The National Institute for Cynical Expedience

The good old Dis-United Kingdom is a place where how long you live and how miserably you die is determined by where you live and which politicians and bureaucrats hold power over you.
If you are lucky enough to live in a place where enlightenment and compassion reign, you will receive the best treatments available for your condition.
Whereas if you are unlucky and live in a place where budgets are more important than people your life will be shorter and considerably more miserable.
There is one Government organisation, amongst so many, that has succeeded in attracting a remarkable reputation for making decisions that render the lives of its victims shorter and more miserable: NICE - the National Institute for Clinical Excellence, or, as Nosher prefers to call it, the National Institute for Cynical Expedience.
Just why this should be the case was an issue that came up in conversation shortly after Nosher had taken a delivery of some old Daily Mails for his compost heap.
'How can anyone justify denying treatment for macular degeneration until a person has already lost one eye to the disease?' Nosher sounded outraged.
I was helping him fork over his compost heap, adding assorted bits of Daily Mail as we went.
'This is happening when the NHS bill for Viagra is skyrocketing' I replied 'men who find it inconvenient not being able to perform like a stallion at stud are considered more deserving then elderly people faced with the prospect of losing their sight completely - because treatment on the one remaining eye is not always successful.'
'Then there's that drug for early breast cancer' Nosher went on 'it's being denied to patients until their cancer is already so advanced the drug is actually less effective - but it will mean the patient is likely to die earlier and be less of a drain on the NHS. How can that be viewed as anything other than cynical expedience?'
'It's actually worse than that' I said 'because Gordon the Moron's Minister for Disease and Ill-Health has stopped patients from topping up their treatment by paying for these drugs themselves whilst receiving NHS treatment. He claims in his idiocy that it would create two-tier health service - so such patients often have to sell their houses to pay for private healthcare.'
Nosher plunged his fork into the compost with great force, and exclaimed:
'Two tier health service! These people who rule over us are morons! We already have a two tier health service: the first tier is composed of those who, like us, look after ourselves, eat healthily and take regular exercise, and thus make very few demands of the NHS unless we're very unlucky, whilst the second tier is composed of those culpable idiots who insist on eating junk food, take no exercise and lead lives full of foolish risk-taking. The latter group consume a disproportionate amount of NHS recourses, leaving very little left for those who live responsible lives, whose care ends up being rationed.'
Nosher almost growled with indignation as he turned over another great pile of compost.
'And then' I said 'there's the Altzheimer's situation, where a perfectly good drug that delays the onset of early symptoms has been barred by NICE for use until the patient is ill enough to almost require admission to a care home, when suddenly it is made available, delaying admission into care but too late to make much difference to the patient's quality of life. This really is a case of cynical expedience, because patients who are given the drug very early on live much longer, have a much better quality of life, but, unfortunately for the Government, are also likely to linger longer once eventually admitted to a care home. The rationale for denying early treatement is totally obvious - and cynically cruel.'
We stood for a while admiring the havoc we had wreaked upon the old Daily Mails, now shredded into tatters and mixed up with freshly-turned compost.
'I'm sure the men and women who make these decisions at NICE are pefectly decent people' I continued 'but their terms of reference are set by the Government specifically on the basis of some carefully obscured notion of cost-effectiveness, rather than clinical excellence, so NICE is actually misnamed. And anyway, in all the three cases we've mentioned, scientific opinon is divided over the defensibility of NICE's decisions, so it can't be as cut and dried as NICE likes to claim. In effect, NICE is the Government's poodle to disguise the fact that health care is now strictly rationed in this country and people are suffering and dying because the resources aren't being made available to treat them properly. That, ultimately, is a political responsibility, not a medical one. All NICE achieves it to disguise the fact that the cynical and idiotic politicians who rule over us are not allocating enough money to spend on making proven treatments available to those who would most benefit from them.'
'Like I say' said Nosher 'The National Institute for Cynical Expedience is a far better description of what NICE stands for. I don't know how the people who work for it can sleep at night.'
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