Beating the NHS postcode lottery – Dom’s on the Case

Visit the "Dom's on the Case" homepage at BBC iPlayer

2008 marks the 60th anniversary of the establishment of the National Health Service (the NHS) in the UK. While it has undoubtedly served the British public well in that time, the five part BBC1 series Dom’s on the Case continues the current trend for documentary programming which investigates inequalities with the NHS system, specifically geographical inequalities which arise from the so called ‘postcode lottery’.

Previous BioethicsBytes posts have highlighted resources which have examined this issue in detail (including The NHS Postcode Lottery: It Could Be You – Panorama and Herceptin: Wanting the wonder drug – Panorama), so here we highlight some additional issues raised within the third episode of Dom’s on the Case, which was first broadcast on BBC1 on Wednesday 24th September 2008, at 09.15. In this 45 minute programme, reporter Dom Littlewood highlights some of the inequalities which arise from differential prescription charging and access to drugs across the UK. While the programme’s tone may seem excessively negative – insofar as it presents only the perspectives of aggrieved patients and members of the public – it offers a number of short clips which provide concise descriptions of the various sources of inequality. Further it highlights the extreme measures that some patients feel forced to take in order to “beat the postcode lottery” (00:10:05) and access the drugs and treatment they feel they deserve.

NewsfilmOnline goes live

I am delighted to report that the NewsfilmOnline (NFO) project – a joint venture by ITN, Reuters and the BUFVC – has gone live. The archive allows academics at Universities subscribing to the BUFVC to access and download copies of significant news stories. Several of these are relevant to teaching of bioethics and will form the basis of forthcoming posts on this site. From early experiments with the new service it looks like you need to log on from an institutional computer to access the full functionality of NFO, although the database can be searched using any machine.

Screenshot from NewsfilmOnline (www.nfo.org.uk)

The NHS Postcode Lottery: It Could Be You – Panorama

Watch "The NHS Postcode Lottery: It Could Be You" online at the BBC's Panorama homepage

In this edition of Panorama (first broadcast in the UK on BBC1 at 20.30 on the August 18th 2008), reporter Shelly Jofre investigates the “postcode lottery”, an expression that has come into usage to describe differences in the availability of medicines and other treatments dependent upon where you live, and hence under the authority of which Primary Care Trust (PCT) your provision falls. This thirty minute episode focussed on discrepancies in the guidelines for prescribing three medications: Avastin, Lucentis and Aricept, which are used in the treatment of bowel cancer, wet age-related macular degeneration (wet AMD) and Alzheimer’s Disease, respectively. What all three drugs have in common is that they are licensed as safe and effective for use in the UK, but have not been approved for unrestricted provision on the NHS by the National Institute of Clinical Excellence (NICE).

Using the stories of patients – including the author Terry Pratchett – and their doctors, The NHS Postcode Lottery explores the various agencies who have a role in deciding whether or not these drugs could or should be provided at the point of NHS care, and to whom they should go.

This is an engaging, if a little sensational, introduction to some of the ethical issues raised by current resource allocation practices within the UK healthcare system, and – insofar as it is organised around three ‘case studies’ of approximately ten minutes in length – it could form the basis for discussion of resource allocation within a GCSE science or biology lesson (see the BioethicsBytes “Bioethics in the UK Curriculum” website for details of curricula requirements in this area). This post highlights the framework into which these cases fit and, based on the information presented in this episode of Panorama, it addresses two questions: How does the ‘postcode lottery’ arise? and What are the consequences of it? It also provides a rough guide to how the programme might be used in teaching.

Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer – Bazell (1998)

Bazell, R. (1998). "Her-2: The Making of Herceptin". New York: Random House.

In his interesting and insightful account of “the making” of Herceptin, Robert Bazell, shows how the creation of a new drug is not only a scientific process, but also a social endeavour involving patients, doctors, regulators, funders, politicians, activists and the media. This is particularly so when it comes to clinical trials for a new product, and Bazell’s description of this procedure for Herceptin (Trastuzumab) is detailed and would form an excellent resource for illustrating its complexities and/or discussing its complications.

While the book deals with much more than the clinical trials of Herceptin – including the sources of early interest in the Her-2/neu receptor in breast cancer and the collaborations that eventually brought the potential of this monoclonal antibody to the attention of Genentech’s management – this post focusses on the clinical trials that formed the basis for its licensing by the FDA (Food and Drug Administration) in the US and subsequent worldwide use as an adjuvant therapy in advanced (metastatic) breast cancer.

This post is accompanied by a BioethicsBytes Extended Commentary on the making of herceptin (available here), which discusses some additional bioethical issues raised in this post.