6:02 pm - January 13th 2010
If you were to ask David Cameron to sum up the content of the Conservative Party’s draft health manifesto in three words then I dare say he’d reply, ‘decentralisation, accountability and transparency’.
Read the manifesto for yourself, and you’ll quickly find three much better words to describe it, ‘lies, libel and price-fixing‘.
Now, admittedly, you do expect that political parties will be somewhat economical with the truth in setting out their manifestos, but by any reasonable standards, the lie contained in this manifesto’s introduction is a whopper…
We understand the pressures the NHS faces. In recognition of its special place in our society, we are committed to protecting health spending in real terms – we will not make the sick pay for Labour’s Debt Crisis. But that doesn’t mean the NHS shouldn’t change. When you’re more likely to die of cancer in Britain than most other countries in Europe –
You are not more likely to die of cancer in Britain than in most other European countries as a peer reviewed study of estimated cancer incidence and mortality rates in 39 European countries, which was published in 2007 in ‘Annals of Oncology’, clearly demonstrates.
What the European Cancer Statistics actually say.
For British men, the evidence in this paper is pretty much cut and dried.
Britain has, according to this study, the 11th lowest overall cancer mortality rate in Europe (215.4 deaths per 100,000 men), slightly behind Germany, which comes in 10th (213 deaths per 100,000 men) but well ahead of The Netherlands (21st, 235.7 deaths per 100,000), Spain (23rd, 237 deaths per 100,000) and France (26th, 247.6 deaths per 100,000 men). In regards to some of the more common cancers in men, Britain has the 9th lowest mortality rate for stomach cancer, 8th lowest rate for collorectal cancer and the 10th lowest mortality rate for lung cancer. On paper, the only common cancer in men in which the UK has fallen behind, in relation to the rest of Europe, is prostate cancer, in which we come 23rd out of 39.
However, we have to be a little bit careful here as these figures are, for most of the countries included in the study, the mortality rates were derived from national incidence rates and rather than being taken from recorded standardised mortality rates. There were also some countries included in the study for which national incidence data was not available, in which case the researchers reversed the calculation and estimated the incidence of each cancer from its recorded mortality rate.
The upshot of is that some of the data, particularly for countries in Eastern Europe, looks to be rather suspect. On paper, both Serbia and Bulgaria are ranked higher than the UK and have a lower estimated mortality rate for all cancers, despite having higher mortality rates for stomach, collorectal and lung cancers and a much lower average male life expectancy than the UK (UK = 77.1 years, Bulgaria = 69.5 years and Serbia = 71.7 years). Both beat the UK by some distance on their mortality rates for prostate cancer, as does most of Eastern Europe, the Balkans and Southern Europe (except Portugal), and what most of these countries have in common is a much lower average male life expectancy than the UK.
Prostate cancer is a disease of old age and, importantly, a disease that men die with rather than die of – around half of all men who die after the age of 50 are found, at autopsy, to have had prostate cancer but only 1 in 26 men diagnosed with prostate cancer die of that illness. As such, the UK’s seemingly poor showing in its mortality rate for prostate cancer is almost certainly a consequence of its higher average male life expectancy.
Taking this into account moves the UK up three places and ahead of Bulgaria, Serbia and Malta, which has the fourth lowest average male left expectancy in Europe (65 years), giving the UK the 8th lowest male cancer mortality rate in Europe behind Switzerland, the Scandinavian bloc (including Iceland), Belgium and Luxembourg.
For women, the picture seems, at first sight, to be rather more mixed. Overall, the UK ranks 33rd in Europe for its female cancer mortality rate, despite having the 7th lowest mortality rate for stomach and collorectal cancers and 12th lowest for cancer of the uterus. Where the UK appears to do very poorly, on paper, is its female mortality rates for breast cancer and lung cancer, where the UK rolls in 32nd and 35th respectively.
There is, however, again good cause to question the validity of the statistical evidence for Eastern Europe, particularly in regards to breast cancer where it is clearly evident, when you look at the data as a whole, that the highest incidence and mortality rates are found almost entirely in those countries that have implemented a population-based national breast cancer screening programme, including the UK ans Scandinavia. Indeed, this assumes even greater importance in this particular study, given that in the majority of cases, the stated mortality rates have been estimated from national incidence rates, which are significantly higher in countries that screen women for breast cancer simply because doctors are routinely looking for it.
It also worth noting that although UK’s female mortality rate for lung cancer is one of the highest in Europe, so to are same mortality rates for much of Scandinavia, which is generally acknowledged as having amongst the best and most comprehensive healthcare systems in the world. Sweden, for example, is ranked 32nd, Norway 33rd, Iceland 38th and Denmark comes bottom of the table at 39th. What this suggests is that the poor showing of all these countries (and the Netherlands, which lies 36th, slightly behind the UK) almost certainly stems from a combination of higher average female life expectancy, relative to Eastern Europe, the Balkans and parts of Southern Europe (Italy & Greece) and a higher incidence of smoking in women in Northern-West Europe and not from shortcomings in the NHS relative to the healthcare systems of other European countries.
If anything, lifestyle factors appear to account for far more of the differences in mortality rates for certain cancers, in women, than the performance of their national healthcare system. Mortality rates for collorectal cancer are, for example, higher in Scandinavia, Germany and part of Central Europe than they are in the UK, which may well reflect that fact that these are areas in which red meat is larger component of the traditional local diet.
The Conservative’s claim that ‘you’re more likely to die of cancer in Britain than in most other parts of Europe’ does not stand up to scrutiny at all for men, while for women the picture is considerably more complex than a simple comparison of the mortality rate for all cancers suggests, on a purely superficial reading. Indeed, one of the key reasons that the UK appears to perform less well than much of the rest of Europe appears to be a direct consequence of measures undertaken specifically to reduce the mortality rate for breast cancer but which also have the unfortunate effect of inflating our own incidence and mortality statistics by ensuring both that more cases of breast cancer are diagnosed and recorded and by helping women to live longer than their Eastern European counterparts. Long enough – in fact – to die of cancer rather than of other causes.
After promising to focus on improving survival rates for cancer, the Tory manifesto adds:
We will measure our success against those countries with the most effective systems of healthcare…
Which will be nice, if the Tories ever manage to figure out what an effective healthcare system is and how to identify it, something they’ve signally failed to achieve in relation to cancer.
The Tory Libel Magnet.
The same paragraph continues by stating that that the plan to:
enable patients to rate hospitals and doctors according to the quality of their care.
Or to put it another way.
We will facilitate the systematic defamation of doctors and other medical professionals by every single fuckwit in Britain with a vague sense of grievance and has a massively over-inflated sense of their own self-importance.
I won’t dwell overmuch on this one, largely because the reasons why this is a lousy idea, not to mention a libel magnet, have been covered in considerable detail by the esteemed Dr Crippen, although I will give this one example of the kind of issues that arise when patients are given an open public platform to air their sometimes ill-conceived and unfounded grievances:
Dr Julia Webster is one of the senior partners at the Sleaford Medical Group. She and I overlapped at medical school, though I don’t recognise her name. Julia has just been “named and shamed” by Baconshit. It seems that she was a bit “short” with a patient who wanted to be treated by a homeopathist, or some such wibble merchant. For that “offence” she is castigated on “I want great care” Has she been consulted in advance before this defamatory material was published? I think not. Has she been given the chance to put her side of the story? I think not. One patient was upset because Julia was not prepared to discuss medical wibble, ergo, Julia is not a very good doctor.
Price-fixing – A strategy for the Rasputin generation
We’ve now done lie and libel, that just leaves price-fixing, which the manifesto mentions here:
British patients should be among the first in the world to use effective treatments, but under Labour they are among the last. The current system lets Ministers off the hook by blaming decisions on unaccountable bureaucrats in NICE, the agency which approves drugs for the NHS. We will reform the way drug companies are paid for NHS medicines so that any cost-effective treatment can be made available through the NHS, with drug providers paid according to the value of their new treatments.
Remember, this is the same manifesto that claims that:
Our reform plan is based on the methods of the post-bureaucratic age – decentralisation, accountability and transparency.
…and that promises to:
scrap all of the politically-motivated process targets
…but also plans to centralise decision-making on the efficacy and cost-effectiveness of new drugs and other treatments and medical devices on a [shadow] ministerial team that currently consists of an ex-civil servant, a former district nurse, a solicitor, a journalist and a chartered surveyor.
To make things even more interesting, that ministerial ‘brains trust’ is not only going to tell doctors what treatments they can’t and can’t prescribe but also tell pharmaceutical companies exactly what they can and can’t charge for their new drugs as well – in other words, its a new system that’s designed to let Ministers off the hook by blaming pharmaceutical companies for profiteering if they won’t supply the NHS on the cheap.
The Tories don’t seem to have thought this through properly.
Yes, there is no express reason why they couldn’t legislate to fix the price of new drugs but what they can’t do, without nationalising a bunch very large multi-national pharmaceutical companies, is compel those companies to supply the NHS at the price set by the government.
Most of high-profile disputes that NICE have been embroiled in the last couple of years have related to the latest generation of drug treatments for advanced-stage metastatic cancers and dementias, drugs for which there is very small market in the UK but which attract a very hefty premium because they extend the life of a terminally ill patient, or delay the onset of dementia, by a few months and, importantly, because people facing up those situations don’t, typically, make entirely rational decisions about their treatment options. The reason these decisions are controversial is because they involve putting a price on someone’s life in circumstances in which, for most people, money is no object and they would willingly pay anything for those extra few months.
Not only does a price-fixing policy not provide any guarantee whatsoever that British patients will be amongst the first in the world to use effective treatments – if Big Pharma doesn’t like the price, it doesn’t have to sell – but it puts Ministers right into the middle of the processes of putting a price on people’s lives – it’s the ultimate political hospital pass and poison chalice all rolled into one. Although most political careers ultimately end in failure, any Minister who willingly takes this idea on board is looking squarely at their career ending like Mussolini or Rasputin, such is the price of making a bad judgment call and fighting the wrong corner on this one.
If the Tories really are serious about implementing this policy then I’d also suggest that they quickly sign up Anjem Choudary, fast-track him into a nice safe seat and hand him the Health portfolio as he’s just about the only person in Britain, at the moment, who doesn’t seem to mind that everybody hates him.
'Unity' is a regular contributor to Liberal Conspiracy. He also blogs at Ministry of Truth.
· Other posts by Unity
Story Filed Under: Blog ,Conservative Party ,Health
Sorry, the comment form is closed at this time.
Reactions: Twitter, blogs
- Liberal Conspiracy
:: The Tory NHS: Lies, Libels and Price-fixing http://bit.ly/7KGiFu
- Evidence Matters
@bengoldacre rt @libcon The Tory NHS: Lies, Libels & Price-fixing http://bit.ly/7KGiFu by @Unity_MoT
- ben goldacre
.@EvidenceMatters mm not sure about unity's cancer figures either. but right on with libel and bizarre drugs committee http://bit.ly/7KGiFu
- Michelle Brook
Makes for an interesting read; a breakdown on Conservative Party’s draft health manifesto http://bit.ly/7KGiFu (via @bengoldacre)
- James Cowley
RT @libcon: :: The Tory NHS: Lies, Libels and Price-fixing http://bit.ly/7KGiFu
- Gareth Winchester
RT @libcon The Tory NHS: Lies, Libels & Price-fixing http://bit.ly/7KGiFu by @Unity_MoT #welovetheNHS
- uberVU - social comments
Social comments and analytics for this post…
This post was mentioned on Twitter by libcon: :: The Tory NHS: Lies, Libels and Price-fixing http://bit.ly/7KGiFu…
- Tweets that mention Liberal Conspiracy » The Tory NHS: Lies, Libels and Price-fixing -- Topsy.com
[…] This post was mentioned on Twitter by ben goldacre, Michelle Brook. Michelle Brook said: Makes for an interesting read; a breakdown on Conservative Party’s draft health manifesto http://bit.ly/7KGiFu (via @bengoldacre) […]
Another Tory fail: http://tinyurl.com/ybq9tjn Better get used to this nonsense if they win I suppose.
- Linky Love for the 14th of January « Left Outside
[…] Unity exposes the Tories’ NHS plans as Lies, Libel and Price Fixing […]
- George Allwell
Liberal Conspiracy » The Tory NHS: Lies, Libels and Price-fixing http://bit.ly/7KGiFu
Sorry, the comment form is closed at this time.