British officials recently announced that citizens who privately purchase drugs will no longer be forced to forfeit all access to public health care. This puts to rest one of the most despicable facets of the country’s national healthcare system.
With the announcement, officials are essentially acknowledging the failings of Britain’s National Institute for Health and Excellence (NICE) — the government-run “comparative effectiveness” agency that’s responsible for weighing the relative costs and benefits of new drugs and determining if they should be covered.
American lawmakers should take note. The recent developments across the Atlantic indicate the pitfalls of both government-run comparative effectiveness research and increased government control of the healthcare market.
NICE makes it assessments by reviewing clinical data on new drugs, and then measuring their medical efficacy against alternative, older treatments. The drug coverage provided by Britain’s public insurance system is primarily based on NICE’s decisions.
Previously, British patients would be disqualified from all public healthcare assistance if they went outside the NICE-approved drug list and purchased newer pharmaceuticals on their own.
Problem is, NICE has been notoriously stingy in the drugs it’s willing to approve. In 2006, it denied approval for the Alzheimer’s drug Aricept. The decision was later ruled to be “procedurally unfair” by the British Court of Appeals, and has been overridden by numerous local governments.
NICE also denied approval for the popular breast cancer drug Herceptin. The public outcry from a number of professional medical organizations eventually caused the agency to reverse its decision.
And in August, NICE determined that four new kidney cancer drugs shouldn’t be covered — despite the fact, as prominent British cancer specialist Peter Johnson has noted, “there are few alternative treatments” to these medicines.
NICE’s restrictive approval record has left countless British patients with an impossible choice. Either stay on government insurance and be forced to use sub-par pills. Or, buy the best meds privately and bare the full cost of medical treatment.
Expectedly, NICE officials have thrown a tantrum at the prospect that their drug decisions will no longer be immutable. The agency has already announced plans to tighten approval standards on new drugs for some relatively rare conditions.
Despite NICE’s shameful track record, some American politicians are pushing to establish just such an agency stateside. Senators Max Baucus (D – MT) and Kent Conrad (D – SD) introduced a bill doing as much last congressional session. And President-elect Obama’s healthcare platform includes creating a NICE-like agency that could end up determining Medicare and Medicaid drug coverage schemes.
NICE’s failings indicate that government is liable to misuse drug approval power, and they should arouse suspicion about the merits of additional government intervention in the healthcare market. The British government is finally giving patients and physicians the freedom they need to best combat disease. American lawmakers should follow their lead.
Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA Associate Commissioner.
