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

boyntonstu · 2nd August 2009, 09:37 AM

http://www.telegraph.co.uk/health/he...njections.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 · 2nd August 2009, 09:43 AM

Originally Posted by boyntonstu

NHS, coming soon to your neighborhood in this Obamanation!

No. This is completely false.

joobz · 2nd August 2009, 09:54 AM

anecdote OFF!!

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

Professor Yaffle · 2nd August 2009, 10:27 AM

Originally Posted by Cochrane Review

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 · 2nd August 2009, 10:30 AM

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

boyntonstu · 2nd August 2009, 12:12 PM

Originally Posted by Lonewulf

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 · 2nd August 2009, 12:19 PM

Originally Posted by boyntonstu

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 · 2nd August 2009, 12:36 PM

Originally Posted by boyntonstu

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 · 2nd August 2009, 12:40 PM

Originally Posted by boyntonstu

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 · 2nd August 2009, 12:53 PM

Originally Posted by boyntonstu

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 · 2nd August 2009, 02:25 PM

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 · 2nd August 2009, 02:44 PM

Originally Posted by 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.

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 · 2nd August 2009, 02:49 PM

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 · 2nd August 2009, 02:50 PM

Originally Posted by Delscottio

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 · 2nd August 2009, 02:54 PM

Originally Posted by boyntonstu

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

Originally Posted by Delscottio

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 · 2nd August 2009, 02:55 PM

Originally Posted by Delscottio

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 · 2nd August 2009, 03:01 PM

Originally Posted by volatile

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 · 2nd August 2009, 03:03 PM

Originally Posted by joobz

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 · 2nd August 2009, 03:05 PM

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

Not quite

Quote:

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 · 2nd August 2009, 03:08 PM

It's definitely worth noting that:

Quote:

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.

parky76 · 2nd August 2009, 03:12 PM

#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 · 2nd August 2009, 03:34 PM

Originally Posted by volatile

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/...9.5iv_Item.pdf

Part way down - The Richards Review

Quote:

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 · 2nd August 2009, 04:19 PM

Originally Posted by Delscottio

http://www.norfolk.nhs.uk/resources/...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 · 2nd August 2009, 04:30 PM

Originally Posted by volatile

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 · 2nd August 2009, 04:31 PM

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 · 2nd August 2009, 05:40 PM

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

Corsair 115 · 2nd August 2009, 07:20 PM

Originally Posted by boyntonstu

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):

Quote:

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 · 2nd August 2009, 07:42 PM

Originally Posted by Dr Adequate

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 · 2nd August 2009, 09:20 PM

Originally Posted by David Wong

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

Eh, the lies make for "lively discussion".

GreyICE · 2nd August 2009, 09:22 PM

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

Quote:

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

kellyb · 2nd August 2009, 09:30 PM

Originally Posted by GreyICE

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

Manufactured ****ing 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 · 2nd August 2009, 09:38 PM

Originally Posted by 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?

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 · 3rd August 2009, 12:59 AM

Originally Posted by boyntonstu

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 · 3rd August 2009, 01:17 AM

Originally Posted by volatile

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 · 3rd August 2009, 01:19 AM

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/extra.../jul28_3/b3049

Darat · 3rd August 2009, 01:21 AM

Originally Posted by boyntonstu

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 · 3rd August 2009, 01:57 AM

i love such threads.
classic.

Rolfe · 3rd August 2009, 04:01 AM

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 · 3rd August 2009, 04:15 AM

Originally Posted by Delscottio

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 · 3rd August 2009, 04:52 AM

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.

2nd August 2009, 09:54 AM	#3
joobz Tergiversator Join Date: Aug 2006 Location: Inside the Magical Murder Bag Posts: 11,812	anecdote OFF!! I see your pain med story and raise you "pregnancy as a pre-existing medical condition." http://www.americanpregnancy.org/pla...ealthcare.html
	__________________ "Joobz you can be something else sometimes."- DOC "Hopefully joobz can one day be totally objective and unbiased ..." - DOC

2nd August 2009, 10:27 AM	#4
Professor Yaffle Butterbeans and Breadcrumbs Moderator Join Date: Jan 2007 Location: Emily's shop Posts: 7,132	Originally Posted by Cochrane Review 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
	__________________ I think you'll find it's a little bit more complicated than that.

2nd August 2009, 10:30 AM	#5
Lonewulf Humanistic Cyborg Join Date: Nov 2005 Location: San Antonio, Texas Posts: 10,379	As always, the issue is a bit more complicated than certain people make it out to be.
	__________________ Writing.com Account I need a better signature

2nd August 2009, 12:36 PM	#8
volatile Scholar and a Gentleman Join Date: Aug 2006 Location: The Uncanny Valley Posts: 6,322	Originally Posted by boyntonstu 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.
	__________________ - ""My tribe has a saying: 'If you're bleeding, look for a man with scars'" - Leela, Doctor Who 'Robots of Death'.

2nd August 2009, 12:40 PM	#9
Leif Roar Master Poster Join Date: Nov 2002 Posts: 2,059	Originally Posted by boyntonstu 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.
Leif Roar Master Poster Join Date: Nov 2002 Posts: 2,059	__________________ "Our feature on cloud seeding (16 Apr, p40) should have started with the words 'Cannons blazed'. No clergy were set on fire in China's rainmaking experiment." -- New Scientist, 7th May 2005

2nd August 2009, 09:37 AM	#1
boyntonstu Suspended Join Date: Jun 2009 Location: Florida Posts: 352	Patients forced to live in agony after NHS refuses to pay for painkilling injections http://www.telegraph.co.uk/health/he...njections.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!

2nd August 2009, 09:43 AM	#2
Cleon King of the Pod People Join Date: Aug 2001 Location: Atlanta, GA Posts: 14,360	Originally Posted by boyntonstu NHS, coming soon to your neighborhood in this Obamanation! No. This is completely false.
	__________________ "Intolerance does not flourish without ignorance to feed it." - kittynh "A jerk who is right is still a jerk." - Ducky My blog

2nd August 2009, 12:12 PM	#6
boyntonstu Suspended Join Date: Jun 2009 Location: Florida Posts: 352	Originally Posted by Lonewulf 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

2nd August 2009, 12:19 PM	#7
Delscottio Critical Thinker Join Date: Oct 2007 Posts: 348	Originally Posted by boyntonstu 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??

2nd August 2009, 12:53 PM	#10
Lonewulf Humanistic Cyborg Join Date: Nov 2005 Location: San Antonio, Texas Posts: 10,379	Originally Posted by boyntonstu 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.
	__________________ Writing.com Account I need a better signature Last edited by Lonewulf; 2nd August 2009 at 12:54 PM.

2nd August 2009, 02:25 PM	#11
joobz Tergiversator Join Date: Aug 2006 Location: Inside the Magical Murder Bag Posts: 11,812	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.
	__________________ "Joobz you can be something else sometimes."- DOC "Hopefully joobz can one day be totally objective and unbiased ..." - DOC

2nd August 2009, 02:44 PM	#12
Delscottio Critical Thinker Join Date: Oct 2007 Posts: 348	Originally Posted by 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. As long as they can find a private doctor who sees the clinical need for the injections, of course they could pay for them
	Last edited by Delscottio; 2nd August 2009 at 02:45 PM.

2nd August 2009, 02:49 PM	#13
Stimpson J. Cat Graduate Poster Join Date: Sep 2001 Location: Oxford, UK Posts: 1,738	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
	__________________ A poke in the eye makes Baby Jesus cry.

2nd August 2009, 02:50 PM	#14
volatile Scholar and a Gentleman Join Date: Aug 2006 Location: The Uncanny Valley Posts: 6,322	Originally Posted by Delscottio 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.
	__________________ - ""My tribe has a saying: 'If you're bleeding, look for a man with scars'" - Leela, Doctor Who 'Robots of Death'.

2nd August 2009, 02:54 PM	#15
Upchurch Papa Funkosophy Join Date: May 2002 Location: Funky Town (STL, MO) Posts: 19,555	Originally Posted by boyntonstu 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 Originally Posted by Delscottio 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

2nd August 2009, 02:55 PM	#16
joobz Tergiversator Join Date: Aug 2006 Location: Inside the Magical Murder Bag Posts: 11,812	Originally Posted by Delscottio 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.
	__________________ "Joobz you can be something else sometimes."- DOC "Hopefully joobz can one day be totally objective and unbiased ..." - DOC

2nd August 2009, 03:01 PM	#17
Delscottio Critical Thinker Join Date: Oct 2007 Posts: 348	Originally Posted by volatile 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.

2nd August 2009, 03:03 PM	#18
Delscottio Critical Thinker Join Date: Oct 2007 Posts: 348	Originally Posted by joobz 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.

2nd August 2009, 03:05 PM	#19
Fiona Philosopher Join Date: Dec 2007 Posts: 6,103	http://news.bbc.co.uk/1/hi/health/8068427.stm Not quite Quote: 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
Fiona Philosopher Join Date: Dec 2007 Posts: 6,103	__________________ To see you, who you wanted to be, amongst the bastards out there. Damn you, Fiona - MattC. Damn you, Fi - SkeptikKhatt Damn you, anoiF - CriticalSock You are become Fiona, destroyer of threads! -realpaladin Last edited by Fiona; 2nd August 2009 at 03:07 PM.

2nd August 2009, 03:08 PM	#20
kellyb Master Poster Join Date: Jan 2006 Posts: 2,619	It's definitely worth noting that: Quote: 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.
kellyb Master Poster Join Date: Jan 2006 Posts: 2,619	Last edited by kellyb; 2nd August 2009 at 03:20 PM.

2nd August 2009, 03:12 PM	#21
parky76 Penultimate Amazing Join Date: Nov 2006 Posts: 15,493	#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?
	__________________ 9-11 Truther: "We don't need facts. We only need doubt."

2nd August 2009, 03:34 PM	#22
Delscottio Critical Thinker Join Date: Oct 2007 Posts: 348	Originally Posted by volatile 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/...9.5iv_Item.pdf Part way down - The Richards Review Quote: 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”

2nd August 2009, 04:19 PM	#23
volatile Scholar and a Gentleman Join Date: Aug 2006 Location: The Uncanny Valley Posts: 6,322	Originally Posted by Delscottio http://www.norfolk.nhs.uk/resources/...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?
	__________________ - ""My tribe has a saying: 'If you're bleeding, look for a man with scars'" - Leela, Doctor Who 'Robots of Death'.

2nd August 2009, 04:30 PM	#24
Delscottio Critical Thinker Join Date: Oct 2007 Posts: 348	Originally Posted by volatile 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.

2nd August 2009, 04:31 PM	#25
casebro Illuminator Join Date: Jun 2005 Posts: 3,728	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?
casebro Illuminator Join Date: Jun 2005 Posts: 3,728	__________________ Please pardon me for having ideas, not facts. Some have called me cynical, but I don't believe them. It's not how many breaths you take. It's how many times you have been breathless that counts.

2nd August 2009, 05:40 PM	#26
Dr Adequate Banned Join Date: Aug 2004 Location: Waiting Long Enough By The River Posts: 17,902	So, another thread with a thundering great lie in the title.

2nd August 2009, 07:20 PM	#27
Corsair 115 Illuminator Join Date: Apr 2007 Location: Tranquility Base Posts: 4,338	Originally Posted by boyntonstu 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): Quote: 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.
	__________________ "We choose to go to the moon in this decade and do the other things not because they are easy, but because they are hard. Because that goal will serve to organize and measure the best of our abilities and skills, because that challenge is one we are willing to accept, one we are unwilling to postpone, and one which we intend to win."

2nd August 2009, 07:42 PM	#28
David Wong Graduate Poster Join Date: Sep 2006 Posts: 1,697	Originally Posted by Dr Adequate 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.
	__________________ Author, John Dies at the End. Available now in hardcover. Editor, Cracked.com.

2nd August 2009, 09:20 PM	#29
kellyb Master Poster Join Date: Jan 2006 Posts: 2,619	Originally Posted by David Wong In a perfect forum, such thread titles could be edited as not to spread misinformation. Eh, the lies make for "lively discussion".
kellyb Master Poster Join Date: Jan 2006 Posts: 2,619

2nd August 2009, 09:22 PM	#30
GreyICE Philosopher Join Date: Mar 2008 Posts: 6,541	Dr Adequate clued me into this one. I think the telegraph is full of crap, based on what I'm reading. Quote: 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 ****ing crisis people, don't be stupid. How does anyone call themselves a skeptic and let honking great whoppers like this slide by?
GreyICE Philosopher Join Date: Mar 2008 Posts: 6,541	__________________ I love these forums If Hitler was a bloodthirsty psychopath don't you think at least someone would have noticed? - MagZ

2nd August 2009, 09:30 PM	#31
kellyb Master Poster Join Date: Jan 2006 Posts: 2,619	Originally Posted by GreyICE Dr Adequate clued me into this one. I think the telegraph is full of crap, based on what I'm reading. Manufactured ****ing 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 Master Poster Join Date: Jan 2006 Posts: 2,619

2nd August 2009, 09:38 PM	#32
kellyb Master Poster Join Date: Jan 2006 Posts: 2,619	Originally Posted by 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? 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.
kellyb Master Poster Join Date: Jan 2006 Posts: 2,619	Last edited by kellyb; 2nd August 2009 at 09:40 PM.

3rd August 2009, 12:59 AM	#33
Architect Chief Punkah Wallah Join Date: Aug 2006 Location: UK Posts: 5,911	Originally Posted by boyntonstu 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.
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3rd August 2009, 01:17 AM	#34
Darat Lackey Administrator Join Date: Aug 2001 Location: South East, UK Posts: 47,689	Originally Posted by volatile 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.
	__________________ If it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart? - Aleksandr Solzhenitsyn 1918-2008 Last edited by Darat; 3rd August 2009 at 01:23 AM.

3rd August 2009, 01:19 AM	#35
Darat Lackey Administrator Join Date: Aug 2001 Location: South East, UK Posts: 47,689	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/extra.../jul28_3/b3049
	__________________ If it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart? - Aleksandr Solzhenitsyn 1918-2008 Last edited by Darat; 3rd August 2009 at 02:10 AM.