Patients forced to live in agony after NHS refuses to pay for painkilling injections

[boyntonstu]

http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html

http://tinyurl.com/l8s8xk

Patients forced to live in agony after NHS refuses to pay for painkilling injections
Tens of thousands with chronic back pain will be forced to live in agony after a decision to slash the number of painkilling injections issued on the NHS, doctors have warned.

By Laura Donnelly, Health Correspondent
Published: 7:45AM BST 02 Aug 2009

Cuts to treatments would save the NHS £33 million. Photo: ANDREW CROWLEY

The Government's drug rationing watchdog says "therapeutic" injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known.

Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy. …

NHS, coming soon to your neighborhood in this Obamanation!

[Cleon]

NHS, coming soon to your neighborhood in this Obamanation!

No. This is completely false.

[joobz]

anecdote OFF!!

I see your pain med story and raise you "pregnancy as a pre-existing medical condition."
http://www.americanpregnancy.org/planningandpreparing/affordablehealthcare.html

[Professor Yaffle]

There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain. However, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy.

http://www.cochrane.org/reviews/en/ab001824.html

[Lonewulf]

As always, the issue is a bit more complicated than certain people make it out to be.

[boyntonstu]

As always, the issue is a bit more complicated than certain people make it out to be.

Complicated, yes.

The question is should anyone besides the patient and the physician be involved in the decision?

Do you really want a government agency to make the call?

BoyntonStu

[Delscottio]

Complicated, yes.

The question is should anyone besides the patient and the physician be involved in the decision?

Do you really want a government agency to make the call?

BoyntonStu

I assume you prefer a private company to make that call? Why do you prefer that situation?

In the US is the decision purely between doctor and patient? No checks with the insurance company to see if there is coverage etc??

[volatile]

Do you really want a government agency to make the call?

I'd like the doctor to make the call on what's medically necessary. It seems that, as Yaffle explains, this is precisely what's at play here.

We have heard in recent days and weeks on this forum, however, of numerous posters given tests and procedures deemed medically appropriate by their doctors, only to have their insurance company later decide that it wasn't needed after all, and, despite being covered, these people have to pay anyway. This is common-place in America, as I understand it. Do you understand the system to be any different?

So if you want a system where bureaucrats don't stand between you and the healthcare your physician suggests you need, pick a Universal system every time.

[Leif Roar]

Complicated, yes.

The question is should anyone besides the patient and the physician be involved in the decision?

Unless the physician wants to forego the bill or the patient would prefer to pay everything from his own pocket, yes.

[Lonewulf]

Do you really want a government agency to make the call?

And again, an attempt to cram reality into simplicity it isn't built for.

[joobz]

Out of curiousity,
If this takes hold. Would the patient be free to pay for the steroid shot out of pocket?

If yes, then this is identical to US insurances. If no, then I see a problem.

[Delscottio]

Out of curiousity,
If this takes hold. Would the patient be free to pay for the steroid shot out of pocket?

If yes, then this is identical to US insurances. If no, then I see a problem.

As long as they can find a private doctor who sees the clinical need for the injections, of course they could pay for them

[Stimpson J. Cat]

I guess this is worse than the situation my mother is dealing with, where she cannot get her doctor-perscribed pain injections because she simply can't afford to pay the percentage that her health insurence doesn't cover.

Oh wait, no it isn't. It's actually a lot better than that situation.

Never mind.


Dr. Stupid

[volatile]

As long as they can find a private doctor who sees the clinical need for the injections, of course they could pay for them

Actually, that might not technically be true - wasn't there a flare-up around the herceptin situation, because people who "top up" a specific course of treatment forego the rest NHS treatment for the same course? I think patients who bought herceptin in cash were facing losing their NHS chemo?

I don't know how that'd work out in this case.

[Upchurch]

Complicated, yes.

The question is should anyone besides the patient and the physician be involved in the decision?

Do you really want a government agency to make the call?

BoyntonStu

I assume you prefer a private company to make that call? Why do you prefer that situation?

In the US is the decision purely between doctor and patient? No checks with the insurance company to see if there is coverage etc??
Delscottio FTW

[joobz]

As long as they can find a private doctor who sees the clinical need for the injections, of course they could pay for them
In other words, the real tragedy here is that the British system is becoming more like the current US system.

[Delscottio]

Actually, that might not technically be true - wasn't there a flare-up around the herceptin situation, because people who "top up" a specific course of treatment forego the rest NHS treatment for the same course? I think patients who bought herceptin in cash were facing losing their NHS chemo?

I don't know how that'd work out in this case.

I didn't think of that, it wouldn't stop the doc giving the jab though ;)

Not sure where the line is drawn though, I'll have a look in the next few days.

[Delscottio]

In other words, the real tragedy here is that the British system is becoming more like the current US system.


Not really its been like this for years, Proffessor Yaffle posted a link that will have impacted on the decision.

[Fiona]

http://news.bbc.co.uk/1/hi/health/8068427.stm

Not quite :rolleyes:
In addition to painkillers and regular advice to stay active and carry on with normal activities as much as possible, patients, together with their doctor, can decide to opt one of three complementary treatments.

Not great that they are supporting complementary medicine but not quite what the telegraph claims

[kellyb]

It's definitely worth noting that:

A spokesman for NICE said its guidance did not recommend that injections were stopped for all patients, but only for those who had been in pain for less than a year, where the cause was not known.

They're basically just saying it's silly to give steroid shots to people for what's probably muscular pain, since the shots only work for spine-related issues (which will generally show up on imaging). I think.

[Thunder]

#1. can't these people pay for the medication out of their own pocket?

#2. the USA plan would let private insurers compete with a government plan, just as they already compete with Medicaid. I don't see folks calling Medicaid "Communism", now do I?

[Delscottio]

Actually, that might not technically be true - wasn't there a flare-up around the herceptin situation, because people who "top up" a specific course of treatment forego the rest NHS treatment for the same course? I think patients who bought herceptin in cash were facing losing their NHS chemo?

I don't know how that'd work out in this case.

http://www.norfolk.nhs.uk/resources/pdf/board/meet/2009/july/9.5iv_Item.pdf

Part way down - The Richards Review

Richards review
The essential conclusion of the Richards review was that patients have the right to
pay for top-up drugs without losing their right to basic NHS care
“No patient should lose their entitlement to NHS care that they otherwise would have
received, simply because they opt to purchase additional treatment for their
condition”

[volatile]

http://www.norfolk.nhs.uk/resources/pdf/board/meet/2009/july/9.5iv_Item.pdf

Part way down - The Richards Review

Oh, good. They got that isssue sorted out. As it should be.

Superb.

So what was the problem again? Doctors not giving patients injections they didn't need, but giving them oral painkillers instead, with the option to top-up should you really want to have a medically-unnecessary procedure done and can find a doctor who thinks it's worthwhile.

How is this worse than the US system, again?

[Delscottio]

Oh, good. They got that isssue sorted out. As it should be.

Superb.

So what was the problem again? Doctors not giving patients injections they didn't need, but giving them oral painkillers instead, with the option to top-up should you really want to have a medically-unnecessary procedure done and can find a doctor who thinks it's worthwhile.

How is this worse than the US system, again?

The ironic thing is one of the criticisms leveled at UHC's is that little research takes place.

[casebro]

Steroids are NOT pain killers, they are anti-inflammatories. As such, they should be used for cases where the inflammation causes pain, like swelling tissues pinching a nerve. Like a blown disc. NOT for muscle pain. And in American, the shots are given by an anesthesiologist, since it's not just a simple injection of pain killer, but a shot into the spinal region.

Sounds like evidence-based medicine to me- only use this procedure where it is warranted. No brainer, eh?

[Dr Adequate]

So, another thread with a thundering great lie in the title.

[Corsair 115]

The question is should anyone besides the patient and the physician be involved in the decision?

Do you really want a government agency to make the call?


From the third paragraph of the article (emphasis added):

Specialists fear tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as £500 each for private treatment.


This would indicate that, while the treatments in question are no longer going to be paid for by the public system, the patients are free to purchase the treatments from the private system if they wish.

Your "should anyone besides the patient and the physician be involved in the decision" line is a canard.

[David Wong]

So, another thread with a thundering great lie in the title.

In a perfect forum, such thread titles could be edited as not to spread misinformation.

[kellyb]

In a perfect forum, such thread titles could be edited as not to spread misinformation.

Eh, the lies make for "lively discussion". :D

[GreyICE]

Dr Adequate clued me into this one. I think the telegraph is full of crap, based on what I'm reading.

A spokesman for NICE said its guidance did not recommend that injections were stopped for all patients, but only for those who had been in pain for less than a year, where the cause was not known.

Iris Watkins, 80 from Appleton, in Cheshire said her life had been "transformed" by the use of therapeutic injections every two years. The pensioner began to suffer back pain in her 70s. Four years ago, despite physiotherapy treatment and the use of medication, she had reached a stage where she could barely walk.

Manufactured *********** crisis people, don't be stupid. How does anyone call themselves a skeptic and let honking great whoppers like this slide by?

[kellyb]

Dr Adequate clued me into this one. I think the telegraph is full of crap, based on what I'm reading.


Manufactured *********** crisis people, don't be stupid. How does anyone call themselves a skeptic and let honking great whoppers like this slide by?

Hey, I quoted half of that in post 20.
I did fail to note the amusing juxtaposition between the NICE statement and the anecdote, though.

[kellyb]

Steroids are NOT pain killers, they are anti-inflammatories. As such, they should be used for cases where the inflammation causes pain, like swelling tissues pinching a nerve. Like a blown disc. NOT for muscle pain. And in American, the shots are given by an anesthesiologist, since it's not just a simple injection of pain killer, but a shot into the spinal region.

Sounds like evidence-based medicine to me- only use this procedure where it is warranted. No brainer, eh?

I don't know how it works in humans, but my geriatric dog takes a short course of steroid pills when some terribly painful spinal swelling thing that I'm unable to elaborate on coz I don't know if it's a disc or what exactly, happens to him from time to time.
It seems unlikely that it absolutely must come in injection form for it to work for humans.

But my gut feeling is that NICE has decided, based on the evidence, that there are a lot of people with muscular back pain getting these shots and only experiencing a placebo effect...and there are cheaper placebos out there, so...enter the woo, stage right.

[Architect]

Complicated, yes.

The question is should anyone besides the patient and the physician be involved in the decision?

Do you really want a government agency to make the call?

BoyntonStu


Like the others, I call you out on this one. You've completely failed to address the medical (that's doctors, BTW) view that the treatment isn't appropriate in certain cases and instead focussed on the claim that this is an example of government imposed rationing of essential treatment. I further note that at least the Government makes the decision on the basis of clinical advice, not a private insurance company's profit margin.

[Darat]

Actually, that might not technically be true - wasn't there a flare-up around the herceptin situation, because people who "top up" a specific course of treatment forego the rest NHS treatment for the same course? I think patients who bought herceptin in cash were facing losing their NHS chemo?

I don't know how that'd work out in this case.

That caused a bit of media inspired "out-rage" even though many NHS regions were allowing it anyway. (Interestingly many consultants even in areas that didn't offciially allow it were foxing the system - they simply made the paperwork look as if each treatment was a separate course of treatment). The guidelines have now been changed and patients could do something like this.

[Darat]

Interestingly the opening post really is about a story that belongs in the Politics section , there is a lot of politics behind the story, see this extract for further information: http://www.bmj.com/cgi/content/extract/339/jul28_3/b3049

[Darat]

Complicated, yes.

The question is should anyone besides the patient and the physician be involved in the decision?

Do you really want a government agency to make the call?

BoyntonStu


I want my Doctor to use the best medical knowledge there is available when determining what treatment I should receive. Which is what this is all about.

[DC]

i love such threads.
classic.

[Rolfe]

I think it's the "refusing to pay for" bit that's such a lie. Anyone actually living here with the slightest knowledge of how these things work, knows that this cannot be accurate. The NHS doesn't start "refusing to pay for" things that are proven to be efficacious until you get into the realms of the astronomically expensive anti-cancer drugs that merely prolong dying for a few months.

What it does do is issue guidelines stating that certain treatments are inappropriate, or useless, or not evidence-based, in certain circumstances. In these cases it's generally entirely up to the doctor whether to follow the guidelines or not, though anyone flaunting them too blatantly or too often might have to answer some questions.

There's no way the NHS will "force patients to live in agony" because it's too stingy to pay for effective pain relief. The Torygraph has just made this into a scare story.

On the other hand, ask Ducky about how it is in the USA, if you want a real horror story.

Rolfe.

[ponderingturtle]

I assume you prefer a private company to make that call? Why do you prefer that situation?

In the US is the decision purely between doctor and patient? No checks with the insurance company to see if there is coverage etc??

Because that way when they deny payment you know that at least someone is making money from doing so. That will give you enough joy to over come any pain right?

[Rolfe]

I've has a closer look at the article, and it's ringing bells. I read a couple of long threads on this in the BMJ "Rapid Responses" columns. I was reading them in the context of the politics of alternative medicine (the recommendations for acupuncture), and it's really quite a complex issue involving resignations and a lot of accusations and counter-accusations flying around. It's by no means news, and I wonder why the Torygraph is highlighing it now, and in such inflammatory terms (pun intended).

There is a huge row going on between two medical factions, as regards the most approprate way of managing the patients in question. NICE thinks that while 60,000 treatments are currently being given, only about 3,000 of them are appropriate. Some other doctors beg to differ.

The money is an entirely separate issue. This isn't a decision being made on monetary grounds, and it's not "rationing". If someone were to come up with a better treatment that was unquestionably appropriate in these cases, NICE would pay for it, even if it was a bit more expensive than cortisone shots. The issue is, whether or not the cortisone shots are best practice, or even evidence-based, in many of the cases.

Now I don't know who's right. I'm not an orthopod, and I'm not a pain specialist. However, I do know that injecting cortisone into healthy joints can cause signs of abnormality in the joints. It doesn't sound like a good idea to do it in cases where you don't have a diagnosis and don't know what you're treating, even if a proportion of patients do report a dramatic improvement.

Knowing how doctors cling to their pet therapies even when the evidence shows they're useless, I'm not really surprised there's a controversy. That some doctors are upping the ante by making inflammatory statements about patients "living in agony" doesn't really surprise me either. But to portray this as purely a rationing decision based on a desire to save money is just totally missing the point.

I'm not surprised that right-wing Americans latch on to this to portray it in that light either though. News flash, guys. I thank God fasting I'm not a US resident forced to take my chances with your variety of rationing. For example, ask Ducky.

Rolfe.

[Darat]

...snip...

Knowing how doctors cling to their pet therapies even when the evidence shows they're useless, I'm not really surprised there's a controversy. That some doctors are upping the ante by making inflammatory statements about patients "living in agony" doesn't really surprise me either. But to portray this as purely a rationing decision based on a desire to save money is just totally missing the point.

...snip...

If you want to read a good-old-fashioned-slinging-match try to find the letters from and in response to Professor Littlejohns over the recent forced resignation of the President of British Pain Society. This has been ongoing on for some time and is now a political (with a small p) matter.

[volatile]

Interesting article in the New Scientist (http://www.newscientist.com/article/mg20327194.100-insight-why-dollars-alone-wont-fix-us-healthcare.html), again demonstrating the role of rhetoric in this debate:
"Why the reluctance to tackle these issues? Partly it's because no politician wants to be accused of rationing healthcare."

[Rolfe]

If you want to read a good-old-fashioned-slinging-match try to find the letters from and in response to Professor Littlejohns over the recent forced resignation of the President of British Pain Society. This has been ongoing on for some time and is now a political (with a small p) matter.


Oh, I've read it all! I just didn't immediately connect this thread with that slanging-match because of the entirely different tack being taken.

It's not rationing, it's a difference of opinion on the best way of managing a particular group of patients. And some people are stooping to some pretty unsavoury debating tactics.

Rolfe.

[Ducky]

On the other hand, ask Ducky about how it is in the USA, if you want a real horror story.

Rolfe.

Most people against UHC have avoided commenting on my posted account of the horrors of today's american health care systems:

http://forums.randi.org/showthread.php?postid=4945797#post4945797

[joobz]

Oh, I've read it all! I just didn't immediately connect this thread with that slanging-match because of the entirely different tack being taken.

It's not rationing, it's a difference of opinion on the best way of managing a particular group of patients. And some people are stooping to some pretty unsavoury debating tactics.

Rolfe.
Are you acusing the american medical system of rationing the use of leeches in the critical care of humor balancing?

[leftysergeant]

The government has decided that the people are being over-medicated with no real benefit to the patient or society arising therefrom, and turned off the money spigot.

Good. There are more appropriate treatments.

I have heard that the injections are not only not beneficial, but can do harm if they are not needed.

There is nothing of any great interest here. Just a government regulatory agency doing its job correctly.

How awful!:rolleyes:

[Rolfe]

There is nothing of any great interest here. Just a government regulatory agency doing its job correctly.


And a bunch of prima-donna doctors who know better than the controlled trials bleating to the press about "patients forced to live in agony", and "refusing to pay".

Rolfe.

[Safe-Keeper]

Patients forced to live in agony after NHS refuses to pay for painkilling injectionsWhat do you mean, "forced to live in agony"? Isn't the whole deal with you right-wingers that people should pay for their own treatment?

So if someone in the UK can't afford painkillers and don't receive them from the State, it means the medical system is a failure, but if someone in the US can't afford painkillers and don't receive them from the state, then tough luck?

:confused:

[Architect]

And of course if the patients are unhappy with the clinical recommendation then they can use legal aid to mount a challenge at the government's expense. I'll not hold my breath.

[Skeptic Ginger]

anecdote OFF!!

I see your pain med story and raise you "pregnancy as a pre-existing medical condition."
http://www.americanpregnancy.org/planningandpreparing/affordablehealthcare.html
:D

[Skeptic Ginger]

Typical claim that a clinical decision is some kind of evil rationing. No, it is a clinical decision. Steroids are not recommended for long term pain management because the side effects are too great.

[Fishstick]

Typical claim that a clinical decision is some kind of evil rationing. No, it is a clinical decision. Steroids are not recommended for long term pain management because the side effects are too great.

You can trust that if they were all suffering side effects that would be blamed on "Obamacare forcing decrepit medicine on patients in agony!"

[Rolfe]

Well, not excatly, because this is something that's happened in the NHS, but yes, I take your general point!

The really frustrating thing is that those of us whose countries have already gone through this (in the case of most people in Britain, before they were born) know that once "Obamacare" is in place and working, and of course can be tweaked to work better, nobody will want to go back to how things are now on a bet. (Except the fat cats siphoning all the money out of the present system, of course.)

Right now, I just want to smack a bunch of Americans on the head and say, just do it, you'll like it when it happens.

Rolfe.