Regrettable repercussions?

I’m sure Jeremy Hunt must have some admirable qualities.  If nothing else, his gift for concealing these qualities from the casual observer must be commended – though he may be taking his natural modesty just a little too far.  I have reason to believe that he might be a viable choice of translator on a trip to Japan, but a much poorer one if the purpose of the trip is the sale of marmalade (or other preserves) to the indigenes.

I strongly suspect that PPE followed by a career in teaching english to Johnny Foreigner and then PR may not have fully equipped him for his role as titular head of the Department of Health.  The placebo effect, along with its evil twin the nocebo effect,  are notoriously tricksy to come to terms with – even for those with the qualifications to do so.  My own knowledge of the field comes from Daniel Moerman’s very readable book Meaning, Medicine and the ‘Placebo Effect’ – so I am far from expert (but still massively over-qualified for the role of Health Secretary).  This makes very clear that the impact of medicines on a patient can be impacted by rather unexpected factors.  The size, colour and shape of a pill can all alter its clinical effectiveness, as can the number of pills taken (as with heads, two pills are better than one – even if the active ingredient is exactly the same).

The latest policy wheeze dreamt up by Mr Hunt (or his minions – but as our health Gru he must carry the can) is to print the price paid by the NHS for more expensive drugs on their packaging.  It strikes me that this information is likely to have some psychological effect on the consumers of the drugs and this suggests that some unintended clinical consequences could easily arise thanks to our spooky friends placebo and nocebo.  Will we suddenly find that cheaper drugs lose some of their effectiveness?  Could this cunning plan actually force up the NHS bill for drugs?

Even without considering such weird consequences, basic psychology might suggest that some patients taking more expensive drugs could reduce their intake out of a mis-placed sense of civic duty.  If this occurs with antibiotics, for example, we might be unwittingly feeding the growth in resistance.

Surely some drug prices will reflect better or poorer price negotiation by the NHS or on the level of competition in the marketplace.  I’m not sure this data should really be informing either prescribing or subsequent patient behaviour – it should rather be informing procurement within the NHS or regulation of drug companies or the market.

Finally, I cannot help but notice that drugs do not come in normalised quantities such that every prescription contains the same number of days (or doses) of treatment.  As a result, cheap pills bought in large quantities might appear more costly than expensive ones sold in only small doses.  This is going to hopelessly muddle the financial signal we are trying to send to patients, even if by chance they do latch on to the desired response to the new price data.

I strongly suspect that the results of this new initiative will bear little relation to those planned – always assuming there is a plan rather than just implementation of the ravings of a power-crazed buffoon – except to the extent that we live in an infinite multiverse and by random chance we may be living in the one of all possible worlds where Jeremy gets lucky.  However, as no-one will probably bother to measure the results properly – or honestly report them if they do – we will probably never know.

Oh, what a time to be alive!  (And preferably in good health…)

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