The Politics of NHS-ConMedChapter 3, The politics of NHS-ConMed: Why are expensive treatments preferred to inexpensive, unsafe preferred to safe, and ineffective preferred to effective?by Steven Scrutton17 August 2011 
Chapter 2, The History of ConMed Chapter 3 - Synopsis This chapter looks at the financial politics of health care, and how the funding of health has become a centrally important part of the nation's political and economic life. It examines how this is now dominated and controlled by the government funded NHS-ConMed establishment. It examines the profitability and wealth of the Big Pharma companies, and the social, economic and political power they wield. It looks at how the NHS-ConMed partnership has created a monopoly that completely dominates not only our health services, but the way we think about, and understand our health.
The original intention of the NHS was not to give one type of medicine a monopoly, nor to exclude traditional therapies. Its commitment was quite clearly to provide 'the best medicine for all'. The NHS became a monopolistic supplier because by the start of the 20th century, and certainly by 1948, ConMed was the best organised and the most vocal medical therapy. At its inauguration politicians and NHS managers probably believed they were providing 'the best' medicine available, and as the decades passed, the dominance of ConMed has grown to a point that no-one bothers to ask questions about its efficacy. Its position has become almost unassailable. Meanwhile, traditional medicine has been virtually excluded from the NHS. People who want 'drug free' treatments have either to pay for them privately, or do what most people have had to do - to use drugs because they are the only NHS treatment on offer, free at the point of need. Arguments that traditional therapies are safer, more effective, and less expensive are summarily dismissed by the NHS establishment. Safety Effectiveness Cost This extraordinary scenario may seem entirely irrational. It certainly raises important political, social and medical questions about why the NHS has created a monopoly market for ConMed, and why traditional therapies have been virtually excluded. So why are expensive treatments preferred to inexpensive treatments, unsafe treatments preferred to safe treatments, and ineffective treatments preferred to effective treatments? The justifications used by NHS-ConMed (for instance, "there is no scientific evidence that traditional medicine work") are merely smokescreens. The real answer is found by asking one simple question - "who profits financially from the NHS-ConMed monopoly?" "Following the money" in this way leads in just one direction - to the mighty industrial-commercial world of ConMed, and particularly to the Big Pharma companies whose huge UK profits are won almost entirely via their monopoly relationship with the NHS. Yet the money trail is now much wider than Big Pharma, involving the large political, social, financial and economic interests that have become dependent on the NHS-ConMed establishment. It is these political and economic issues that will now be examined. The profitability of the NHS-ConMed establishmentThe rise of the pharmaceutical industries during the 20th century was meteoric. The purpose here is not to chart this rise but to examine the massive social and political influence and power NHS-ConMed has today because of its wealth. Before World War 1 there were dozens of pharmaceutical companies in Europe and in the United States, but it was the war itself that triggered America’s explosive development in the field of organic chemistry” Griggs (p261) Drug patents and profitabilityThe influence of the NHS-ConMed establishment is based on wealth. Big Pharma has found that selling drugs is a highly profitable enterprise. When medicines were based on common plants and herbs it was not so profitable. When ConMed switched to more exotic plants, and then to dangerous mineral substances, poisons and chemicals, it not only made the ingredients more expensive but ensured that the process of turning them into 'acceptable' medicines required considerable development and research, and this has always been their main defence for the cost of drugs. Patents are vital to ConMed, to such an extent that drug companies began to 'isolate' the 'active ingredients' of naturally occurring plants and substances. The history of Aspirin is illustrative. Hippocrates (circa 400bc), often called the father of modern medicine, left historical records of pain relief treatments that included the use of powder made from the bark and leaves of the willow tree. It helped to relieve headaches, pains and fevers. In 1829 scientists discovered that the active substance in this traditional remedy was 'salicin', contained within the willow. In 1899, Felix Hoffmann, who worked for the German drug company Bayer, made salicylic acid and gave it to his arthritic father - with good results. Hoffmann then persuaded Bayer to market the new 'wonder' drug. Aspirin was patented on 6th March 1889. Whilst it is not possible to patent the bark and leaves of the willow tree, it was possible to patent the isolated 'active' ingredient. Then, as now, the ability to patent 'new' drugs has made Big Pharma hugely profitable. Patents are granted by governments. They bestow on the owners exclusive rights to make, use, and sell the products or processes they have invented. Throughout the 20th century, to today, the ability to patent drugs is vital to Big Pharma profits. In the case of aspirin it was ancient knowledge that led to a patent - a herbal remedy, readily and cheaply available, plundered for the financial benefit of the rapidly expanding industrial medical complex. Big Pharma had arrived! Patenting means that drug companies can charge almost what they like for their drugs. Competition from other drug companies is barred during the patent period. Big Pharma has only to market the drug successfully and profits are assured. Initially drug marketing was done through successful advertising campaigns. Now, with their NHS partner acting as a monopoly retailer, all they have to demonstrate is 'patient need', and they have a ready-made market. The NHS is, after all, a highly respected government-funded institution, and it now sells and distributes ConMed drugs on their behalf. Moreover, the marketing of drugs appears to less business and profit motivated when done this way! And as the NHS-ConMed partnership has developed, successive governments have given it access to an apparently bottomless pit of tax-payers money, which both increases and guarantees ConMed profitability. The Department of Health’s attitude towards even the most expensive drugs has often been stated - patients should have access to them, they should not be refused treatment, regardless of cost. This may seem a laudable position to take but it is undoubtedly a foolish one, both financially and medically. The cost of NHS-ConMed drugs bill has become astronomical. Indeed, there is increasing evidence that national health services throughout the world are being led inexorably towards bankruptcy, notably in countries such as the UK and the USA where ConMed has attained a virtual monopoly position in health care. ConMed – a high stakes industryThe enormous profitability of Big Pharma ensures that they operate in a hard, ruthless, competitive business world. Company shareholders invest their money in the expectation of high returns. Yet if the rewards are high, the cost of developing drugs (research and development costs, the task of testing their efficacy and safety, the need to sell to patents - and indeed the cost of compensating people who are subsequently damaged by them) is also high. Massive resources are invested in each new drug, and the success or failure of drug companies can rest on getting a large return on each investment. Indeed, investing in a new drug without getting it to market (for instance, because of unacceptable adverse reactions during testing), or failing to obtain a suitable patent, can be disastrous for ConMed companies. Big Pharma has much to lose once it commits to developing a new drug. If they get it wrong they can easily find themselves financially over-committed, and facing insolvency. For instance, the giant USA drug company Merck has had a particularly difficult time in recent years and its stock market price has plummeted as a result. The company had to withdraw its anti-inflammatory drug, Vioxx as a result of its adverse reactions and it is now facing thousands of law-suits arising from the deaths it caused. Worse for the company is that there is evidence that they were aware of these lethal DIEs, so litigation is resulting in heavy compensation payments. Moreover, the company faces other problem. For example, the life of important patents on some of its profitable drugs, like Fosamax, are coming to an end. The media also discusses failed drugs on the basis of the economic health of the nation, and the company. Concern about the DIEs of a drug appears to be secondary to the financial consequences of drugs causing harm to patients. Take a look at this Reuters article on the drug Avandia as just one example of this type of journalism: http://www.reuters.com/article/idUSTRE66E11220100715. Notice that the concern is about the profitability of GlaxoSmithKline, its share price, and how huge sums ($2.4b)paid out to patients in legal settlements can be paid, and discounted against future trading. Yet this is a problem not only for the companies involved, but for national governments too. The US government felt that Merck was so important to the national economy it had to be saved. Legislation was proposed designed to ban 'class action' lawsuits - the effect of which will effectively eliminate compensation claims for the pain and suffering caused to Vioxx victims. So the survival of drug companies has become a vital concern, not only for Big Phara companies, but for national governments. Drug companies make huge profits, they employ large numbers of people, and the financial contribution they make to national economies is immense. None of this means that ConMed contributes positively to health, or that they do not cause immense harm and suffering to patients. It is just an incontrovertible statement - that ConMed’s commercial and financial importance can now outweigh medical issues. The financial viability of drug companies has become so important to national governments that this transcends even the health and suffering of patients. By 'following the money' we can begin to piece the veil of deception that surrounds health care provision. We can begin to uncover and understand the hidden agendas and the conflicts of interest. We can begin to see through the decades of propaganda and misinformation we have been fed. We can make sense of the decisions of national governments about health care provision that may appear irrational. And no-one should underestimate the power of propaganda when in the hands of a powerful and influential establishment. In the UK the NHS-ConMed monopoly drives large sections of the national economy. It makes huge personal fortunes for large numbers of people. It is a major employer. And in comparison to these economic considerations the health status of patients, even the health status of the entire nation, seems to have become a secondary consideration. It is in this way that for over 60 years, NHS ConMed has persuaded us to spend £100 billion on a medical system that does not work! Health is good, therefore spending on health is goodSo what is the political benefit of spending massive resources on health? Since 1948 NHS expansion has been based on one extraordinary idea - that as health is 'good', a vote winner, spending on health must also be 'good'. It is on this single idea that the NHS has been able to grow at such a phenomenal rate. There are few other areas of government spending that have had such uncritical and unquestioned support over such a long period of time. Health is an issue that no political party in our democracy can ignore. In any election campaign, a politician who does not support additional NHS funding is likely to end up on the losing side. NHS popularity has made it an uncomfortable issue for politicians, political parties and governments. Indeed, the NHS has been, at least in part, instrumental in bringing down virtually every government since its inception. Each new government has been committed to increased NHS spending, but never able to satisfy a critical electorate that they were doing enough. Each new opposition party has sought to win back political power by making elevated promises of increased NHS funding, improving management structures, and the like. And so the spending circus has continued through 6 decades. This political commitment to health spending is not unnaturally welcomed by ConMed. The more government spends on health the more profitable their business become. The NHS-ConMed partnership is mutually beneficial! Yet if health spending is misdirected, if it is leading in directions contrary to people's health and welfare, if it is causing more sickness and disease (as will be argued, see chapter five), increasing expenditure on the same failed product can lead only to an ever-increasing disaster. The situation can be likened to the captain of a runaway tanker, heading towards an iceberg, who, with a view to impending disaster, can only think to order greater speed forward - never considering the value of changing direction! The question about NHS resources are being spent, and examining the outcomes of that expenditure, has rarely been considered. Every increase in spending during the last 60 years has been almost exclusively on ConMed treatment - simply because ConMed has persuaded us that increased expenditure on its drugs, medical testing, and ever-more complex operations, is the best, and indeed the only way forward. There are some early signs that questions relating to cost-effectiveness are beginning to be raised, albeit in a modest way. In February 2006, the Kings Fund, an independent charitable foundation that carries out research and policy analysis on health issues, said that the Government should be clear about "what would be gained from further investment in the NHS" before it commits any more funding. The report stated that there had not been a detailed review of "the benefits and costs of bringing in existing policies", and that without this it was hard to know if patients are receiving value for money. That the Kings Fund has made such a statement is remarkable. It recognises that there has been an insufficient 'return' on NHS investment, although there is certainly no recognition yet that it has been caused by the NHS-ConMed monopoly. But at least this report has pointed to the inadequate monitoring of the relationship between health spending and health benefits. No nation can afford to squander enormous resources on health care that is ineffective, when there is little or no evidence that health care is producing better health. Griggs (p320) said: A recent WHO study has shown, in fact, that in a number of industrial countries the life expectancy of people over the age of 60 has actually started to fall. In the US where expenditure on health care is enormous, life expectancy for men and women of all ages is falling. Infant mortality rates are rising in many developed countries. This insight appears in a book written in 1981! Such evidence has always been overlooked, and as far as the NHS-ConMed establishment is concerned, for good reason. It does not fit the picture that NHS-ConMed claims for itself, that it is winning the war on disease, and that we are better for it, and living longer too. Indeed, the idea that health care spending can be wasted, that the way we spend money can seriously damage our health has rarely, if ever, been seriously considered. If the NHS spends money on ConMed it must be the bestYet even if the NHS-ConMed spending spree has been misdirected, the impression that such spending gives patients has been powerful. No Government, no NHS management, can spend vast sums of public money on health without tacitly expressing a view about the value of that spending. Most people would assume that the NHS spends its resources on health treatments only after they were fully considered, and found to be safe and effective. Therefore, there is an implicit assumption that the NHS spends its money on the 'best available medicine', one that will make us fitter and healthier. New hospitals, new hi-tech equipment, new GP surgeries, and increased spending on new, more expensive drugs, is all done on the basis that they will benefit our health. Patients naturally believe that the NHS would not knowingly spend money on treatments that are either ineffective or dangerous. So few people consider looking beyond NHS-ConMed treatment. They leave it to people they assume to know best to make decisions about the best treatment available. And the contrary argument also applies. If the NHS refuses to provide patients with traditional therapies the assumption implicit in that decision is that such therapies are not so good, not so effective - they are 'inferior' types of medicine. So we must add to the unquestioned assumption that health spending is politically ‘good’ another assumption that health resources are being spent on treatments judged to be 'the best available'! Most people do not study health matters in detail, relying instead on 'experts', the people they believe should know best how to invest in health provision! But these 'experts' invariably have a vested interest in the NHS-ConMed establishment, and their expertise is neither unbiased or independent. The economic advantages of medical failureBefore moving on from medicine and profits it is worth noting that any truly successful medical therapy (that is, one that is successful in medical rather than commercial terms) would not be profitable. This is a major problem for traditional practitioners who have a successful track record of treating patients. When a therapy is successfully applied the therapist loses a patient! His or her business is diminished. Indeed, the medical success of traditional therapies is one of the problems many therapists face in establishing a business! Compare this to the business model created by NHS-ConMed. A sick patient is given drugs that, at best, ameliorates their condition (and often requires a lifetime prescription), and at worst, generates serious DIEs that in turn often require further medication. It is this medical 'failure' that makes ConMed such a successful and attractive business venture! It is not in its financial interests to improve health, or to prevent and cure disease (even if it had the ability to do so). When sick people are treated 'successfully' no further treatment is necessary, and profitability is reduced. If NHS-ConMed was really able to produce "miracle" cures, or "magic bullets" it would actually be harming its commercial interests! It is in the maintenance, and even the creation and expansion of illness, that ConMed’s commercial and industrial growth, and future profitability, depends. ConMed has been hugely successful in this respect. It has managed to develop drugs that are successful in temporarily masking the symptoms of illness, whilst avoiding the cure and elimination of the disease itself. Pain killing drugs are probably the best example of this. Taking a pain-killer can successfully mask pain for a time, although they do little to deal with the underlying cause of the pain. Once the chemical effect of the drug begins to diminish more drugs are required. If the condition generating pain continues (or worsens as the underlying condition is not being treated) the patient is usually given more powerful pain-killing drugs. In diseases like arthritis this can, and often does form a never-ending sequence:
Similar sequences can be seen in most NHS-ConMed drug treatments. Most NHS-ConMed treatments offer little more than temporary amelioration. The drugs may appear to help but they achieve little permanent or lasting change. Yet by masking the symptoms of illness, without actually treating the illness, ConMed is able to maximise drug sales and profitability whilst disease continues unabated. Indeed, ConMed drugs will often exacerbate the initial disease, or create 'new' diseases through their 'adverse reactions' - which are really new disease states, and more appropriately called DIEs. And by doing so, they generate new business for Big Pharma. In this way medical failure is transformed into commercial success. The sick individual regularly needs either more drugs, or more powerful drugs, or entirely new drugs for a 'new' disease caused by earlier drugs. ConMed’s financial success has been, and continues to be, generated by medical failure! The motivation of Big Pharma - profit or safety?Big Pharma is driven by financial profit, and the need to pay a dividend to shareholders. In this it is no different to any other commercial enterprise. Their interest in public health is a means to this primary end. ConMed companies will usually quite happily admit this, but add that being 'profitable' demands that their medicines and treatments are effective and safe. This would be true but for two considerations:
So when Big Pharma is asked to explain why it has marketing failed and unsafe drugs, it should be remembered that patient health and safety is not their only, and perhaps not even their main priority. Uppermost in the agenda is to restrict damage to their financial and business interests rather than proving that ConMed treatments are safe and effective. Similarly, the main issue for governments and many politicians is that the economy would be compromised if they allowed too much criticism of the NHS-ConMed establishment. Governments cannot allow Big Pharma to fail, or even to disinvest from the country. They have manoeuvered themselves into a position of inter-dependence, they have a vested interest in buying ConMed drugs, and supporting ConMed's profitability. Again, the NHS-ConMed partnership is useful here. The NHS is the public face of the NHS-ConMed establishment and its commitment to safe health care is regularly and routinely enunciated. Yet the NHS, in defending the medicine it provides, feels obliged to defend the safety and effectiveness of ConMed treatment. In this, the two partners complement each other well:
But in other ways it is an uncomfortable alliance. The primary interests of the NHS is safe and cost-effective health care. The primary interest of ConMed is profitability. So the NHS often finds itself having to defend what have become regular failures and disasters. And ConMed gets annoyed when government bodies, such as the MHRA and NICE, seek to restrict patient access to profitable drugs. It is not that the FDA in the USA, or the MHRA and NICE in the UK, are not trying to make the pharmaceutical drug culture safer. It just seems that there are too many powerful vested interests, too much money, power and influence, too much at stake for them to be allowed to do so effectively. They cannot risk open conflict with the NHS-ConMed establishment, and the overwhelming pressure and influence it can bring to bear on their decision-making. So the NHS provides ConMed medicine with a public credibility its performance does not deserve. It deflects attention from the damaging publicity its failures would otherwise attract. It is likely that if ConMed had to stand on its own, and was recognised for what it is, a commercial, profit-making enterprise, serious questions about its performance would have been asked many decades ago. Unfortunately, the confidence that the public places in the NHS has shielded ConMed from the kind of critical analysis its performance deserves. The NHS-ConMed monopolyThe NHS-ConMed partnership provides mutual benefits. ConMed, eager to increase their sales at the highest possible prices, to maximise their profits, to pay their shareholders, and to survive in the 'high stakes' medical business world, need to support of politicians and governments. Politicians and governments feed the monopoly with money because it knows that spending on health is a vote winner, and they want to be seen spending as much money on the NHS as possible. On its own ConMed would have never convinced the public of the efficacy or safety of its drugs, or to spend as much on them as it does. Its alliance with the NHS has been vital to selling its promises and dreams successfully. It has won public confidence. People have been happy to accept that the NHS is offering us the 'best medicine' available, that the NHS has objectively evaluated and validated ConMed’s claims and promises. So the NHS and ConMed have become inseparable, indeed, dependent upon each other. Both parties are content to live the same lie.
The MonopolyIt may seem strange that whilst both Labour and Conservative governments have sought to dismantle monopolies in the UK in recent decades, including former public monopolies such as water, electricity and gas supply, they have quite unashamedly developed, supported and maintained the NHS-ConMed monopoly intact. Why is NHS-ConMed a monopoly? Quite simply, it is a monopoly because anyone visiting their doctor’s surgery, or visiting an NHS hospital will automatically, and exclusively, be offered ConMed treatment:
Such treatment decisions are taken routinely, and without alternatives being offered. Patients will not be given information about how a homeopath, an acupuncturist, a herbalist, a reflexologist, or any other traditional therapist, would treat an illness. Patients will rarely find literature explaining that there are alternative medical therapies to treat illnesses of every description.Even if the patient enquires about traditional therapies (s)he will invariably be told that "there is no evidence that such therapies work". This routine 'advice' will be given by NHS-ConMed practitioners who have no training in these therapies, and usually know little or nothing about them. In other words, to use an analogy, they are Ford salesmen telling you that Vauxhall cars are no good! The NHS has taken a unilateral decision to spend its vast budget exclusively on ConMed, even though this is not supported by legislation or government directive. Moreover, it is an interesting and unique monopoly. It should be remembered that every patient (or customer) has paid in advance for medical treatment but when they need treatment they are not offered a choice. It is perhaps the only monopoly that consumers are expected to pay for in advance, and then be told what they will receive! If there were just one supplier of motor car, or washing machine, or indeed any other commodity, customers would have a better choice – to buy it or to do without! NHS patients, in contrast, pay their money, and get what they are given, with no pretence of personal choice! The Cost of the NHS-ConMed MonopolyIn other areas of social life, monopolies are frowned upon - for good reason. It is generally understood that monopolies are inefficient, and over-charge their customers. When governments have dismantled other public service monopolies they have usually established statutory bodies (Ofwat, Offcom, etc) to oversee and control their investments, pricing policies and general performance. There is no such body overseeing the NHS. It is willingly fed with public funds, and channels its resources exclusively into ConMed. Traditional therapies, the natural competitors of ConMed, are excluded, ensuring that NHS-ConMed is not subject to competitive comparisons about its performance, its safety, or its costs. ConMed treatment is more expensive than it should, or would be if real competition was permitted within the NHS. There is little investigation into whether enormously expensive treatments are over-priced, or cost effective when compared to traditional therapies. Exorbitantly expensive drug treatments are never compared with treatments offered by traditional therapies. So it is not surprising that the NHS is often suspected of being 'overcharged' by its commercial business partner. The 'science' of drugs and homeopathic remediesSo how does the monopoly justify itself?
Both arguments are without foundation, but once again it is again important to 'follow the money' in order to understand why such claims are made, and how the monopoly seems to substantiate them. NHS-ConMed claims that it is 'securely based on science'. Chapter 6 closely examines the claims of this 'science' and will show that it has consistently failed to protect the public from costly, ineffective, dangerous and sometimes lethal drugs. All drugs have been 'scientifically' tested but this does not prevent large numbers of 'scientifically' validated drugs being regularly withdrawn when they are later, often much later, discovered to be ineffective, unsafe, or both. The 'guarantees' offered by ConMed 'science' are to regularly proven to be worthless! The sad history of testing, licensing, prescribing and eventually, banning ineffective and unsafe drugs can be compared to the history of homeopathic remedies. Most common homeopathic remedies have been in use for over 200 years, with a proven record of success, and in complete safety. No remedy has ever been withdrawn because it was 'unsafe' or 'dangerous'. Yet the 'science' argument is even more specious than this. When NHS-ConMed is presented with an individual who has been treated successfully by homeopathy (or other traditional therapies) the event is usually dismissed as being 'anecdotal' or 'unscientific'. This seems to entirely discount the science of empiricism (that is, "I was ill, I received treatment, and now I am better") when in fact the sole outcome most sick people want is to get better, and to do so safely! Moreover, even when good scientific research proves homeopathic remedies to be effective in treating disease, or suggests how and why the therapy might work, NHS-ConMed usually ignores or dismisses it. There is nothing rational or reasonable in this attitude, just sheer prejudice. (To read more about homeopathy and science, see Dean 2004, Bellavite/Signorini 2002, and the website of the Homeopathy Research Institute). It is money rather than science talking here. The acceptance of ConMed drugs, and the denial of homeopathic remedies has little to do with 'science'. There are none so blind as those who do not want to see - or perhaps, more accurately, those who are just 'following the money'. It is not science that NHS-ConMed is based upon - it is the preservation of a highly profitable monopoly.
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