From the desk of Dr Sam Shohet
BDS MGDS RCS(Eng) LiAc MBAcC ICAK
NICE IF YOU CAN GET IT
NICE, the National Institute of Clinical Excellence, the government agency charged with the remit of deciding which drugs make it on the list of medications paid for by the NHS, has come under fire once again for its decision not to include four drugs used in combination for the treatment of cancer of the kidney, whereas allowing a drug for the treatment of AMD or Age-related Macular Degeneration which is responsible for causing blindness in some people.
These decisions followed closely on the heels of first not including another drug, Herceptin, for the treatment of breast cancer and then relenting after much publicised protests.
Drug testing
All drugs for consideration must undergo a series of rigorous tests and, for any test to be carried out properly, a set of criteria need to be established in advance to make sure that the results are a true reflection of what we are trying to achieve and an accurate answer to the question or questions we are asking. But more importantly of all, the test should be capable of being repeated to give the same results and outcome.
Safety
So in the case of any drug we must ascertain that it is safe and that it is fit for purpose in that it actually accomplishes to treat an illness or disease successfully. The long-established gold standard for this method of testing has been the blinded, placebo controlled clinical trials where a drug is tested against a placebo or "neutral" substance without either operator or patient knowing which substance is being used.
I have already written about this method of testing and the drawbacks including that what is regarded as an inactive placebo may in reality contain active ingredients which questions the very credibility of the test and therefore the outcome.
The NICE remit
But this aside and to be fair to NICE, their remit is not to question the tests but to decide whether the cost of treatment would be justified by the results in alleviating the signs and symptoms of disease in a large number of cases. In the case of Herceptin for example, it was found that only 2 or 3 patients out of a hundred sufferers given the drugs, would actually benefit from the treatment. Or, put another way that 97-98 patients out of a hundred sufferers with breast cancer receiving a costly drug such as Herceptin would not benefit from it. This obviously diverts money from treatments elsewhere which could help more people.
What is the answer?
Drugs are touted as the answer to all ills and, if there should be no answer by way of a drug, then there is only death to look forward to as a form of release.
We have all been brain-washed from birth that science has all the answers and if there are no answers then there can be no question! Since science only works in a linear fashion: one course of action for one effect and, as it deals solely through the five senses, touch, taste, sight, smell and hearing; anything outside of these that cannot be explained by science therefore does not exist.
The intangibles
But we know that love, hate, anger and other emotions do exist, thoughts exist, why we even recognise that depression and anxiety exist, so much so that we have a well-respected branch of medicine devoted to it: Psychiatry. So can science be wrong?
Complex biological systems
Whether it is our body, our planet or the universe, they all function in a very complex array of systems where the outcome is dependent on many interacting factors. So much so that it becomes unpredictable from one nanosecond to the next, let alone over the course of a week, a day, or even a minute. If we can't even predict the weather with our advanced technology, what makes us believe that we can predict the outcome of a complex biological system such as the human body?
Science is not wrong, it is too simplistic and what is worse is that it refuses to seek answers outside of the box it has created for itself. And as the saying goes: if you do not seek you will not find.
There is hope.
There are many researchers breaking away from these constraints despite the pressures of the old guard who remain resistant to change. Many are recognising the individuality of the person, their unique genetic coding and how this is affected by outside influences such as environment, diet, lifestyle, emotions and so on to create modifications within their physiology which causes them to react in a certain way.
Should this reaction give an unfavourable outcome to that individual it is perceived to be "wrong" by science but given the circumstances of genetic expression, it is the "right" reaction for that person at that time and under those circumstances.
Our remit
It is therefore for us to devise the means whereby we are able to influence a change to a more favourable result by addressing the cause/causes of the problem and dealing with them naturally.
This surely is the remit of a proficient health service and not the drug lottery being played out today purely for financial gain.
Warm regards
Sam Shohet