Sunday, 11 December 2016

#PoliticalSpeak: in memory of AA Gill

AA Gill (1954-2016) died yesterday; could he have lived another 10 years? #PoliticalSpeak #MSBlog

It is always sad when a person dies young. AA Gill a renowned UK food critic and journalist died yesterday, with what I assume was small cell lung cancer. For Londoner's he made and destroyed restaurants with his acerbic wit and ruthless critiques. Just before his death AA Gill penned his last article on the good, the bad and the ugly of the NHS. AA Gill did not have private medical insurance and therefore was unable to top-up his cancer treatment. His consultant wanted to use an immunotherapy that is not available under the NHS.  The therapy in question is a relatively new, innovative immunotherapy, called Nivolumab, that can result in dramatic responses in some people with small cell lung cancer. Nivolumab at £60,000-£100,000 a year for lung cancer is simply too expensive for the NHS. The article highlights the 'elephant(s) in the room'; the poorer survival rates of cancer in the UK compared to other EU countries. Is this acceptable? I have little doubt that when we get a league table on MS outcomes we will also be floundering at the bottom of the league tables. With the NHS in crisis and outcomes falling is it not time for the British public to look in the mirror and ask themselves the question 'Is this good enough?'. Do we want rationing? Do we want to a two-tiered healthcare system with the 'haves' and the 'have-nots' (AA Gill included)? 

With cancer the outcome is usually black-and-white; alive or dead. With MS the outcomes are more nuanced; from normal, to independent, semi-independent, dependent and dead. The issue of access to DMTs is very pertinent as the MS special interest group of the ABN meets tomorrow to help NHS England draw-up new guidelines about the treatment of MS in England and Wales. What cap will  the ABN be asked to wear? In my opinion it is essential that we represent our patients; we are neurologists that look after pwMS. The ABN has to take on the role of patient-advocate; it is not our role to enforce NHS policy, but to fight, based on the evidence, for the best outcomes for our patients. How many more AA Gill stories do we need to hear? 


........ It seems unlikely, uncharacteristic, so un-“us” to have settled on sickness and bed rest as the votive altar and cornerstone of national politics. But there it is: every election, the National Health Service is the thermometer and the crutch of governments. The NHS represents everything we think is best about us. Everyone standing for whatever political persuasion has to lay a sterilised hand on an A&E revolving door and swear that the collective cradle-to-crematorium health service will be cherished on their watch.....

CoI: multiple

8 comments:

  1. One side of it is the NHS... the other side is the pricing of the new drugs. Why are the pharmaceutical companies allowed to price the medicines in such a way that only the governments ( and for that matter, only the governments of very rich countries ) are able to pay the price? It is ugly.
    (and yes, the development of new drugs costs money, I get it. But I see the greed, too.)

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    1. Not the case with biologicals (at least now), but small molecules are readily available for a small fraction of original formulation provided you know magic numbers and where to seek. I'm not advocating such use, but in our reality this is the only way people in resource poor countries could access them

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  2. "With cancer the outcome is usually black-and-white; alive or dead. With MS the outcomes are more nuanced; from normal, to independent, semi-independent, dependent and dead."

    Cancer death is fairly quick, even when prolonged. MS is a very slow brain death. I wonder if it's the concept of a very slow brain death (slow simmering death of everything that makes a person uniquely them) is part of the reason some people with MS are wanting more aggressive treatment then their neuros.

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  3. ps. http://www.australiandoctor.com.au/opinions/journal-talk/cochrane-is-all-cure-and-no-care

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  4. AA Gill had a lifestyle cancer. If he hadn't smoked he may have lived 10-years longer. I am not sure people with lifestyle diseases should be allowed to consume valuable NHS resources.

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    1. Right-o. I suppose by the same token those who travel to Asia and get yellow fever should pay for their own treatment because it's a lifestyle choice.

      Equally, all patients with lung cancer should be given a polygraph to determine whether they are telling the truth about smoking history just so we ensure we don't waste public funds on those who apparently don't deserve it.

      Maybe only kind people should receive publicly funded medicine. Or at least publicly funded psychological services- surely mean people don't deserve those?

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    2. As a doctor you have to treat everyone equally; if you start making judgements like this you are on a slippery slope.

      When someone walks into my consulting room or is admitted under my care they are my responsibility and I have to do everything possible to help them. I refuse to treat someone with a so called lifestyle disease any differently.

      My heart goes out to AA Gill and his family; all he was asking for was more time. Having read his last article it was clear he loved life and simply wanted more of it. NHS England let him down; if he had been treated in Scotland he would have received the therapy under the NHS.

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    3. Who knows MS may yet turn-out to be lifestyle disease; would you change your attitude then?

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