US Old Media Virtually Silent as UK Severely Restricts Use of Alzheimer's Drug

Even as one of them heatedly denies that she advocates "socialized medicine," it is a fact that each major US presidential candidate on the Democratic side favors some form of nationalized health care. Additionally, while governor of Massachusetts, Republican candidate Mitt Romney was firmly behind health-care legislation that, as commentator John Stossel noted back in May, the Wall Street Journal described as "a death warrant for small business in the Bay State."

Given its potential as a top-tier 2008 presidential campaign issue, you would think that there would be Old Media interest in how nationalized health care is working out in other countries.

But if there was, you would have surely heard about this news a week ago without having to go to British newspapers to learn of it:

Drug companies and campaigners yesterday lost a high court appeal for people in the earliest stages of Alzheimer's to be prescribed on the NHS a £2.50-a-day drug (about $5/day in $US -- Ed.) which is said to provide relief from the symptoms and respite for families.

..... The ruling means the drug will not be available for people in the earliest stages of the disease, allowing the decision of the National Institute for Health and Clinical Excellence (Nice), that Aricept's benefits are too slight to justify prescribing, to stand.

..... Eisai and Pfizer, which make and market Aricept, supported by patient groups, (had) sought a judicial review.

Yesterday, Paul Hooper, managing director of Eisai, said: "The guidance Nice has issued is morally reprehensible. They are denying patients access to early treatment and that is wrong. This is about patients, not profits. For Nice to deny treatment to patients with mild Alzheimer's disease is disgraceful."

The Alzheimer's Society said it was frustrated at the decision.

"Frustrated"? I would characterize the Alzheimer's Society's reaction as a bit stronger than that:

However, the result is deeply disappointing for everyone in the early stages of Alzheimer’s and their carers. Without further change to the guidance, people in the early stages of the disease will still be refused drugs because NICE considers that these people are not worth £2.50 a day. This is insulting and devastating news. People will be forced to deteriorate before they get the treatment they need. Is this the sort of society we want to live in?

NICE failed to listen to the views of thousands of carers who told them drug treatments make a huge difference to their lives. It is deeply disturbing that a public body, required to use rigorous standards of evidence based decision making, can simply guess at vital data. This is simply unacceptable.

When NICE speaks it has huge implications for people's lives. Its decision on Alzheimer's affects hundreds of thousands of people. NICE must get it right. To retain its authority as a public body it must command the confidence of the public. The result of this case must call into question whether NICE has lost that confidence. It is up to Government to consider the changes needed to stop this from happening again.

Some context:

  • According to this press release written before the high court NICE ruling came down, "700,000 people in the UK have a form of dementia, more than half have Alzheimer’s disease. In less than 20 years nearly a million people will be living with dementia. This will soar to 1.7 million people by 2051. 1 in 5 people over 80 have dementia." The ruling clearly denies treatment to hundreds of thousands of UK citizens.
  • Aricept (also known as Donezepil) was approved by the US Food and Drug Administration, an agency not exactly know for moving quickly, in 1996 -- 11 years ago -- for mild to moderate dementia.
  • The FDA approved the drug for use in cases of severe dementia in October of last year. The NHS/NICE, as noted above, is limiting Aricept's use to severe cases.
  • This March 2006 Consumer Reports article, written before the FDA's severe-case approval, designated Aricept one of three Best Buy drugs for people with early-stage Alzheimer's disease.

Exemplifying NHS's top-down control, a Nottingham (UK) University Hospital "Medicines Management Report" on "Controlling the Drugs Budget" from two years ago specifically states (in table row C2 near the bottom of the document in the middle column) that doctors are to "Stop all NICE approved prescribing outside guidelines." So the government, aka the British National Health Service's supposedly "NICE" guys, is deciding what drugs every one of its millions of patients are allowed to take -- purely based on NICE's, and not the doctor's or patient's, cost-benefit considerations. There's outrage in the US when a managed-care organization attempts to do this in relatively isolated instances.

Given the stringent guideline just noted and the strong cost-control language in the Nottingham report, it's not unreasonable to believe that doctors will be under severe pressure to defer a diagnosis of severe dementia until the latest possible moment.

Negative government intervention in the doctor-patient relationship has happened in every country that I am aware of where nationalized health care has been imposed. Yet politicians, including many of the 2008 presidential aspirants, continue to pretend that it won't happen here. It will, and it's only a question of how quickly it occurs.

As if anyone should be surprised, a New York Times search on "Alzheimer's" has no articles relating to the UK ruling. A Google News Search on "Alzheimer's NHS" without quotes, and limited to US sources, shows only one Old Media reference -- a article that is no longer there.

We don't hear much from Old Media in the US about how nationalized health care is working elsewhere -- because it hasn't worked elsewhere. It's hard not to conclude that the coverage of foreign nationalized health care failures is light because exposing the truth would hurt US presidential candidates who favor it.

Cross-posted at

Health Care New York Times