A Last Straw or Nail in the Coffin for the NHS? These discussions
almost invariably polarise into the caring-and-sharing exclude all cancers
with 100% certainty in everyone lobby, and the presumed uncaring opponents
dedicated to protecting the NHS from unsustainable excess and the slippery
slope to an insurance based, high co-payment, no choice Choice for
unglamorous routine conditions, dismal future. The former may be crudely
parodied as halo wielding, shroud waving "I will do the best for my
patient" Spend, Spend, Spend-ers, and the latter as heartless desiccated
calculating machines intent upon sending Granny and little Johnny to an
early grave.
The tension is illustrated in my own hospital where the availability
of expensive breast MRI led in a few years to it becoming routine for
breast cancer patients, followed by the abrupt complete withdrawal of
breast MR when no-one would pay for what was apparently unnecessary after
all. There is still no local breast MR for this Breast Screening Unit many
months later. Watch out for more such conflicts. It is both a truism and
true that procedures cost money, and you can't have everything you can
think of, particularly if it doesn't do any good.
Salutory examples raised here include the prevalence of 'bloating' in
women presenting to a GP, which at least some people including me believe
to be much higher than suggested, and a proposal for CA125 screening which
has already been convincingly rejected; a conclusion viewed by some as
akin to an EU referendum: if the wrong answer is returned, you just repeat
the process until you get the right one.
Another threat is PSA prompted prostate cancer diagnosis where those
of my age would all stand a good chance of winning the diagnosis if they
allowed the zealots to biopsy often enough in order to ramp up the
diagnosed prevalence 6 times to equal the USA and thereby improve the
survival statistics - I now only have to make it through another 13 years
before even the Americans say I should avoid PSA testing because of the
low chance of the result being of benefit. Both of these cancers are the
subject of stealth screening where questionable symptoms such as bloating
and difficulty with micturition provide an excuse for investigation, and
guidelines generally support the 'you can't be too careful' principle. You
can, but there aren't many incentives to avoid an easy referral.
Probably worse still would be lung cancer screening by CT, oral
cancer screening by saliva and mass genomic analysis, all of which can't
be afforded; the aneurysm screening programme where we'll wait and see;
and better will be the probable triumph of the bowel cancer programme, and
you need a National health service for that. Three cheers for Socialised
Medicine despite what many Americans have been saying recently. Don't let
it die.
Rapid Response:
Just To Be On The Safe Side
A Last Straw or Nail in the Coffin for the NHS? These discussions
almost invariably polarise into the caring-and-sharing exclude all cancers
with 100% certainty in everyone lobby, and the presumed uncaring opponents
dedicated to protecting the NHS from unsustainable excess and the slippery
slope to an insurance based, high co-payment, no choice Choice for
unglamorous routine conditions, dismal future. The former may be crudely
parodied as halo wielding, shroud waving "I will do the best for my
patient" Spend, Spend, Spend-ers, and the latter as heartless desiccated
calculating machines intent upon sending Granny and little Johnny to an
early grave.
The tension is illustrated in my own hospital where the availability
of expensive breast MRI led in a few years to it becoming routine for
breast cancer patients, followed by the abrupt complete withdrawal of
breast MR when no-one would pay for what was apparently unnecessary after
all. There is still no local breast MR for this Breast Screening Unit many
months later. Watch out for more such conflicts. It is both a truism and
true that procedures cost money, and you can't have everything you can
think of, particularly if it doesn't do any good.
Salutory examples raised here include the prevalence of 'bloating' in
women presenting to a GP, which at least some people including me believe
to be much higher than suggested, and a proposal for CA125 screening which
has already been convincingly rejected; a conclusion viewed by some as
akin to an EU referendum: if the wrong answer is returned, you just repeat
the process until you get the right one.
Another threat is PSA prompted prostate cancer diagnosis where those
of my age would all stand a good chance of winning the diagnosis if they
allowed the zealots to biopsy often enough in order to ramp up the
diagnosed prevalence 6 times to equal the USA and thereby improve the
survival statistics - I now only have to make it through another 13 years
before even the Americans say I should avoid PSA testing because of the
low chance of the result being of benefit. Both of these cancers are the
subject of stealth screening where questionable symptoms such as bloating
and difficulty with micturition provide an excuse for investigation, and
guidelines generally support the 'you can't be too careful' principle. You
can, but there aren't many incentives to avoid an easy referral.
Probably worse still would be lung cancer screening by CT, oral
cancer screening by saliva and mass genomic analysis, all of which can't
be afforded; the aneurysm screening programme where we'll wait and see;
and better will be the probable triumph of the bowel cancer programme, and
you need a National health service for that. Three cheers for Socialised
Medicine despite what many Americans have been saying recently. Don't let
it die.
Competing interests:
None declared
Competing interests: No competing interests