, as would requiring that all malpractice suits have a minimum number of Doctors on the jury. (The average person is not able to understand the information given during trial. All they hear is this person had a bad outcome, which is a risk in any procedure, so they deserve millions). There are many ways to decrease the cost of health care. It is a complex issue, beyond most peoples ability and time to analyze (myself included). The answer does not reside in government control.
I am sure I will stir some anger with this but here goes. Health insurance is not a right. Access to Health Care is a right in this Country and it is one which we are all able to claim. However this comes with a bill. You will not be denied care based on your inability to pay, however you will still get a bill for that service which you received.
- J.G., Concord, NH
Glenn Beck said it best a few years back, "of course we have the best health-care in the world? Where else do rich people in other countries go when they want to bypass their community health-care systems, where their money doesn't put them at the front of the line? they come here." Its sad when foreigners have better access better health care then we do here. This system is morally wrong because it runs on the same principle as organized crime. They charge you a monthly fee for protection against a possible and unknown threat, but then when the time comes they don't pay-up, or they underpay. And doctors won't even see people unless they can afford the enormous monthly fees! Health insurance is extortion. Its a scam, and its high-time we got rid of it!
- joe t, derry, nh
Let's take a look at the trial lawyers just thirsting for a quick buck from a malpractice suit before we go into full scale socialized medicine. This drives insurance costs for hospitals and doctors WAAAAY up. It also puts an undue stress on many health care professionals and institutions, forcing them to cut back on costs and compromising on quality. Also, it discourages many nurses and medical assistants from staying in the profession. But alas, trial lawyers have long been allies of and protected by liberal politicians, so don't expect that to happen.
- Bob Pickett, New Castle
Health care reform as needed should be stopping the layers who sue the hospitals and doctors looking for a quick dollar for some sleazy client. Bring back the family doctor who ran a small practice from his or her house. I’m sure they could practice again with the lawyers gone and insurance they could afford. Last of all not a citizen no health care and having your illegitimate child here does not automatically make you a citizen.
I can’t help but feel we are being manipulated to have government take our health care over.
- Deb, Derry
When the government controls your abilty to get health care.....they control you. Americans are such sheeple these days.
- Jay Collins, Laconia
Surprise! It's also a great way for corporations and unions to unload their costs on to the taxpayers.
- Mae, Plaistow
I'm sure the UL is glad that they only had to go to Britain to find an opinion piece that matched their political position. It would have been problematic if the opinion came from some hack in Upper Mongolia.
- Bob V, Manchester
Jason has drunk the Obamian kool-aid, which unfortunately most of the media has too. It's a sad day for health care in America. Read Daschle's book, upon which our so-called "healthcare reform" is modeled, and you'll see that it targets old, chronically ill people as the way to save money (i.e., deny medicines and services as NICE does). In fact, Daschle praises NICE. Our only hope as citizens under "Medicare for all" is to have enough money to purchase treatment and medicines abroad--or just stay healthy and fall over and die at 84 or so while playing golf in Spain a la Bing Crosby.
- Gary, Los Angeles, CA
In a sense our own Medicare and Medicaid programs are mini versions of the British system and we're not even close to keeping them under control. The way I see it, until the patient becomes the payer nothing changes and we'll eventually end up with a US version of the British plan.
- John Robins, Strongsville, OH
We will be lucky if Obama "reform" kills ONLY thousands. From Hillarycare to the reforms hidden inside the "stimulus" bill, the problem to be solved by "reform" has been that "we spend too much on health care." Well, I don't spend too much on your facelift or Lasik, and the fact that you do doesn't mean it's a national problem, any more than my "addiction" to Arab oil (that is, to freedom of movement).
Ms. Sikora notes that we are entering an era of wonder drugs. These wonder drugs are invented in America. "Overpriced" American health care saves not only American lives but lives everywhere, even in Canada, whose only role is to demand lower prices. How will the rest of the world work around it if Obama wrecks (excuse me, "reforms") American health care?
The problem is entitlements and that it is too easy to sue practitioners. Fix those problems; don't "reform" the victims.
- Spike, Brentwood NH
Jason Londonderry; you had better check your facts. USA has one of the highest life expectency rates. Secondly, infant mortality rates are "higher" in the US because the US counts every birth while most other countries have qualifiers e.g. weight, and many do not count infants born dead or those that expire within 24 hours. Source: Wikipedia
- sandy, thornton
It very widely known that prescriptions have the average mark up of or around 200 to 400 percent. Are the older cheaper perscriptions not working as well or is it that the drug company want you to promote the new more expensive drugs?? There is the problem. The government needs to crack down on this highway robbery and make everything more affordable. Lets not even mention what doctor visits will cost you!
- ryan, manchester
America's "healthcare system" (in quotes because we do not have a system) is broken. We have among the lowest life expectancy in the industrialized world, we are among the least healthy countries and our infant mortality rate is comparable to many African countries. And for that, we pay more per person than any other country in the world.
I agree that Britain's system is not the best choice, but it's still better than the free market system where only those people who don't need coverage can receive it. A better option would be the Swiss model, which has healthy for-profit insurance companies but everyone is required to be covered.
- Jason, Londonderry
It is common knowledge that you get what you pay for. What quality does anyone think they will get if healthcare is free (so to speak)?
- Zizzy, Manchester
Congress cannot manage themselves. Are you willing to hand your family's lives and all you hold dear to these weasels in DC? Safer to work with our doctors than to surrender our freedoms to politicians. Better to expand the current Health Care Savings account program to accomodate an all states plan, allow an option for over 65's, and make all medical expenses fully tax deductible. Consumers are the best watchdogs for controlling costs.
- Mae, Plaistow
So, what we're saying is that OUR system is broke, and Britain's sucks. But France's is great. Great to hear it.
I think most people would be stoked just to be able to see a doctor without being rushed to the emergency room first.
- jor t, derry, nh
I am sure the usual apologist for the inexcusable will call this a GOP plot to destroy the American economy, but the truth is that the American Medical system, although expensive, is the best there is. Treatment is denied to no one, at least not legally. If the government takes over as those on the left desire, the innovation that has created most of the life saving treatments will be greatly reduced. Your dog will get an MRI faster than you will, and treatable cancers will often be too far advanced to treat by the time your turn comes up. We may have to make some serious changes, no question health care is expensive, but government run health care will be as kind as the IRS, more difficult to deal with than your current insurance company, and likely to litterally "be the death of you" when the government decides you are no longer worthy of continuing investment.
- Jeff, Goffstown
I doubt that any readers will give this doctor/author any credibility, we'll just rush into yet another government spending program to "cut costs".
I hope that every citizen starts calling their legislator in Congress and demands that he/she keep the federal government out of health care.
There is not one federal program in existence that has ever saved money or worked, other than the US military forces. They are expensive, but worth every cent.
There has to be a better system than national health care. We can't afford it anyway.
- Melvin, Keene
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