Showing posts from 2008

Liberté, Egalité, Fraternité et Justice

"Days of Glory" is movie that is presently on general release on DVD. It highlights the actions of the French Government in relation to the colonial soldiers who fought and died fighting for France during the Second World War. It was originally released in 2006 as "Les Indigenes". An interesting BBC website article observes, albeit somewhat wryly, how the French Government modified its policy to these soldiers in reaction to the film. Just another reason for the French to feel proud about the war. We await with anticipation the movie exploring the actions of the British Government in relation to the Gurkhas.

NICE, politics and puppetry

There has been a call for NICE to see cancer drugs differently from other treatments. Has NICE really got it's sums wrong? The payor and the beneficiary have been separated by the existence of a political promise that the NHS will deliver treatment to the patient free at the point of delivery. Assume a treatment that carries proven clinical benefit. From the perspective of a patient a treatment is free when they do not need to pay for themselves directly. But almost any such free treatment, however small the potential net benefit, which gives a potential for an increased chance of survival almost inevitably carries utility. Cost free utility carries value and is the driver for infinite demand. NICE is the politicians tool to address the demand side of the supply-demand imbalance for healthcare within the NHS. NICE answers the question whether the drugs are value for money from the perspective of a fee-payer with a finite resource who is seeking to discharge a duty to deliver care.

Co-payments in the NHS - a review at last

The UK Government has at last announced a review of the question surrounding top up fees for patients who wish to receive more expensive care that meets NICE guidance or local spending priorities. This has been discussed on this blog in the context of Donezepil (see link below). However the principle applies as much to drug-eluting stents, ICD's and biventricular pacing devices as to dementia drugs and cancer treatments. NICE approves treatments on the basis of cost-effectiveness rather than pure efficacy. This leads to 2 broad groups of non-NICE approved drugs: drugs that are more expensive and more potent than their NICE approved counterpart drugs that are less potent and, either less expensive or more expensive, than their NICE approved counterpart. The first group of treatments, but not the second group of treatments, can be regarded as the group of marginally effective treatments which fall into the affordability gap . For these treatments the ethical choice in relation to to

Believing in Science

Introduction Richard Dawkins’ argument that there is no God is an argument that purports to deploy scientific truth against religious belief. The question to put to Dawkins is: "Do you know that God does not exist or do you believe , on the basis of the evidence you accept, that God does not exist?" The existence of a scientific explanation for observed phenomena doesn't prove that God does not exist. It is no more powerful than the fact of the existence of order in the Universe proves that God does exist. Knowledge, belief and the unprovable If Dawkins cannot know that God does not exist, then he can only believe that God does not exist. In this case he is in no stronger position than someone believes that God does exist. The question then reduces to a conflict of beliefs and turns upon the nature and type of evidence one is willing to accept. The question of whether Gods exists or not may be unprovable. There is a philosophical limitation upon what we ca