Ration roulette
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YEARS of research into a single molecule have given Karen back her life. Four years ago, aged 55, her immune system started to attack her joints. The resulting severe arthritis made her joints seize up one by one. Standard treatment with aspirin-type drugs and the immunosuppressant methotrexate was failing. Immobile and in agony, by the spring of 1998 she was going weeks without sleep, and sank into despair. Then a press report alerted her to an experimental treatment about to be tested at Charing Cross Hospital in London. The therapy was a genetically engineered antibody against the molecule TNF-alpha which plays a pivotal role in activating the immune system. Its developers hoped that by neutralising the excess of TNF-alpha in the joints of people with severe arthritis, they could stop the white blood cells destroying tissue there. This approach had already shown signs of success in another auto-immune condition, Crohn’s disease. Karen began a remarkable recovery that saw her regain most of her mobility within weeks of the first infusion. With the trial now over, she waits anxiously to learn if the treatment will be licensed. And the uncertainty doesn’t stop there. Even if the antibody is deemed safe and clinically effective, Karen and other arthritis sufferers may not receive it. That’s because Britain has created an extra hurdle for new drugs and medical devices: the National Institute for Clinical Excellence (NICE), set up this year to establish whether new treatments are sufficiently cost effective to justify a share of the increasingly stretched budget of Britain’s National Health Service. If not, they will only be available to patients who can afford to pay for private healthcare. High-tech drugs and medical devices may work better than established treatments: the problem is that they are often phenomenally expensive. That is proving a burden to healthcare systems throughout the world, which is why officials elsewhere are keeping a close watch on Britain’s experiment in creating an additional economic hurdle for new medicines. “It’s rationing plain and simple,” says Tony Harrison, a senior policy researcher with the King’s Fund, an independent health think-tank based in London. “And there’s got to be rationing. We can’t afford everything.” More : newscientist.com |