My main complaint against Sicko was that some of the "horror stories" he presented as failings of the US health system weren't specific to the US.
Here's
Robert Bazell's take on Moore's presentation of the case of Julie Pierce, whose husband was denied a bone marrow transplant to treat his kidney cancer.
Thanks, that's exactly what I wanted to do with these cases, and you've picked the one I had spotted as being certainly questionable. I did type out an analysis of it, but it's on my other computer so I'm doing this from memory.
The obviously sad thing about it was exactly as you say. Mr. Pierce had a fatal illness, which nothing was going to cure. And I agree,
exactly the same thing could have happened in a universal heathcare system, certainly in the NHS.
The interesting thing about that case was that two letters relating to the appeals were shown onscreen, and the resolution is good enough to read what they say. I got a lot more information from doing that.
Although the letters were shown during the discussion about the possible bone marrow transplant, they weren't about that. They were about the previously-denied treatment, which was an experimental drug treatment. The letter said that Tracy Pierce had metastatic primary renal carcinoma. This had been treated by heminephrectomy, and he had had a course of the standard chemotherapy for the condition. Unfortunately that hadn't worked. So first, we must recognise that the insurance company
had funded the standard treatment, surgery followed by chemotherapy.
The letter went into quite a bit of detail. It was from Tracy Pierce's consultant to the insurers, requesting funding for an experimental drug treatment, because the standard chemo hadn't worked. The experimental drug was described in detail, with the information that it had been the subject of a large grade II clinical trial by a very reputable group, and the results of that suggested it was an excellent option for Mr. Pierce. The point was made that a randomised placebo-controlled trial had not yet been done, but that Tracy didn't have time to wait for that to be organised.
The results quoted from the clinical trial were variable. Only a minority of patients got spectacularly better, although 70% were said to have shown "some benefit". The awful thing was, as far as I could see, it was another life-extending treatment, and not really expected to produce a permanent cure.
The second letter was the refusal for that treatment.
Should they have funded it? I have no idea. However, from my limited experience of the NHS, I would have thought a well-argued appeal like that was in with a good chance, especially in a patient in his thirties. The system for making these decisions in the NHS is fairly open, and one such session was actually broadcast as part of a recent documentary. The senior consultants had a very difficult job to do, deciding just how much of the common good fund should be spent on a new and expensive drug. It went to a "yes" by one vote. Nevertheless such an NHS panel, with access to the full facts such as Tracy Pierce's insurance assessors had, might well have made exactly the same decision as they did.
[Aside - the son-in-law of someone I work with, who is a bit younger than Tracy Pierce, has recently been diagnosed with some sort of lymphoid cancer. I didn't follow all the details, but his NHS consultant wanted to use a similar unapproved drug on him. This went before the appropriate committee, was considered, and was approved - because the consultant in question was willing to fund the treatment from his NHS research budget. I still have a very bad feeling about the prognosis in that case as well though.]
As far as the bone marrow transplant thing was concerned, can you spell "clutching at straws"? This was a desperate woman and her desperate husband, eager to try anything else that had any chance at all, and not as far as I can see being realistic about the prognosis. If anything was demonstrated by that, it was how much difference some end-of-life counselling might have made.
So I agree, this one falls. The only question I have is, would an NHS decision panel have allowed the experimental drug, and all I can say is, maybe. It's perferctly possible exactly the same scenario would have played out in the NHS, and then the right-wingers would have used it in exactly the same way. I would also criticise the patient counselling, which left Julie Pierce with apparently unrealistic hopes, and then a dreadfully negative overview of what had happened. And could that also happen in the NHS? Sure it could.
I do not know if this presentation in the film is deliberate dishonesty or not. I think not so much, but rather an uncritical acceptance of Julie Pierce's version of events. I would criticise Moore for not taking medical advice about whether Julie actually had the right end of the stick. However, if there are too many examples in this category, the whole thing becomes much more suspect.
Rolfe.
