Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
Aims: This Handbook represents initial good practice guidance and resources to help PCTs to review current decision-making processes about the funding of medicines with co-operation from Provider Trusts and other stakeholders. Intended audience: Healthcare professionals. Publication history information: Published February 2009. Access: Available to the general public.
The National Library of Guidelines is a collection of guidelines for the NHS. It is based on the guidelines produced by NICE and other national agencies. The main focus of the Library is on guidelines produced in the UK, but where no UK guideline is available, guidelines from other countries are included in the collection. NICE issues guidelines of very high quality. They are based on a systematic review of the evidence and have extensive consultation not only with clinicians but also with patients and, where relevant, industry. Professional associations do not have the resources to carry out this type of consultation but they can follow the principles set out in the AGREE protocol which helps guideline writers minimise bias, meet the needs of all stakeholders and maximise clarity.
The vast sums of money ploughed into efforts to fight diseases such as Aids, TB and malaria in the last 10 years have saved many lives but have also sometimes undermined health systems in poor countries, according to a survey by the World Health Organisation and others published today. A worldwide outcry around the turn of the millennium over the plight of people in Africa dying of Aids, a disease kept in check with drugs in rich countries, triggered a rush to fund big disease-fighting programmes on the part of western governments, aid organisations and philanthropic donors such as the Bill and Melinda Gates Foundation. But until now, there has been little attempt to find out how well the money has been spent and what impact the focus on high-profile diseases has had on the everyday business of hospitals, clinics and overworked healthcare staff in the poorer countries.
For many in the field of public health, the eradication of smallpox was one of the greatest triumphs of 20th-century medicine. This astounding achievement has influenced national and international organisations to mount or consider efforts to eradicate many other infectious diseases, including measles, Guinea worm disease, Chagas' disease, polio, and malaria. Eradication may well be public health's greatest rhetorical weapon in the battle against dread diseases. Indeed, the ability to command funding, popular support, the attention of politicians, and positive media coverage by talk of disease eradication is unparalleled. ... It may seem churlish to wonder in the face of a public health triumph that saved untold numbers from death and disability if disease eradication is ethical. Nevertheless, there are sound reasons for wondering whether the pursuit of eradication—as opposed to aggressive and effective disease management—is the right thing to do for other infectious diseases.
A trainee teacher with primary refractory Hodgkin’s lymphoma has launched a High Court action against her primary care trust, NHS Surrey, which has refused to pay for her treatment with an unlicensed drug. Philippa Bigham, aged 28, from Frimley, Surrey, has been given a prognosis of two years’ survival without a bone marrow transplantation. But her medical team at the Royal Free Hospital in London want her to have treatment with radiolabelled basiliximab, a monoclonal antibody conjugated with radioactive iodine and also known as CHT-25, before she has the transplantation. The primary care trust has refused to pay for the drug, which costs £3000 ({euro}3500; $4900) for a course of treatment. Basiliximab is licensed in the United Kingdom for use in renal transplant rejection but the radiolabelled version is not yet licensed.
The hopes of people with mild Alzheimer’s disease have been dashed again by the agency that appraises treatments for use by the NHS in England and Wales, which has reaffirmed its original decision to deny them treatment with dementia drugs. The National Institute for Health and Clinical Excellence (NICE) has issued amended guidance but still asserts that the drugs would not be cost effective for the mild stages of the disease. The original guidance from NICE was challenged by Eisai, the UK licence holder for donepezil (Aricept), one of the class of acetylcholinesterase inhibitors affected. The Court of Appeal ordered NICE to hand over a fully executable form of its economic model for determining the drugs’ cost effectiveness, and Eisai and the Alzheimer’s Society made further representations that highlighted flaws in the model.
A LESBIAN couple have won the right to IVF on the NHS after a legal tussle, ahead of laws that will put same-sex patients on an equal footing with heterosexuals. The couple, who remain anonymous, had to go through a legal fight to push the NHS to fund IVF because, at the moment, individual trusts decide whether they wish to pay for treatment for lesbians. The couple were initially refused IVF by their primary care trust because they were of the same sex. One of the women had polycystic ovarian syndrome, which disrupts ovulation, and is one of the most common causes of infertility. From October, clinics will no longer be able to block lesbians by referring to a child’s “need for a father”. Instead, same-sex couples will need to demonstrate only that they can offer “supportive parenting”.
The government says it will ban all private transplants of organs from dead donors in the UK. The move comes after media reports of overseas patients paying to get onto the waiting list for organs donated by British people. An independent report said organs were scarce and no one should be able to pay for transplants, to ensure NHS patients did not miss out. Surgeons said it should reassure people organs went to those in most need.
More than 80% of NHS primary care trusts in England fail to offer the recommended three free cycles of IVF to infertile couples, an MP has claimed. The Department of Health says 30% of PCTs provide three cycles of the fertilisation treatment. But Tory MP Grant Shapps, who has contacted every PCT, says these figures are out of date. A "postcode lottery" operates, with rules on age, relationships and other children varying widely, he insists. In some cases women who would be deemed too old for treatment by one PCT would be seen as too young by another.
The government has announced a ban on patients paying for private transplant surgery using organs donated within the NHS. Ministers have accepted the recommendations of an independent report commissioned by the government after concerns that foreign patients were bypassing lengthy NHS waiting lists by paying up to £75 000 ({euro}90 000; $130 000) for a transplantation. Earlier this year it was revealed that the livers of 50 British NHS donors were transplanted into foreign patients over a two year period, with the bulk of the operations taking place in London at King’s College Hospital and the Royal Free Hospital.
Patients with rarer forms of cancer may have been denied potentially life-saving drugs due to a postcode lottery, campaigners said today. A study by the Rarer Cancers Forum found patients faced a postcode lottery when requesting drugs that had not been licensed for their condition, with many people being refused treatment.
A distraught Newtownards father is today set to take his battle for a liver transplant for his severely ill son to the High Court. But while his legal team argue for a judicial review of a rule requiring alcoholics to be off drink for six months before being considered for a life-saving transplant, devoted dad Brian Anderson will travel to King’s Hospital in London to see his son Gareth.
Northern Ireland Health Minister Michael McGimpsey has said he cannot change organ transplant rules to allow Gareth Anderson to be added to the waiting list. Mr McGimpsey said guidelines state that he has to be alcohol free for six months before going on the organ list. “There are not enough livers to go around and the reason behind that guidance is that to be sure that precious gift isn't destroyed by alcohol immediately after, or soon after, the transplant occurs,” he said.
The 2009 Equality Bill will, if enacted, make age based discrimination in the provision of health care and social care illegal for the first time in the United Kingdom. In a speech in 2008, the then health secretary, Alan Johnson, said, "Old age is the new middle age. Health and social care services need to adapt to the changing needs of today’s older people . . . to promote health in old age and help older people to maintain independence and quality of life."
A man serving a life sentence for a double murder has won a High Court victory over his right to have cosmetic surgery on the NHS. Denis Harland Roberts, 59, currently in a Co Durham jail for killing an elderly couple in East Sussex in 1989, wanted treatment to remove a birthmark. An undisclosed policy operated by Justice Secretary Jack Straw had restricted non-urgent inmate treatment. The case may mean other inmates are considered for similar treatments. However, the Prison Service said it was still "entitled to refuse escorts to hospital on grounds of risk". On Wednesday, London's High Court declared the justice secretary acted unlawfully and "contrary to good administration" in failing to disclose his full policy on medical appointments.
The refusal to move a pre-operative transsexual prisoner from a men's jail to a women's prison is a violation of her human rights, says the High Court. Deputy Judge David Elvin QC quashed Justice Secretary Jack Straw's decision to keep the 27-year-old, who cannot be identified, in a male prison.
The National Institute for Health and Clinical Excellence proposes to reject a breast cancer drug despite its own rule changes on end-of-life treatments Wednesday 21 October 2009 18.11 BST A drug which can give women with advanced breast cancer extra weeks or months of life has been turned down by a government watchdog body for use in the NHS. The National Institute for Health and Clinical Excellence (Nice) says it proposes to reject Tyverb (lapatinib) in spite of changes in the rules brought in specifically to allow people at the end of their lives to have the chance of new and often expensive treatments. Tyverb is the only drug licensed for women with advanced breast cancer whose tumours test positive for a protein called HER2 and for whom Herceptin, a Nice-approved drug, is no longer working. In much of the rest of Europe, Tyverb is then given, in combination with a standard chemotherapy drug called capecitabine.
Hospital patients in England will get the legal right to be seen privately if they face NHS delays. Hospitals have to start treating patients within 18 weeks of referral - or two weeks in the case of cancer. But ministers will now give patients a legal right to private care - or treatment at another NHS centre if so desired - if this does not happen. The Tories, who would scrap waiting time targets, said it was an "unaffordable and uncosted" pledge.