HIV

NHS Again Denies Access to HIV Prevention Drug Because of Bureaucracy

Government control of healthcare gets dangerous when there are entrenched interests.

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Truvada
Credit: Jeffrey Beall

The United Kingdom's National Health Service (NHS) system of socialized medicine is lagging behind the United States in offering a very useful treatment to prevent the spread of HIV, and it's doing so deliberately.

The NHS has announced—or rather reaffirmed—that it will not arrange for the providing of PrEP drug treatments to citizens to help prevent the transmission of HIV.

PrEP is an acronym for a drug cocktail that, when taken regularly, is hugely successful in preventing an HIV-positive person from infecting an HIV-negative person. In the United States it is increasingly being used as a prophylactic drug, especially for gay men who are sexually active but are not using condoms or are in relationships with HIV-positive men. It reduces the risk of HIV transmission to near zero.

In the United Kingdom, these drugs are only prescribed as a post-sex treatment for somebody who believes he has been exposed. Essentially, it's a "Plan B" for unprotected sex in the United Kingdom, even though it can do so much more.

The NHS already announced once it was not going to provide PrEP drugs as a preventative treatment, which prompted huge outrage from activists. NHS officials promised to look over its system to see if it could change the rules. This week they announced they would not, due to possible legal challenges from "proponents of other 'candidate' treatments and interventions that could be displaced by PrEP if NHS England were to commission it." Yes, that's right: These people cannot get these drugs through NHS because it could disrupt some other entrenched treatment provider who would sue.

It is very much an important reminder than under a socialized medicine system, you are no longer the customer. Some very naïve supporters of nationalized healthcare have gotten it into their heads that government-controlled services eliminate corruption and profiteering in the medical system. That couldn't be further from the truth. Nationalized healthcare puts a government stamp of approval on it, as long as the right regulations are followed. This is the actual example that enemies of "big pharma" always point to: the idea that some powerful company would intervene to block treatment because it has a financial stake in the matter. But it's happening because the government controls healthcare.

In America, it's also true that you're really not the "customer" in health care. Increasingly it's your insurance provider. But until the Affordable Care Act came around, we were all free to reject insurance providers that were not covering the services we needed them to. Now we can still technically do so, but we get fined for expressing our right do without.

Here in the states, we can argue whether it's the role of the government to subsidize drugs that exist for the purpose of letting people have sex more safely. But in Great Britain, that's a ship that has fully sailed. The people who are being denied free access coverage to these drugs are nevertheless forced by law to pay into this national system. Then they have to pay out of their own pocket to buy these drugs online. They are not getting the treatment that they are paying for, and on top of that they have to pay extra.

NHS officials did promise to keep working on it to see if there are other ways to improve or increase the distribution of PrEP. An AIDS activist group has said they're considering their own legal action.

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  1. Yes, that’s right: These people cannot get these drugs through NHS because it could disrupt some other entrenched treatment provider who would sue.

    This is what happens when government policy is driven almost entirely by activists.

    What’s RC’s law on this, you today, me tomorrow?

  2. This is impossible. I’ve been told so many times that patient-focused socialized medicine is a perfect system, far better than our evil profit-driven system.

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  4. “But until the Affordable Care Act came around, we were all free to reject insurance providers that were not covering the services we needed them to”

    My employer had one shit plan before the ACA and has one shit plan after. As an alternative, I could go for a shit plan at 10 times the cost on the exchange.

    1. I had an ok plan before, which got canceled. I was then offered a shit plan for twice the price. Thanks, Obama.

  5. Can they buy the drugs outside the system?

    1. Can you buy cocaine or heroin outside the NHS?

    2. You’d think that would be addressed in the article, but no.

      1. The people who are being denied free access coverage to these drugs are nevertheless forced by law to pay into this national system. Then they have to pay out of their own pocket to buy these drugs online. They are not getting the treatment that they are paying for, and on top of that they have to pay extra.

        See next to last paragraph.

  6. We have a cure for AIDS. It’s called not having unprotected sex with strangers or sharing needles.

    1. Looks like SOMEBODY doesn’t know how to have fun.

      1. He has never been to a Reason cocktail party.

    2. I always have a problem with issues like this too. Why is it valuable to the human race to preserve deadly fucking diseases that can kill us?

      1. Well, you saw what happened to the Eloi, no?

        1. Dude, Eloi taste great, I don’t know what your point is.

  7. Wait a second. They can just buy this shit for themselves online?

    And reason calls that “denying access”?!?!

    What fucking site am I anymore? I really can’t tell.

    1. Are you ignoring the part where they’re forced by law to pay into a national healthcare system them that is supposed to pay for their treatment but refuses?

      1. “Not buying me something with other people’s money” is not “denying me access”, Scott. Even if I am also a taxpayer.

        Once you start down that road, it ends in a very dark, very poor, place.

        This strikes me as a very expensive (I bet) version of birth control pills. Its a lifestyle drug to facilitate your chosen social/sex life. Why should any third party, government or private*, pay for it?

        *Naturally, if your insurance company has agreed to pay for it specifically, they should.

        1. I’ll switch “access” to “coverage” for the sake of accuracy.

          But I would remind folks that the only reason that HIV is no longer a killer public health crisis is entirely because of medicine, regardless of how or who pays for it.

          1. I honestly don’t know the entire story. Maybe these drugs are illegal to buy online without a prescription from a gatekeeper? In that case you could say that access is being denied. And it would be a way better comparison to birth control where there’s at least some argument.

            This article makes it sound like you can buy HIV protection on Amazon and people are pissed off that it ain’t free. Fuck that.

          2. Just like smoking? People were legitimately getting lung cancer in droves from cigarettes at one point. Would you support an expensive lifetime treatment paid for by the NHS to prevent only lung cancer caused by smoking?

            1. I don’t support the NHS at all. That’s the entire point of this whole damn post!

            2. Nope – that would raise costs.

              Funny thing that – the majority of the average person’s health care costs come in the last 5 years of their lives. Being a smoker doesn’t change that, just moves that 5 years up a bit.

          3. I’ll switch “access” to “coverage” for the sake of accuracy.

            Thanks. Its a big difference, you know.

            Nobody is denying me access to beer just because I have to pay for it myself.

            1. STOP DENYING ME BERR COVERAGE!!!

          4. But I would remind folks that the only reason that HIV is no longer a killer public health crisis is entirely because of medicine, regardless of how or who pays for it.

            If everyone dies of HIV, who will pave the roads?

            WTHF, Scott, *entirely*? No less than zero cultural shift on HIV/AIDS?

            1. the only reason that HIV is no longer a killer public health crisis is entirely because of medicine, regardless of how or who pays for it.

              Heck of a non sequitur, there, Scott, seeing as this whole article is about who pays for it.

              As mad points out, a big part of the reason HIV is no longer front-page news is because it gets transmitted less now, which has little or nothing to do with treatment, and everything to do with better control of our blood supply and (mostly) a change in attitudes about unprotected sex.

  8. PrEP is an acronym for a drug cocktail that, when taken regularly, is hugely successful in preventing an HIV-positive person from infecting an HIV-negative person. In the United States it is increasingly being used as a prophylactic drug, especially for gay men who are sexually active but are not using condoms or are in relationships with HIV-positive men.

    How much does this cost, and who is paying for it?

    Because, I gotta say, this sounds like another lifestyle drug, in this case the lifestyle being bare-backing gay sex, that shouldn’t be paid for by anyone but the actual patient. Just like I don’t think that birth control should be paid for by the government or insurance plans, either.

    If this is expensive (and I bet it is), then I am supportive of the NHS saying “no thanks”.

    1. The slippery slope in this case comes when you start defining ‘lifestyle drug’ and denying people access to medical care that you’ve otherwise obligated yourself to provide because they have a lifestyle you disapprove of.

      You’d think that things like refusing to treat a broken foot because the guy was a smoker would be out of bounds – but its already happened.

      http://tinyurl.com/jolbn5s

      http://tinyurl.com/7l5ht8b

      1. That’s one slippery slope, sure. But its got nothing to do with lifestyle drugs. Its got everything to do with the evolution of our health care system from a medical care system to a public health system (which is what Britain has with the NHS).

        1. No treatment for sports injuries. Sports are, after all, a lifestyle choice

          1. I think its not terribly difficult to draw a distinction between a drug that is intended to facilitate a given lifestyle (sex, bareback sex, no kids, bigger tits, whatever), and providing treatment for injuries or illnesses that actually exist, regardless of how they came about.

            1. I think it is. Sports are a lifestyle choice. Kids are a lifestyle choice. BMX is a lifestyle choice. Smoking is a lifestyle choice. Drinking is a lifestyle choice.

              If these people had chosen to refrain from those activities then they would not have receive the now existing injuries that they expect the tax payer to cover.

        2. Except the system that claims it will cover all medical care then starts denying care based on ‘lifestyle’ choices.

          Smoking can keep you from getting your broken ankle set – unless you fork over extra to a private practitioner. unprotected gay sex requires you to fork over extra for a prophylactic treatment. Both are being denied funding due to lifestyle choices and the latter is just as crazy as the former as all this ‘nationalize’ everything rhetoric has centered around how *preventative* care is so important and how private health care does a poor job implementing it (because a doctor makes more money setting a bone than he does cautioning you against riding a bike too fast!) and a nationalized system removes those perverse incentives.

          And you’re right – its a lifestyle drug and, in a rational society, would never have been considered for government funding. But the UK is a socialist society now and they have the ‘wonder of the world’ in the NHS – to the point that people *seriously* advocate for not allowing private competition at all. Its billed as a cradle -to-the-grave health care system and so when its shown to blatantly not be, these people freak the fuck out.

      2. The slippery slope in this case comes when you start defining ‘lifestyle drug’ and denying people access to medical care that you’ve otherwise obligated yourself to provide because they have a lifestyle you disapprove of.

        That slope is in the rearview mirror when it comes to topic at hand, i.e. NHS. Denying or granting government-paid treatment to people as decided by the government-created organization that issues treatment for whatever reason said organization bureaucracy comes upon (FYTW being one) is how the entire system works.

        And this is not Cuba – they still have access to that care. As long as they are willing to pay out of pocket or find a private insurer who’ll cover them. Even UK had to start letting private health care pick up some slack in the past 20 or so years.

  9. It is very much an important reminder than under a socialized medicine system, you are no longer the customer.

    Which is good, because that takes the filthy profit motive out of the equation altogether!

  10. It is very much an important reminder than under a socialized medicine system, you are no longer the customer.

    No, it’s even better. It is socialized, therefore We are in control. Medicine and its availability is now responsive to Us and Our demands, not those of a profit-seeking firm.

    If Brits want this drug to be available, they just need even larger protests from even more activists. That’s much better than having to buy the drug.

    1. Health care by majority vote

      I can’t wait.

  11. Is this one of those behavioral nudges the Brits are always talking about?

  12. The problem with the NHS is that it obviously isn’t N enough – “other ‘candidate’ treatments and interventions that could be displaced by PrEP”? How are they even allowed to exist? Nobody needs 23 different kinds of AIDS drugs.

    1. You’ve got it wrong. It’s about the jobs. They’re striving for maximum employment and keeping employees with seniority.

  13. True but America’s focus on pushing these pills is just as bad – the pills are sold as cure-alls for HIV yet compliance is low due to side effects so people stop taking them and then get the disease and say, “But I was taking the pill!” The end result is a higher rate of infection. Of course people should have access to them but there’s no point in pushing this junk on people who just want to have a good time. One more thing: Gilead is Hebrew for “Eternal happiness”. The “Republic of Gilead” is the Christian Caliphate that is imposed by the president after staging a terrorist attack in Margaret Atwood’s A Handmaid’s Tale (1980). Oh the ironies.

    1. So you’re all onboard with the NHS (and the FDA and other like agencies) restricting your access to everything ‘for your own good’?

      I will repeat that ‘for your own good’ is not sufficient justification for the use of coercion.

      1. I don’t see the NHS “restricting access”, as apparently this can still be bought with your own money.

        1. With a prescription, of course.

        2. Sure, until the NHS says, as it already has said with certain experimental cancer treatments, that if you choose that treatment not only will they not pay for it, but they’ll demand to be reimbursed for the treatments they’ve already covered.

          1. That’s just whack.

            1. NHS said it ‘wasn’t fair’ to others for them to top off treatment.

              I wish I could find that article though.

      2. I say god damn the pusher man.

    2. Gilead is Hebrew for “Eternal happiness”.

      Not according to a couple of bible dictionaries:

      Hill of testimony, (Genesis 31:21), a mountainous region east of Jordan.

      The name is explained in Genesis 31:46, 51, as derived from Hebrew gal, “a cairn,” and `edh, “witness,” agreeing in meaning with the Aramaic yegharsahadhutha’. The Arabic jilead means “rough,” “rugged.”

      Gilead Sciences is named after the Balm of Gilead, a universal cure.

  14. I think the NHS showed their true colors when they transplanted the lungs of a heavy smoker into a young man whose lungs had been destroyed as a result of his military service:

    Why would a hospital implant the lungs of a person who smokes so many cigarettes a day into a patient? Was it the result of an inexperienced surgical team making a ghastly mistake? No. The surgery was performed by Papworth Hospital in England, which is the main transplant hospital in the United Kingdom, whose spokesmen claim that in fact everything was done properly!

    But, unfortunately for Corporal Millington, he wasn’t the customer … Rather, some officials of the NHS were. [They desired] to keep costs down by a) cutting corners on the type of lungs transplanted into patients, b) concerning themselves with patient outcomes in the aggregate, and reducing seemingly unnecessary, redundant duplication of services by centralizing transplants as much as possible.

    Thus they faced no economic loss for allowing him to die of cancer. There was no profit to saving him; in fact, saving him would have been an expense. They didn’t have to cooperate with Corporal Millington and so they didn’t.

    1. Look – he lived longer with the transplant that he would have without it, right? That’s a net gain on the books.

      1. And, the goal of a medical care provider is to please his pay-masters rather than the patients he treats; and all to frequently when the interests of patients and the government clash, the patients will lose out.

        Something the author of this piece needs to internalize – the goal of all service providers is to please their pay-masters, without exception. When the patient is also the pay-master the patient has control, when someone other than the patient is the pay-master the patient will lose out.

        But no matter what permutation you think up – the service provider is working to please the pay-master, no matter who that person is. We should be striving to make the patient the pay-master.

        1. I can assure you, Mr Agammamon, the author of this peace (me) does internalize it; it was the thesis of my article.

          1. Heh, you did right that – I don’t look at bylines usually.

            Its good that you’ve got it internalized, t’would be better if that had been laid explicit there. Take that as you will – nobody’s published anything *I’ve* written.

            1. Knock head against wall – *WRITEWRITEWRITEWRITE*

    2. JHTFC

      I’d murder some people over that if it were my family.

  15. They are not getting the treatment that they are paying for, and on top of that they have to pay extra.

    They are getting exactly the treatment they paid for, which is whatever treatments the government wants to pay for.

    That is exactly the deal. Its not “We’ll buy you anything you want”. Its “We’ll buy you whatever we want to buy you”. Its never been anything else.

    1. This is why the situation is so funny to me and why, even though I agree with the thrust of the article, I think the emphasis thatRustyShacklefordShackford puts on how things are allocated in a scarcity economy and how making health care political means that you no longer have any say in how its done *except* through the political process (which has the double problem of not only diluting your voice but the very act of participation empowers the people who are doing this to you in the first place) should be up front and there should be less ‘OMG the gayz are being discriminated against’.

      Because they’re not. Because the NHS is looking where it can most profitably spend its funding (profitable in this case = more political control) and these particular guys are losing out.

    2. Your comment puts me in mind of a recent explosive federal court ruling that could have far-reaching implications. Previously, the government (medicaid) [denied access] to hep-c drugs to all but those with the most acute infections. A federal judge ruled that the government must provide hep-c treatments to all comers in the medicaid system.

      In a letter to the U.S. Senate last fall, Washington state Medicaid director MaryAnne Lindeblad estimated that having to pay for hepatitis C treatment for all Medicaid patients seeking it would triple the agency’s current $1 billion drug budget.

      Imagine that a flip ruling on a single drug treatment could push a state’s healthcare budget to 3x it’s current levels– measured in billions.

      I’ve seen very little coverage on this, but the implications nationally seems huge.

      http://www.thefiscaltimes.com/…..itis-Drugs

  16. The issue seems to be that NHS England is not allowed by law to perform functions that are reserved to the Secretary of State, or to local governments.

    Local governments are responsible for preventing the spread of STDs and providing treatments. The regulations exclude the treatment of people infected with HIV from this duty, allowing the NHS to act. Unfortunately, the people who want PrEP are a little bit too not infected, so NHS can’t act. The post exposure stuff may be permissible because they might be infected enough for quasi-government work.

    Local authorities could provide PrEP, but aren’t obligated to (they could just offer condoms, pamphlets, cold showers etc.)

    The secretary of state is authorise NHS England to provide this service, but would also have to allocate funding.

    Meanwhile, even though NHS England can’t commission PrEP as a service, they can run test programs to see how cost effective it is, so 500 people may be able to receive treatment.

    Simple really.

  17. Universal care IS NOT RATIONING!

    Sure it isn’t.

  18. I am curious how my blog post–which blasts the NHS and government-run healthcare for about a dozen different reasons–is somehow being interpreted as a call by me for government-run healthcare to be doing more and to be expanded.

    1. Scott, if it weren’t for the misinterpreted readings of your articles, you’d only get 1/3 the comments.

      1. I’m quoting this in my next annual self-evaluation.

        1. It’s your unwavering support of ____________ that gets people riled up.

    2. somehow being interpreted as a call by me for government-run healthcare to be doing more

      Honestly, I think its because this is just another variation on the “government-paid birth control” thing. Right down to the rhetoric (since fixed) that if somebody else doesn’t pay for it, you are being denied access to it. So, you triggered some reflexive reactions when you wrote an article critical of a government not paying for something. It was wrapped in “this is what you get when the government pays for anything”, but it still presents as “the government should expand what it pays for”, which gets a bad reaction around here.

      Most of the article is actually just fine. But commenting is about pulling out a phrase and beating it to a bloody pulp.

    3. Because all of that in in the last third of the article. The first third is outrage at how these guys are being denied coverage for a prophylactic treatment of a potential lethal disease.

  19. Is this the same author that claimed criminal cases need to be proved ‘beyond a shadow of a doubt?’

    That was my favorite, but ‘access’ is pretty funny.

    If he’s not, then nevermindcheddar!!

    It reminds me of constantly reading about govt. bans on X (certain forms of stem cell research) when in fact there was no BAN on the research

    There was a ban on govt funding.

    It’s a liberal ploy to conflate govt saying ‘no govt expenditure’ with just a ‘ban’ on X.

    Please let’s not play that here.

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  22. I’m Larrie, I contracted HIV in 2014, I was told by my doctor that there’s no possible cure for HIV. I started taking my ARV’s, My CD4 was 77 and viral load was 112,450. I saw a website of Dr. Olorun, also I saw a lot of testimonials about him on how he uses herbal medicine to cure HIV. I contacted him and told him my problems, He sent me the herbal medicine and I took it for 4 days after then I went for check-up and I was cured. The medicine has NO SIDE EFFECT, there’s no special diet when taking the medicine. He also cure DIABETES, EX BACK, ALS, HEPATITIS B, CANCER, HERPES and lots more. You can reach him on: olorunoduduwaspiritualtemple@gmail.com

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