The prospect of progressively losing one's faculties might seem as grim as any imaginable. Yet for patients diagnosed with Alzheimer's, the recent decision by the National Institute for Health and Clinical Excellence (Nice) to block NHS use of certain drugs that may help them will add to the agony. The exception for advanced cases hardly helps, amounting to an offer of remedial action that can be cashed in only after half the mind is lost. On Friday, Nice was back under fire after it was learned it would also reject a bone-cancer treatment, Velcade.
In the Alzheimer's case, the £2.50-a-day costs were relatively modest, and the dispute centred on how much benefit the drugs offered. Doctors are split on the evidence, with Nice being downbeat about the effect, but support charities offering a more optimistic interpretation that sufferers will understandably be drawn to. Government talk of patient power may leave some hoping that it would be for them to decide which assessment to believe, but choice will prove a cruel illusion for those without the funds to buy the drug themselves.
Decisions on new cancer drugs can be even harder, transparently turning on whether high costs - £18,000 per cycle in the case of Velcade - are justifiable, leaving Nice putting a price on life. Denying life-prolonging treatment on cost grounds will always feel wrong, and there are doubts about whether Nice adequately factors in the broad social costs of withholding medicines, many of which accrue outside the NHS. Yet rationing is not new in the NHS, it has always occurred, although it used to be done opaquely, through ad hoc rules that hospitals would employ, for example, to rule out some treatments to people above a certain age.
A world where patients were unaware of what they could not have was perhaps kinder, but with medical information so readily available, there is no prospect of going back. Nice may make misjudgements - any system would - but the transparent and expert deliberation it embodies is the least bad way of tackling an impossible job. Even if there is no better system, the denial of life-saving treatments that logically flow from it should never be tamely accepted. There is a moral onus on ministers to bear down on the number of such cases by continually pushing the boundaries of what can be provided. That means continuing to increase NHS spending, pushing for efficiencies elsewhere in the service to free resources for drugs, and then driving the toughest feasible bargains with the drugs companies to ensure that the budget stretches to its limit.
