Counting the Cost?

16th December 2014

A couple of days ago, I tweeted that I’d written more than 6000 words in the previous week on the Medical Innovation Bill, noting – somewhat ruefully – that it would take a lot more words to describe all the problems with the wretched mess they call the Saatchi Bill.

I wasn’t joking. The lofty claims being made for this bill by its promoters are both contradictory and impossible. It’s hard to know where to start: with their website, with their claims on social media (this bill has its own Twitter feed), or with last week’s Report stage in the House of Lords. There is so much wrong that they are – in the words of Wolfgang Pauli – not even wrong. It’s actually so difficult to find any statements they have made that are correct, have any evidence to support them, or at least not completely misleading, that I have considered running a competition to see if anybody could locate a single headline claim they have made that is supported by fact. But, figuring that may be too hard a challenge, I’ve decided instead to randomly select a Saatchi Bill claim and see what I can tell you about it.

Today’s claim, Saatchi fans, is from the interestingly-monikered “Get The Facts” page on the Saatchi Bill website. Yes indeed, not only does this bill have its own Twitter feed, it also has its own website.

Here’s the Q&A question I’m looking at:

Untitled

Curses! I’ve fallen at the first fence! Here I am telling you that everything the Saatchi campaign says is wrong or misleading, and the first claim I look at turns out actually to be true. Just so we don’t miss any opportunity to highlight and congratulate the Saatchi team when they manage to publish a true fact, let’s repeat it:

HOW MUCH WILL THE BILL ADD TO THE HEALTH BUDGET?

Nothing.

There we go. The Saatchi Bill will not change or even seek to influence funding for innovative treatment. It’s a bit of a shame, that, because funding is a major problem (perhaps the major problem) in developing new treatments, but let’s pass that by, and look at the rest of the answer.

The Bill is cost neutral. It encourages innovation. That’s it.

Oh. We were doing so well.

If you’ve been following the Stop the Saatchi Bill campaign, you’ll know there’s much to question about the claim “It encourages innovation.” Even the research organisations and charities don’t believe that claim is true. The “That’s it” claim is shaky as well, given the number of organisations that have written about the unintended consequences they fear from this bill. I’m going to leave all those to one side, and just look at the assertion that “The Bill is cost neutral.”

Neutral

The central claim that Lord Saatchi and his campaign, led by his Campaign Director Dominic Nutt (yes, this is a bill that not only has its own Twitter feed, and its own website, it also has its own campaign director) have been making is that doctors don’t innovate because they fear being sued. It’s a claim made via the bill’s official media partner, the Daily Telegraph, for example. (That’s right, this is a bill that not only has its own Twitter feed, its own website and its own campaign director, it also has its own pet newspaper to bang the drum.)

So right from the outset, if the bill is successful in encouraging a doctor to try a treatment where previously they would have refused to treat for fear of being sued, then the cost is going to go up. It has to; we are now carrying out a treatment we wouldn’t have done before. This is a category of patient where the cost is inarguably higher.

Ah, but what about encouraging doctors to try new innovative treatments where before they just would have delivered the standard one? Perhaps there’s no change in cost there? Perhaps they’d be cheaper?

Well, the thing about experimental and new treatments is that they are usually expensive. Really, really expensive. Two examples.

Richard Lehman points out in BMJ blogs that the average cost of new cancer drugs is $10,000 a month. (Noting the mean survival gain of 2.1 months, he wonders if patients would prefer to be offered the drug or 4000 bottles of champagne. I presume that’s not 4000 bottles of the vintage they drink in the House of Lords, more the quality they have to put up with in the Commons.)

Then there’s proton beam therapy, which hit the news this year because of Ashya King. The NHS is setting up two centres to deliver this treatment in the UK, at a cost of more than £200 million, even though its benefits are still not entirely clear.

Experimental, innovative, radical treatment almost always costs more.

Counting the cost

For the Saatchi Bill campaign to claim the bill is cost neutral is highly misleading. When they say it is cost neutral, what they mean is they are making no attempt to ensure that the change they want to promote can be funded. So is there a way that cost neutrality might be possible nevertheless?

If within the NHS, the cost of innovative treatment would have to come at the expense of other treatment. If the NHS budget doesn’t rise to meet the additional cost, something else will have to be cut. Since the innovative treatment is likely to be expensive, many standard treatments may be lost to make room for one innovative treatment that has very little chance of working. It’s more than a little misleading to claim this is cost neutral. It would be like claiming the PlayStation was free because you sold the TV to pay for it.

Or you could go private. It could be argued that this would reduce costs to the NHS, because they’ve been relieved of the burden of having to deliver that boring old standard care, but a couple of points need to be borne in mind. Firstly, the NHS tend to end up picking up the pieces when private care goes wrong or becomes complex or there are side-effects or co-morbidities with private care. Remember, these are supposed –according to the bill campaign – to be last-ditch experimental treatments, their chance of success is expected to be very small. Secondly, relatively few people will be able to find the tens or hundreds of thousands of pounds necessary to fund an experimental treatment by themselves. This proportion of patients is likely to be small.

There is no reason for pharmaceutical or medical device companies to give away their products free for Saatchi treatments. These treatments cannot be used for research – the bill excludes it – so they cannot use them as part of a research programme. And clinicians’ time has a cost as well.

We could interject here that there are of course low-cost “innovative” treatments available, such as homeopathy, but the bill team are very clear that this bill is not about allowing quackery, so presumably the homeopaths are not part of their thinking.

Finally, another way of achieving cost-neutrality is if the “innovative” treatment promptly kills the patient, rather than leaving them alive and continuing to receive treatment under “standard” care, but I don’t suppose the bill team have considered this in their analysis either.

Actually, I don’t think there has been any analysis. Once again, the Saatchi Bill team have put on their wishful thinking hats and their say-it-enough-times-and-it-becomes-true trousers, and made the claim that the bill will be cost neutral, without any attempt to find out whether this would actually be the case in reality. Once again, they are stoking up a demand that cannot in reality be met.

It seems likely that the cost of the bill would actually be very high. We’ll all end up paying the price, and not just in monetary terms.

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One Response to “Counting the Cost?”

  1. fragmeister December 16, 2014 at 3:59 pm #

    I think they are using the word “innovative” to mean “tried and failed but we’ll use it again just in case” like homeopathy, acupuncture, Chinese herbal medicine, etc. Those won’t cost nearly as much as actually innovative treatments of the kind I read about almost weekly but which, apparently,aren’t actually happening (if you believe Saatchi, of course, which I don’t).

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