Martin O’Neill has a characteristically interesting piece in the New Statesman, this time on QALYs (Quality Adjusted Life Years) and their role in the National Health Service decision to provide or deny expensive drugs to patients. Read the whole thing, as they say.
I had one quibble with Martin’s analysis. He writes:
Littlejohns [the clinical director of NICE] has released a preliminary ruling, denying access to the drugs Sutent, Avastin, Nexavar and Torisel to patients with advanced metastatic kidney cancer. These patients will, on average, die months earlier than those with the same condition in other countries in Europe where such drugs are available.
But then later in the same piece:
… if such decisions are made locally rather than nationally, we are thrown into the familiar problems of the ‘post-code lottery’. A patient in Nottingham may find herself denied treatment that is provided to someone in Newcastle. Allowing matters of life and death to depend on the good or bad luck of geographical location seems like the very opposite of finding justifiable policies.
Hmm. So in the first-quoted paragraph, Martin presents the supra-national geographical variation as a troubling datum, to which the adoption of a sensible national drug-evaulation policy is a response, whereas in the second, he presents sub-national geographical variation as a decisive reason for rejecting local discretion. But why not say that local variation is OK, just so long as it is backed up by good reasons, or, alternatively, that we should have European (or even global) standards that treat like cases alike?