This is a warning of what could befall the USA if we allow centralized bioethical planning to become part of health care reform. In the UK, utilitarian bioethicists control who gets—and who is denied—treatment via the Orwellian named organization NICE (National Institute for Health and Clinical Excellence). NICE explicitly uses a quality of life judgment (QALY—quality adjusted life year) to determine which patients are worth treating. It has now denied coverage for anti-dementia medications to mild Alzheimer’s suffers. From the abstract of the story in the British Medical Journal:
The hopes of people with mild Alzheimer’s disease have been dashed again by the agency that appraises treatments for use by the NHS in England and Wales, which has reaffirmed its original decision to deny them treatment with dementia drugs. The National Institute for Health and Clinical Excellence (NICE) has issued amended guidance but still asserts that the drugs would not be cost effective for the mild stages of the disease.
And, it seems, that NICE attempted to keep its methodology secret. From a PR release from the drug company challenging NICE’s dictat:
The new model submitted to the Appraisal Committee incorporated the latest techniques for determining cost effectiveness in Alzheimer’s disease and shows a cost saving to the NHS and society by treating mild Alzheimer’s disease patients. NICE recognised the existence of this model and the implications of its results, but chose not to incorporate them into its review of the Guidance. Serious concerns remain about the quality of the economic models developed by NICE and their own quality assurance processes. That NICE sought to keep these calculations from independent scrutiny fails to serve well either themselves or the integrity of the decision-making process.
This decision would seem to be against common sense. The best time to slow down the ravages of dementia is when the disease is at the early stage. But perhaps that is less important to NICE’s bioethicists and bean counters than green eye-shade mathematical formulas.
The entire cost/benefit approach based on quality of life subjective analyses is blatantly discriminatory—which I don’t think its members would deny. In fact, health care rationing is invidious medical discrimination by a polite name. We don’t want that approach here!
