Episode 91 – 1st July 2011

We have an exclusive clip of Chris Bryant kicking off about Bishops in the Lords, look at Medical Magic Mushrooms, and find out what happens if you don’t wash for 40 days.

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Medicinal Magic Mushrooms (1:49) by Liz Lutgendorff (ft Roland Griffiths)
Johann Harigate (11:51) by Dean Burnett
Bishops in the Lords (21:23) by James O’Malley & Liz Lutgendorff (ft Chris Bryant)
NHS Changes (25:45) by Adam Jacobs
Creationist Geology (32:59) by Salim Fadhley (ft Stephen Newton from NSCE)
Fragile Social Networks (42:42) by Steven Sumpter
Bad PR Results (48:14) by Michael Marshall
Smellytweet Update (58:26) by James Thomas
The sketch at the end is by David Lovesy and Brian Two

Follow-Up Links:

8 thoughts on “Episode 91 – 1st July 2011

  1. Adam:

    I don’t really disagree with the points you are making, but there is no need to bring in the market metaphor of “supply and demand”. Rationing is a response to scarcity, that’s all. No need to shoehorn the idea of a market in there.

    Demand for medical services does not work like traditional, economic demand because people don’t get sick or well in response to a change in the availability of medical services. They may be more willing to visit a GP/hospital, but that doesn’t actually make them sicker, and as I understand it doctors are quite adept (if somewhat annoyed) at turning away the Worried Well before they can consume too many NHS resources.

    Your summary of the solutions also misses some middle ground. Why not increase budgets to cope with the aging population, AND introduce some level of rationing?

  2. I am in awe of Liz and Salim’s interview editing skills. Having tried it myself last week, the output quality you two consistently achieve is amazing.

    I remember with a cringe the early attempts at sketch humour in the Pod Delusion. With no disrespect to those who have bravely gone before, David Lovesy is a great addition.

  3. following on from the reply above, i think the nhs piece was a little simplistic, the classic supply and demand concept does not apply to health services in the same ways as other commodities

    for example, one could look at how to reduce supply. a significant proportion of health issues are lifestyle and environment related (many cancers, heart problems and allergies). exploring ways of reducing these, as the nhs is currently doing to a small degree, would help reduce demand.

    other forms of prevention, such as a yearly ‘MOT’ where people sit down with a medical professional and get the kind of attention and care that has been shown to work well as a placebo, may also reduce demand.

    there is also the issue of costs. a system where companies use patents to charge extortionate amounts of money for drugs which cost far less to produce has the effect of funneling wealth out of the nhs and into private pockets. i don’t have a practical short-term answer for this, but it is a topic that merits investigation.

  4. Pete:

    I was really only bringing in the supply and demand stuff to make the point that although it’s the traditional economic solution to scarcity, it’s not really applicable in the NHS. So I think we basically agree.

    Although I’m not sure I agree that demand doesn’t work like that. While the extent to which you get sick may not be affected by prices (actually it wouldn’t surprise me hugely if it did, as market mechanisms can be very powerful, but I don’t know of any data either way), I would certainly expect the extent to which you then seek care to be affected by market mechanisms (although willing to be proved wrong about that if you can show me any data). However, where I’m sure we do agree is that that kind of market mechanism would be a really lousy way to plan the NHS.

    As for your point about increasing budgets plus rationing, rather than a strict either/or, again I agree with you. That’s probably a sensible solution. I did mention that briefly at one point in the piece, but perhaps you missed it, as I didn’t repeat it in my summing up at the end.

  5. Kev:

    I think I’ve answered your point about supply and demand in my response to Pete. To sum up: market forces probably could be made to apply to the NHS, but that would be a really, really bad thing to do.

    Your point about prevention is well made. Keeping people healthy is a great way of reducing demand. I totally agree that the NHS (and probably other bits of government as well) really need to keep spending money on preventive things.

    As for your yearly MOT idea, do you have any data on that? I don’t find it self evident that something like that would reduce demand, but am prepared to believe it does if someone shows me good supporting data.

    Now, drug costs. The problem is that it costs unbelievably large amounts of money to develop new drugs. No company would ever do that if they didn’t have the benefit of patent protection that allows them to charge a price that allows them to recoup their costs.

    There are, as far as I can see, 3 rather separate approaches to that problem.

    The first approach, which is completely feasible and should be encouraged to the max, is to use generic drugs rather than branded drugs whenever possible. Patent protection doesn’t last forever, and when a drug is out of patent, generic copies of the drug can legally be made, and are usually much cheaper than the original drug. Doctors should always (well, almost always, there are some very limited circumstances when that’s not quite true, but they are rare) prescribe generic alternatives if they exist. A great many useful drugs are out of patent, so this approach has considerable merit.

    The second approach is to take drug development out of the hands of private companies and for drug development to be government funded. I’m not sure that would save any money, because government would then have to fund the huge costs of drug development themselves. Also, history does not give us any examples where this has been successful as far as I know. That’s how they used to do things in the Soviet Union, and I don’t believe any of the drugs developed there are still in use.

    The third approach is to figure out how the cost of drug development can be lowered. I do actually believe that there is huge potential there. As someone who works in drug development, I can see at first hand that many things are done in a rather inefficient way. However, the problem is that it all comes down to risk and safety. Part of the reason why it takes so long is that it is very strictly regulated, because society is not prepared to take the risk of pharmaceuticals that have nasty and unknown side effects. Obviously nasty side effects are a bad thing, so on one level that’s a reasonable attitude to take, but I do wonder if we have become a little too risk averse, and have overlooked the huge costs of that risk aversion. Perhaps we could have a situation where drugs were only a little bit more risky but a whole load cheaper to develop if the regulations were a little less strict, and perhaps that could be a reasonable trade-off. However, I don’t think that’s realistically ever going to happen. No politician would ever dare to stand up and say they’re going to make it more likely that a drug with nasty side effects would get licensed.

  6. Hi Adam

    I’m not aware of any studies regarding an ‘MOT’ style consultation, it was an idea that came up in a discussion with a friend who is involved in complementary medicine research. The premise is that the placebo effect of many complementary therapies is caused by the client feeling listened to and allocated a decent period of time by the therapist. An hour provided by the NHS would provide not only the placebo effect of being listened to, but also the opportunity to catch illnesses that would be costly to treat before they became too serious. It would also be another opportunity to suggest lifestyle changes to improve health

    As regards drug prices, I’d go for your option 2, to nationalise drug research. I accept this is unlikely to happen! According to various studies, drug companies take out more in profits than they invest in R&D, and spend up to three times more in admin and marketing than is invested in R&D. Nationalised research would mean no profits being taken out and a hugely reduced marketing bill, which could either be used for more R&D, or cheaper drugs.

    I don’t think any comparably developed country has ever tried this, so it’s hard to say what would happen, but taking the profit motive out of research would certainly solve a number of problems regarding how drugs are marketed, how studies are manipulated etc

  7. Does anyone have a transcript of the Dean Burnett piece? It just passed by in an unintelligible blur. SLOW DOWN.

    I struggle to follow Liz’s speech too. It has improved, but there’s still some way to go.

    Please, everyone speak SLOWLY and CLEARLY.

    Surely I’m not the only one whose listening pleasure is spoiled.

  8. Enjoyed Dean Burnett’s piece, Johann Harigate, and his contributions to earlier episodes. Just one thing: please speak a little more slowly and pause for breath occasionally. Hope to hear more from you in future.

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