News for hackers. Stuff that matters.

A comment on Why Some Doctors Purposely Misdiagnose Patients. Parent comment

Re:Why Some Doctors Purposely Misdiagnose Patients by gvjddbnvdrbv on Thursday January 23, 2020 @02:58AM (#22125729)
In general you are correct but sadly there are perverse incentives even in a system like the NHS. There are two problems. (1) treatments are approved only if they make financial sense for the country and (2) sometimes those calculations go wrong. At one point people were being allowed to go blind based on a cost calculation. Even though letting people go blind was more expensive overall to the country. The cost of treatment to the NHS budget was greater than non-treatment but the social care costs came from another budget.
[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by eterm on Thursday January 23, 2020 @03:30AM (#22125859)
Source?

Because the NHS doesn't optimise for cost, it optimises for cost per QALY (quality adjusted life years). Given the high impact to quality of life for blindness your claim is dubious.

NICE make the decisions over cost effectiveness of treatments, and publish their findings. If you can tell me the name of the drug we can find the actual report.

[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by mikecsh on Thursday January 23, 2020 @04:28AM (#22126119)
They may be talking about Avastin which there was a controversy around a few years ago. IIRC despite being originally used as an anti-cancer treatment it was found to be very effective (as effective as other treatments) for Wet AMD (age-related macular degeneration, a degenerative condition of the retina). The NICE approved drug options for the condition were significantly more expensive.

Some Trusts were attempting to make this the first line treatment as an off-license prescription as it was cheaper and the pharmaceutical companies were trying to sue the Trusts for "not providing NICE approved medications and therefore disadvantaging patients" while simultaneously not seeking to license Avastin for wet AMD.

This was a few years ago so I may have misremembered some details.

[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by zentiggr on Thursday January 23, 2020 @09:32AM (#22127811)
Surprise, surprise, the underlying complication was someone's profit motive regarding drug selection.

I'm getting really repetitive but transparency transparency transparency.

Let's make public the cases where the suppliers collude to withhold drugs for actual effective usages "because we have this other more expensive option that's the only one we sent in for approval" whine bitch stfu and do what's best for the patients you money grubbing bastards.

[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by matthewmacleod on Thursday January 23, 2020 @08:27AM (#22127333)
Literally none of these are links to the sort of thing being described.
[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by gvjddbnvdrbv on Thursday January 23, 2020 @10:38AM (#22128352)
These links are exactly what I was referring to.
[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by gvjddbnvdrbv on Thursday January 23, 2020 @10:35AM (#22128319)
Thanks this is the story.

The cost decision involved was of course not to have the follow up appointments sooner..

[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by cpach on Thursday January 23, 2020 @08:24AM (#22127306)
In his book The Undercover Economist, Tim Harford has a section about The National Institute for Health and Care Excellence (NICE).

In 2012 they issued a report about the usage of Visudyne/photodynamic terapy which the Royal National Institute of Blind People objected to.

[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by gvjddbnvdrbv on Thursday January 23, 2020 @04:26AM (#22126114)
I heard this on a BBC radio 4 radio program related to disability issues aired on either a Tuesday or Thursday around 9pm in around 2014/2015.
[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by DanBC on Thursday January 23, 2020 @08:46AM (#22127455)
2011? https://www.bbc.co.uk/programmes/b016817t

Avastin / Lucentis does not support the point being made. Lucentis, a very expensive medication, was both licenced for AMD and was approved by NICE for that use.

Avastin is identical, but was not licenced for AMD and so NICE was not able to recommend its use for AMD.

Doctors were using Avastin off label, and they wanted the government to force Avastin to be licenced for AMD which would have allowed it to be recommended by NICE.

The makers of Avastin and Lucentis fought this in the courts for years, and took action against NHS Trusts using Avastin off-label. The NHS won that legal case.

https://www.bbc.co.uk/news/health-30138097

https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wi...

There is a problem of people going blind while waiting for treatment, but this is related to cataracts and glaucoma, not AMD, and it has nothing to do with NICE (who are the organisation that decides about cost effectiveness) and everything to do with a government that has chosen to de-fund the NHS.

[ Parent | on HN ]
Re:Why Some Doctors Purposely Misdiagnose Patients by gvjddbnvdrbv on Thursday January 23, 2020 @10:37AM (#22128342)
> There is a problem of people going blind while waiting for treatment, but this is related to cataracts and glaucoma

This is what I was referring to.

The cost decision involved was of course not to have the follow up appointments sooner.

[ Parent | on HN ]