Pre-emptive treatment is going to be possible, and if the state does not fund then it will increase inequalities… regressive taxation is pragmatic but may be divisive..

Taxation is a restriction of liberty, as are fines for littering, or making a public disturbance. It is necessary to restrict freedom of the individual in a civilised social society. A universal health service is also a restriction of liberty if it rations important health treatments that some people cannot afford.. Genetic editing is likely to be ethically difficult for many, and the costs will be substantial. If the state fails to fund such treatments, then inequality will increase, as the rich and informed pay for the service. Overt rationing is supported by the profession… but regressive taxation is another thing altogether..

Direct taxation on cigarettes, and alcohol is in many ways regressive as it taxes the poor more than the rich. The same will be true of a sugar tax, which has been proposed by the parliamentary sub committee on health. ( British lawmakers call for sugar tax to tackle childhood obesity ) It is very important that taxation, overall, should be seen as progressive, so the richer citizens rightly pay more.

The only way to provide the new technologies equitably under a universal system is to ration goods and services. This is pragmatic, and although it will create inequalities, these will be in bands and far less than the alternatives…Differential co-payments are just one method, exclusions are another, insurance is another (employer and employee) and deserts based is one of the least palatable… Tax free health savings schemes allied to co-payments are another..

Richard Smith in the Times 5th December opines: Drugs for the healthy are future of care, say experts

Statin-style drugs to prevent dementia and other serious illnesses will transform treatment and erode the distinction between the sick and the well, the official medical research body has said.

Medicine is moving towards “pre-emptive treatment”, targeting risk rather than disease itself, according to the Academy of Medical Sciences.

Patients will need to decide whether they are willing to take pills for years to cut their chances of sickness, said Sir John Tooke, outgoing president of the academy, and his successor, Sir Robert Lechler. “We need to prepare for this if we want medicine to move from such a disease-focused process to a health-sustaining process,” Professor Sir John said. “This will shape the whole way a health service has to operate.”

Some leading GPs have expressed concern over people being told to consider taking a daily statin to cut the risk of a heart attack by lowering “bad” cholesterol. However, the two professors said that medicine would increasingly move in this direction. Professor Sir John pointed to research trying to identify people at risk of Alzheimer’s saying: “If you wait until full-blown dementia occurs, the structural changes in the brain could be irreversible.”

Adam Brimilow for the BBC reports: New medicines ‘should prevent not just treat disease’

The Academy of Medical Sciences says personalised medicines tailored to the individual present a “great opportunity” to protect health.

It says this is the way public health should go.

But critics say the emphasis in preventing illness must be on lifestyle.

The Academy says scientific advances mean in future there will be more opportunities to intervene with treatment before there are any symptoms.

It argues developments in genetics present a great opportunity to develop highly effective targeted therapies, with a clear idea of who will benefit and who will not.

Pre-emptive treatment

That could include drugs to prevent rather than treat disease.

The Academy’s new president, Prof Sir Robert Lechler, says the NHS should prepare for this.

“I think it’s unarguable that prevention is better than cure, and if you wait until the patient presents with signs or symptoms of kidney disease, liver disease, heart disease, very often most of the damage is done and can’t actually be recovered.

“So if it were possible to take steps while still in health to prevent or delay the onset of disease that seems to make very good sense.”

Sir Robert says he does not just envisage drug interventions for pre-emptive treatment – but his comments have raised renewed concerns about people being “over-medicated”…….

The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

British lawmakers call for sugar tax to tackle childhood obesity


This entry was posted in A Personal View, Commissioning, Post Code Lottery, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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