ADHD overload

Bryan Hubbard — Mon, 29 Sep 2008 11:42:00 GMT

Nobody has anything nice to say about NICE - so, being a contrarian, I will! As you may know, NICE (National Institute for Clinical Excellence) determines the drugs that should be made available on the National Health Service based upon their effectiveness and price.

Invariably it makes decisions that upset some groups, and is seen as a skinflint denying life-saving pharmaceuticals to people in desperate need. That's the rub, of course. People in desperate need a magic bullet, and are more than willing to swallow any drug company hype, whereas NICE has to take a more considered view.

The institute has hit the headlines again in the past week, this time urging doctors to reduce the prescriptions on drugs such as Ritalin for children with ADHD (attention deficit, hyperactivity disorder). It wants to see the numbers of prescriptions reduced to a third of their current levels, and reserved only for the most extreme cases.

There are a number of pressures going on here, and NICE is being the voice of reason. The first pressure is from the drug's manufacturer. Years ago, WDDTY got hold of a secret memo to the salesforce, stating that it was concerned that too few children in the UK were taking Ritalin. It was the start of a concerted drive, and, as usual, the doctors were willing accomplices.

The second pressure is from parents and doctors alike, who both see any form of errant behaviour as 'ADHD'. It's a catch-all umbrella term that captures any form of problematic behaviour that, once upon a time, was dismissed as 'boys being boys' and the like. Any excitability is exacerbated by diet, and often times the removal of sweets and processed foods from the diet will result in an almost immediate improvement to any bad behaviour.

Of course, this is not to diminish the problems of ADHD and the hell that parents of genuinely afflicted children go through. But NICE has it about right - the prescriptions need to be reduced to around a third of the level of where they are now.

It's time to stop seeing every childhood problem as ADHD in order to sell more drugs.

Pills and privilege

Bryan Hubbard — Mon, 18 Aug 2008 14:28:00 GMT

Drug companies enjoy a very privileged position among the industrial sectors. They are granted extraordinarily high levels of privacy and protection, non-drug competitors are not allowed to bring alternatives to market, especially in the area of cancer care, their relationship with doctors is protected by the Advertising Standards Authority and by the media, and their executives sit on many boards that control editorial output. If this were not enough, the pharmaceuticals also sponsor the largest network of lobby groups in the world that influence the thinking of governments everywhere.

Drug companies are not subject to the usual market forces, and can pretty much charge what they like for their drugs, especially if the drugs are new and still in patent. As the pay of their senior executives is shaped by the share price, and as the share price is, in part, determined by the profit line, it's not in anybody's interests to put a 'fair' price on a new drug.

As a result, cash-strapped health authorities such as the UK's National Health Service simply cannot afford the latest, innovative drugs. An organisation called NICE (National Institute for Clinical Excellence) has to make the tough decisions about what drugs to allow on the NHS, and what it has to leave off. It's a difficult place to be because it will inevitably make decisions that upset some group of patients, who may see some wonderful new compound as their only hope against an inexorable disease.

NICE's head, Sir Michael Rawlins, has been defending his position this week after calls that his organisation was barbaric for refusing a new kidney cancer drug onto the NHS list. He points out that the drugs could be sold for a tenth of their current price, and still leave a decent profit for the manufacturer.

Interviewed on BBC Radio 4's Today programme, Sir Michael was told by the interviewer that the drug industry is there to make a profit. This is, of course, its primary motive, as it is for any industrial combine, and its chief objective is to produce a good return for the shareholder.

Again, nothing unusual there.

That being the case, could someone explain why a for-profit group - that puts shareholders and profits before the well-being of the sick - is granted so many privileges and protections?

Now it's clear what the primary motivation is, it's time these safeguards were removed, and that the pharmaceutical industry were treated like any other.

Adverse Reactions : NICE

ADHD overload

Pills and privilege