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September 8 2009

Reigniting the “Rationing” Debate

Nicole Kurokawa Neily

Britain's Daily Mail highlights another group suffering from government rationing in the United Kingdom: osteoporosis sufferers.

Thousands of women are being denied better osteoporosis drugs because of unnecessarily restrictive Government guidelines, a doctor said last night.

Professor David Reid, an expert on brittle bones, said the rules are so stringent that GPs are often prevented from giving alternative treatments to those suffering side-effects from their pills.

A once-a-year jab that could save thousands from the misery of broken bones is also not going to be assessed for use on the NHS in England and Wales for at least three years, according to Professor Reid, despite being available in Scotland.

It means that sufferers are being denied drugs that could have a major impact on their health and their quality of life. The news will reignite the debate about the evaluation system used by drugs rationing body the National Institute for Health and Clinical Excellence.

NICE has previously been criticised for banning or restricting breakthrough medicines for conditions such as breast cancer and Alzheimer's.

Mr Reid, of Aberdeen University, told the British Science Festival that the NICE guidelines on the disease were 'unnecessarily restrictive'.

Up to a quarter of patients taking the first-choice drug, the £50-a-year alendronic acid, will be troubled by indigestion, with some experiencing crippling stomach pain.

But under guidelines, sufferers may have to wait up to five years for their condition to deteriorate before being put on more expensive treatments with fewer side-effects.

Mr Reid said: 'The guidelines indicate that a lady can have alendronic acid at a certain level of risk.

'If that person doesn't tolerate the drug and goes back to their GP, the GP might have to say, "Your risk isn't high enough to have the next drug" - and frankly, that is just bad medical practice. It defies logic.'

The science conference in Guildford, Surrey, also heard that thousands of osteoporosis patients in England and Wales are being denied the cutting edge drug zolendronic acid.

It has passed the safety checks for use in Britain and has been prescribed in Scotland for about 18 months. But NICE is not due to evaluate it for NHS use in England and Wales for three years, the conference heard.

Although the drug is not vastly more effective than existing medicines, it has the advantage of being given just once a year, through a drip.

With studies showing that over 50 per cent of osteoporosis patients find tablets so inconvenient that they stop taking them, the drug could have a huge impact on health.

With 1,150 Britons dying each month after breaking a hip, better treatment of osteoporosis could have profound consequences.

Nice said its guidelines aim to prevent fractures from occurring, as well as treat existing problems, and provide 'postmenopausal women with consistent access to the most cost-effective treatments'.

A spokesman said that alternative drugs to alendronic acid are recommended based on cost-effectiveness and clinical criteria.

He added that legal issues outside of the rationing body's control meant it could not give a date for guidance on zolendronic acid.

Therein lies the problem with controlling costs - at some point, it's going to mean controlling care. If it's a private insurer who turns down a treatment, a patient has the option to either pay out of pocket for the more expensive option or to just accept the treatment that is offered. If it's the government and a treatment is denied, a patient has no recourse. This already takes place under Medicare in the United States - and will certainly feature in any public option eventually.

IIndependent Women's Forum is an educational 501(c)(3) dedicated to developing and advancing policies that aren’t just well intended, but actually enhance people’s freedom, choices, and opportunities. IWF is the sister organization of the Independent Women’s Voice.​
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