Critical Condition

A Question for Doctor Berwick

Dr. Donald Berwick, the new head of the Centers for Medicare and Medicaid Services, is an avowed admirer of the U.K.’s National Health Service and its National Institute for Health and Clinical Excellence (NICE), which explicitly rations patient access to new treatments based on cost. 

Someone should ask him about NICE’s decision today to effectively ban the breakthrough colon cancer drug Avastin for use in the U.K. (Actually, this is the second time NICE has declined approval for Avastin in recent years.) Cancer outcomes in the U.K. lag well behind those in Europe and the U.S., in part because of limited patient access to cutting-edge but expensive new cancer treatments.

The Daily Mail reports that Avastin is available to patients in France, Germany, Italy, and even Canada. One U.K. oncologist put it this way:

I can see that in even the most up-to-date national drug trials patients with advanced bowel cancer have an average of 19 months survival [in the U.K.].  This compares to up to 27 months survival for patients in countries that use [Avastin], such as in mainland Europe and the United States…These statistics tell their own story and imply that we are likely to fall even further behind in world-wide league tables. 

To add insult to injury, the Mail reports that NICE has spent more on  “communications” defending its controversial decisions than on actually evaluating new medicines. 

Not every expensive treatment is worth paying for, and there is a real debate to be had about how programs like Medicare can slow rising health-care costs while still offering access to innovative and effective new medicines.  

Still, Dr. Berwick should be asked about his admiration for NICE’s principles and processes, and the effect that NICE’s decisions have had on driving poor cancer outcomes in the U.K. This is exactly the question that should’ve been asked during Dr. Berwick’s Senate confirmation hearings. Unfortunately, President Obama’s recess appointment last month denied Dr. Berwick the opportunity to explain and defend his views on rationing. 

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