Grauniad NHS for sale scare

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GeenDienst
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Grauniad NHS for sale scare

Post by GeenDienst » Sun Dec 08, 2019 4:56 am

Now, the NHS may well be up for sale, piecemeal, soon. But not for the reasons spelled out by Toby Helm in a scare story in the Graun today.

https://www.theguardian.com/politics/20 ... ansparency

Now, "real world evidence" (buzzphrase that sounds so much better than boring old "observational studies" are big news lately. The reliability the outputs from these has improved greatly in recent years with the onset of things like propensity score matching, along with generally better design and analysis. They usually include people routinely excluded from RCTs, like the old and the ill, and regulators, payors and so on jes' love 'em because they shed valuable new evidence on drug effects from large populations (including safety after release of new drugs into the wild) that is just not available from RCTs alone.

You do them from databases. One such is a primary care database in the UK - the General Practice Research Datalink. This has been up and running for years, and studies have been published from authors all over the world from it for the foreseable past ever.

But now, Mr Helm tells us...
Data about millions of NHS patients has been sold to US and other international pharmaceutical companies for research, the Observer has learned, raising new fears about America’s growing ambitions to access lucrative parts of the health service after Brexit.

US drugs giants, including Merck, Bristol-Myers Squibb and Eli Lilly, have paid the Department of Health and Social Care, which holds data derived from GPs’ surgeries, for licences costing up to £330,000 each in return for anonymised data to be used for research.
Millions! Farmer! Money! NHS! f.ck!

At least he noticed that the data are "anonymised", which is an important part here, so Big Farmer aren't going to earn about your personal haemorrhoid problem from this. It has bugger all to do with the care provided by and/or destruction of the NHS, it's just one of many electronic patent record databases used for research. I would really expect someone experienced like Helm to have known this.
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Re: Grauniad NHS for sale scare

Post by mikeh » Sun Dec 08, 2019 9:33 am

I agree with the Geen.

Our department used this sort of data all the time, universities and pharma and whoever else buy licenses to get access to anonymised data. There's really really good data therein and very useful findings that can be teased out of it.

For example, my then-boss published this paper looking at antibiotic prescribing. This then triggered a renewed emphasis on guidance for GPs on not giving you antibiotics when you rock up for the first time with an upper respiratory tract infection.

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Re: Grauniad NHS for sale scare

Post by snoozeofreason » Sun Dec 08, 2019 10:36 am

I don't know enough about the use of data in medical research to have an opinion on this specific issue, but I am getting frustrated with politicians and activists making statements about the NHS being "On the table," or "Up for sale," without saying exactly what they mean. I was tempted to join the million plus people who have signed this petition to "Keep our NHS out of US Trade deals" until I read through the details and came to
Opening up the NHS to US corporations would mean that the profit motive invades our NHS, patient data is up for sale, access to healthcare is rationed and we would be staring at a system, as in the USA, where if you can’t pay you don’t get care.
It was the bit about rationing that initially made me hesitate. In some senses of the phrase, rationing access to health care is essential to the functioning of the NHS, and is one of the reasons why prices for pharmaceuticals are lower here than on the other side of the Atlantic. I would guess that Big Pharma would like us to think of any attempt to ration healthcare as an assault on the NHS, because that will help them suck money out of the NHS. After reading OP I am also having doubts about the bit about patient data being up for sale.
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Re: Grauniad NHS for sale scare

Post by murmur » Sun Dec 08, 2019 10:38 am

I'm not at all surprised that the Graun mangles another NHS or health-related story: the standard of their reporting of such things has declined very noticeably in recent years (see also the NHS "rationing" thread).
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Re: Grauniad NHS for sale scare

Post by greyspoke » Sun Dec 08, 2019 12:44 pm

snoozeofreason wrote:
Sun Dec 08, 2019 10:36 am
I don't know enough about the use of data in medical research to have an opinion on this specific issue, but I am getting frustrated with politicians and activists making statements about the NHS being "On the table," or "Up for sale," without saying exactly what they mean. ...
I was thinking the same this morning after hearing the phrases again. The "table" one has no specific meaning. Probably people who use it mean something is on the table if, it having been proposed in a negotiation, it would not be dismissed out-of-hand. Clearly, you can't stop a party to a negotiation from asking for something, getting all upset at that is ridiculous. That then leads to the question of what exactly would be the thing that was put on the table. Not "the NHS" as a thing, nobody is interested in selling or buying it.

It is actually about the availabilty of contracts where NHS services are contracted out, and the position of the NHS as a near-monopoly purchaser of pharmaceuticals and whether a market intervention is appropriate in order to protect pharmaceutical companies from abuse of this position. Which get spinned as privatising the NHS and giving in to the power of Big Pharma.

So instead of an important discussion about how publicly financed healthcare is structured and delivered in the UK and how (the right sort of) pharmaceutical research should be encouraged and financed, we end up with a load of empty slogans being bandied about.

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Re: Grauniad NHS for sale scare

Post by mikeh » Sun Dec 08, 2019 1:21 pm

In my to-some-extent-expert (healthcare and R&D financing and policy) view -

In the short-term at least, the most important aspects that US (and other) healthcare firms are keen to exploit are being providers of drugs and other medical supplies. There are reasons why, for example, former health secretary Andrew Lansley makes plenty of money himself in advising the private medial sector (here, as one article on the subject)

Thereafter, with a longer-term drip-drip effect, the expansion of supplies onto the provision of care to the private sector becomes more and more possible over time. We'd perhaps have to pay for more things that we don't at the moment (so a trip to the GP is currently free, but a trip to the dentist for many is not - that can easily change with political will to do so, and is anyone not concerned about general current state of political will?)

Short-term, no one is going to flick a switch at new year and 1 January 2020, we have to buy medical insurance to get our bunions seen to. But the repelling of the US healthcare provision lobby has been relatively easy previously because the public has been keen enough that governments haven't really and truly encouraged it. We may at the point now, especially with a Tory majority as of Friday, where a switch of sorts may be flicked to 'on'. Perhaps more of 'slowly turning up the dial on the way to 11', but the gatekeeper is now keener to look the other way when they get a fiver slipped into their palm.

I think the concerns about privatisation are fair, even if the current thrust of discussion is not angled correctly. It might be in 20 years time, we will look back at 2016-2020 time period as key to the epidemic of UK bankruptcies due to inability to pay medical bills. Creating a fuss now might be one of the best investments the UK population ever makes in its health.

That's my view.

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Re: Grauniad NHS for sale scare

Post by GeenDienst » Mon Dec 09, 2019 1:20 am

Now they have an editorial full of te terrors of Bg Farmer getting. "unrestricted access to the UK’s medical records, thought to be worth £10bn a year".

https://www.theguardian.com/commentisfr ... tient-data

It's very vague, and nowhere do you really get the idea that they know what this means, or whether such access is to GPRD style anonymised data, or to actual patients. I'm guessing it's from a Labour press release.
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Re: Grauniad NHS for sale scare

Post by JQH » Mon Dec 09, 2019 9:39 am

mikeh wrote:
Sun Dec 08, 2019 1:21 pm
I think the concerns about privatisation are fair, even if the current thrust of discussion is not angled correctly. It might be in 20 years time, we will look back at 2016-2020 time period as key to the epidemic of UK bankruptcies due to inability to pay medical bills. Creating a fuss now might be one of the best investments the UK population ever makes in its health.
Agreed.
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Re: Grauniad NHS for sale scare

Post by cvb » Mon Dec 09, 2019 1:10 pm

JQH wrote:
Mon Dec 09, 2019 9:39 am
mikeh wrote:
Sun Dec 08, 2019 1:21 pm
I think the concerns about privatisation are fair, even if the current thrust of discussion is not angled correctly. It might be in 20 years time, we will look back at 2016-2020 time period as key to the epidemic of UK bankruptcies due to inability to pay medical bills. Creating a fuss now might be one of the best investments the UK population ever makes in its health.
Agreed.
Very much agree. I fear it is too late.

My sons' medical condition already costs a fortune. I could not afford insurance and I doubt they would be offered it anyway.

I think bankruptcies due to inability to pay hospital bills is one of the biggest factors in homelessness in the US.

Surely we are better than that?

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Re: Grauniad NHS for sale scare

Post by bolo » Mon Dec 09, 2019 5:43 pm

From what I can find, bankruptcy resulting from hospital bills is not actually a major factor in U.S. homelessness. This overview, for example, says
According to the most recent annual survey by the U.S. Conference of Mayors, major cities across the country report that top causes of homelessness among families were: (1) lack of affordable housing, (2) unemployment, (3) poverty, and (4) low wages, in that order. The same report found that the top four causes of homelessness among unaccompanied individuals were (1) lack of affordable housing, (2) unemployment, (3) poverty, (4) mental illness and the lack of needed services, and (5) substance abuse and the lack of needed services.
If this post results in a derail, the mods should feel free to split.

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Re: Grauniad NHS for sale scare

Post by Gfamily » Mon Dec 09, 2019 5:50 pm

bolo wrote:
Mon Dec 09, 2019 5:43 pm
From what I can find, bankruptcy resulting from hospital bills is not actually a major factor in U.S. homelessness. This overview, for example, says
According to the most recent annual survey by the U.S. Conference of Mayors, major cities across the country report that top causes of homelessness among families were: (1) lack of affordable housing, (2) unemployment, (3) poverty, and (4) low wages, in that order. The same report found that the top four causes of homelessness among unaccompanied individuals were (1) lack of affordable housing, (2) unemployment, (3) poverty, (4) mental illness and the lack of needed services, and (5) substance abuse and the lack of needed services.
If this post results in a derail, the mods should feel free to split.
Hospital bills may not be the proximate cause of the majority of homelessness in the US, but health costs are certainly seem implicated as a factor in the majority of bankruptcies there, with over half a million families affected each year.
https://www.cnbc.com/2019/02/11/this-is ... uptcy.html
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Re: Grauniad NHS for sale scare

Post by bolo » Mon Dec 09, 2019 6:11 pm

Health is certainly a factor in homelessness, in a bunch of different ways, including the cost of health care, losing a job because of illness, inadequate treatment of mental health issues, etc. And medical bills are certainly a leading cause of bankruptcy. But I suspect relatively few people who end up homeless get there via formal bankruptcy.

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Re: Grauniad NHS for sale scare

Post by Martin Y » Mon Dec 09, 2019 7:12 pm

snoozeofreason wrote:
Sun Dec 08, 2019 10:36 am
... I am getting frustrated with politicians and activists making statements about the NHS being "On the table," or "Up for sale," without saying exactly what they mean.
This.

I'm f.cking sick of Labour saying it's going to be up for sale (whatever that means) and the Tories orthogonally insisting it will remain free at the point of use (but presumably privatised to f.ck behind the scenes) as if they were both addressing the same issue.

It's overtaking people's vote/second referendum as the most annoying sloganeering that doesn't tell you enough to be meaningful.

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Re: Grauniad NHS for sale scare

Post by Sciolus » Mon Dec 09, 2019 8:30 pm

There's no question that there is a huge amount of potential value in sharing this information, but there are also serious concerns about privacy and consent, and the NHS has f.cked up badly enough in the past that they will have to work hard to earn my trust. How is data anonymised for instance? There's much more to that than just taking names off, and the more detail in the dataset (and therefore the more useful), the less anonymous it becomes. Old but good stuff about care.data (RIP) from Goldacre: Part 1, Part 2

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Re: Grauniad NHS for sale scare

Post by dyqik » Tue Dec 10, 2019 2:01 am

There was something recently about Google (I think) medical data being de-anonymizable using something like just 10 of the data entries.

Maybe there's enough information in this post to identify the story I'm thinking of.

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Re: Grauniad NHS for sale scare

Post by dyqik » Tue Dec 10, 2019 2:03 am

Gfamily wrote:
Mon Dec 09, 2019 5:50 pm
bolo wrote:
Mon Dec 09, 2019 5:43 pm
From what I can find, bankruptcy resulting from hospital bills is not actually a major factor in U.S. homelessness. This overview, for example, says
According to the most recent annual survey by the U.S. Conference of Mayors, major cities across the country report that top causes of homelessness among families were: (1) lack of affordable housing, (2) unemployment, (3) poverty, and (4) low wages, in that order. The same report found that the top four causes of homelessness among unaccompanied individuals were (1) lack of affordable housing, (2) unemployment, (3) poverty, (4) mental illness and the lack of needed services, and (5) substance abuse and the lack of needed services.
If this post results in a derail, the mods should feel free to split.
Hospital bills may not be the proximate cause of the majority of homelessness in the US, but health costs are certainly seem implicated as a factor in the majority of bankruptcies there, with over half a million families affected each year.
https://www.cnbc.com/2019/02/11/this-is ... uptcy.html
That's mostly a measure of how many Americans are homeless for other reasons than healthcare bankruptcy.

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