Sunday, October 29, 2006

Blackmail and NRT

Smokers will be denied life-changing operations unless they agree to kick the habit, The Daily Mail revealed on October 23rd.

According to The Mail, cash-strapped hospitals say patients will not be given treatments such as hip and knee replacements until they try to give up. Those who fail could be denied treatment all together.

Managers in Norfolk and Newcastle, where trusts are millions of pounds in debt, say smokers are at a greater risk of complications and the move will help save them money on further care. But critics accused them of putting its finances before the health of its patients - and warned it could lead to surgeons being "browbeaten" into breaking the Hippocratic Oath.

The move will hit patients of Norfolk Primary Care Trust which is £50 million in the red and provides healthcare to the residents of Norwich and surrounding towns and villages. Newcastle-Under-Lyme PCT in north Staffordshire, which is £1.4 million in debt, has taken a similar decision.

So what are we to make of this story?

I am not a Communist but I do believe that there is something useful in Lenin¹s advice which is that if people don't understand something one should explain to them patiently time and time again.

Do smokers cost the NHS more? Well, the government revealed this year that whilst smokers are 'estimated' to cost the NHS £1.7 billion a year, they nevertheless pay in direct taxes on tobacco products the sum of £8 billion a year. That means that each smoker pays for his or her health care costs 4.7 times over which means they are already paying for other people's health care too.

Add to that £8 billion in direct taxes the yearly taxes levied on the profits of the tobacco companies and, at a conservative estimate, that £8 billion easily doubles. So let's say in continuing conservative terms that smokers contribute, through their habit, £16 billion to the economy. That means in health care terms they pay for themselves 9.4 times over. That's a very generous deal from the smokers and imagine what would happen if that £16 billion disappeared. There would be a very large hole in the finances of the treasury which would have to be made up by additional taxes being levied on the whole population.

Under the circumstances, the hospitals who want to deny patients treatments if they smoke should not be doing so for smokers are the only people who DO pay their way in health care costs.

This hypocrisy is scandalous and reflects the fact that these unscrupulous managers want an easy target or scapegoat to justify their actions which are not only unfair but wicked. One should have no hesitation, in fact, in designating them to be scoundrels jumping on the bandwagon of what they perceive to be a fashionable trend with easy victims.

But wait, we cannot leave the story there for what we are also seeing is an attempt to blackmail smokers into giving up a legal product and against their will in many cases. Why? Well, we notice that workers are to be given nicotine patches (NRT) instead of cigarette breaks and, by the same token, we also know that similar schemes offering NRT to patients are now commonplace in the NHS. How convenient, for if the government wants to stop people smoking it¹s going to have to make up the loss of revenue somewhere and what better way than by persuading people to use and then buy NRT? NRT is now a multibillion dollar industry.

At this point it is important to say that it is high time that the relationships between NRT vendors and the government and the NHS were fully explored. We must ask who is getting the perks and kickbacks from promoting NRT?

Why? Well for one reason it's not ethical to get people addicted to NRT patches and as time goes on we hear of this happening more and more and for some people there are very unpleasant resulting effects. Nor is it right to persuade people to buy or partake of products whose efficacy is highly dubious. Remember, the basis on which these patches are sold is that whilst it is the nicotine in cigarettes that causes one to become addicted to them, it is the nicotine in patches that takes that addiction away. This is self-contradictory mumbo-jumbo.

Next, someone taking the trouble to sift through the website of The National Institute for Clinical Excellence will discover that even they admit NRT to have a success rate of only between 3% and 6% and that only after tracking people¹s progress for one year. Similar American websites list an overall 7% success rate over a six month period. Subsequently, it is not unreasonable to conclude from one¹s own experiences and those of acquaintances who have used these products that the longer the period monitored the lower the success rate. Might it then be sensible to suggest that the NHS saves some money by not wasting it on NRT, unless of course much of this product is supplied free by the vendors in the hope of generating an even larger future market.

Finally, what we are currently witnessing is a government that has failed to manage the NHS effectively and there are many areas in which this writer can see how cuts can be made within the existing framework in order to save money. To begin with there are far too many health quangos which do not seem to performing any useful function other than lining the pockets of their employees. Then, there are the silly health schemes on offer like personal health trainers/consultants as opposed to what we really need such as more nurses and useful hospital staff such as cleaners and porters. Add to that the costs of obsessive 'heath and safetyism', the excess of well salaried managers and bureaucrats and we start to tally up some considerable savings.

Blad Tolstoy.