So according to all yesterday’s media — see for example the Guardian and the BBC — we patients need to be much more pushy with our GPs to get the best drugs.
Prof. David Haslam, chairman of the National Institute of Health and Care Excellence (NICE) and himself a former GP, said that patients need to see themselves as “equal partners” with doctors to get the treatment they need.
He went on to say that patients should demand the drugs they need and only be refused NICE-approved drugs if they are actually unsuitable. He says, inter alia:
When products have been approved for use by the NHS by Nice, patients have a legal right to those drugs — as long as they are clinically appropriate. The take-up should be much higher than it currently is.
Patients have a right under the NHS constitution to these therapies, so I really hope we can improve this.
The fundamental point is, it’s your body.
And the more you understand about the drugs you are taking, or what you might be able to have, the better you are able to work with your doctor.
Several things strike me about this.
Firstly, I cannot disagree with Prof. Haslam’s sentiments. There are drugs which people aren’t getting, for all sorts of reasons including the so-called “postcode lottery” of care provision.
And I applaud his stance that we take responsibility for our bodies, understand them and how they work. This has to be good — as regular readers will know I am a vocal advocate of being comfortable with, and talking about your body, as a route to improved medical care.
But there are several things which worry me here.
We have to be realistic and accept that, sadly, many people are not able to understand even the rudiments of how human physiology works and how drugs work. Unfortunately these are mostly the very people who are going to latch onto some drug/treatment they think they should have and be abusive with their GP when they aren’t given it. Doctors are already under enough pressure, and get enough abuse from patients, that they don’t need more.
And then there are the people who really don’t want to think about these things and want to just trust their doctor to give them the best treatment. Not everyone, regardless of intellectual capability, wants to be engaged in the way Prof. Haslam would like. Yes there is still too much of the doctor as demigod who knows best, but there will always be those who treat any professional this way.
Finally I worry about who will pay for all this. I wouldn’t mind betting that many of the drugs we should be demanding are more expensive than the ones we are being prescribed now. So Prof. Haslam’s approach is going to see the NHS drugs bill increase, perhaps dramatically. You watch in a year or so the NHS will be squealing because the drugs budget is out of control.
But perhaps the biggest problem is how we patients actually find out about which drugs are best for us. I reckon I’m pretty good at ferreting out information and have research skills, but even I find it hard to sort the wheat from the chaff when it comes to drugs — especially when so much drug trial data has never been published.
Faecal transplants (the transfer of beneficial bacteria from the colon of one person into the colon of another) are not an entirely new idea. Their first use in Western medicine dates to 1958, but they have been a part of Chinese medicine since the 4th century. Is there anything the Chinese didn’t invent?
And that is hardly surprising when one reads of some of the major surgical interventions that were done on-site by the side of roads and in fields — and yes that does include things like open heart surgery! Which is really scary when one considers that one would not normally want to have this done even in the controlled environment of a hospital operating theatre with three or more surgeons and a full theatre team present. Whereas here this is all done by one trauma surgeon and a paramedic (albeit a super-trained one) in the field with no sterile environment.
This last I do not understand; although there must be a genetic something there as my father was the same. He’d not sleep well but then be dead to the world all morning. I remember him being like this even when I was a teenager. Even on non-work days my mother would be up by about 8.30 and around 9-9.30 bring both me and my father cups of tea (in a desperate attempt to get us out of bed). I’d struggle into consciousness and descend by around 10. But not my father. He’d appear at 11, or later, with the words “It’s very odd, I found this cold cup of tea by the bed”.