RE: Discussion on NHS vs USA medical facilities

[Guest guest]

This is an interesting discussion. One of the things to remember is that British system uses an evidence based model. The reality is that there are gaps in understanding and also knowing how a treatment works in the big picture. The example that comes to my mind is hormone treatment for post-menopausal women. Yes it appeared to make things better for women and many women and their doctors jumped on the bandwagon and took hormones but what was found later was that there are harms. Women have to balance the benefits to the harms now when deciding what to do. In England they are much less likely have men take the risks about a treatment where we do not have complete information. In the US there are men who may be getting a treatment where the full long term impact is unknown. Funny to me because these are sometimes the same men who would not participate in a clinical trial because they do not want to be in a trial where they do not control their treatment but what they are participating in is a big uncontrolled clinical trial. We need to get the information for other men who come after them to make an informed decision. There seems to be a poor understanding of what evidence based medicine is by many patients. There are both advantages and disadvantages of using or not using an evidence based model. It is inappropriate to point fingers. What we should be doing it talking about What information is needed to make good choices with a good understanding of both the short term and long term outcomes. What can we do to impact the decisions about what trials we want to see and about what trials are necessary and how do we find the funding to do them. Kathy From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of MetcalfSent: Friday, March 02, 2012 7:14 PMTo: Prostate Cancer Support e-groupSubject: Discussion on NHS vs USA medical facilities I am willing as ever to have a factual discussion on this, for a limited period. So up to 2400 (12 midnight GMT Sunday) My take is that there is no perfect system. Those who can afford it in the USA can demand the highest level of treatment, but the unemployed or low paid with no insurance strugle to pay for basic drugs. In the UK we don't have this, the NHS provides to both king and pauper. True it is paid for by taxes, generally the rich pay more than the poor (general statement simplifying a really complex tax system - so don't hit me with detail). In the UK we have NHS which as far as I am concerned isn't far behind the USA as far as progress is concerned. Eg We have the cancer drug fund and this allows use of Abiraterone now at least up to 2014, time to make the point to messers Cameron, Clegg and Osbourne. Admittedly it has taken some urologists time to catch up but generally things are much better than when I was diagnosed in 1996. In the UK you can opt for private treatment either via insurance or direct payment BUT for emergencies the expertise is in the NHS and not the private hospitals. I suppose the point should be how can we continue to improve our systems to provide consistently modern treatment to all who need it. Each country has its challenges!

[Guest guest]

Thanks, Kathy – wise words.Bob From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade GoulaitSent: 03 March 2012 22:51To: ProstateCancerSupport Subject: RE: Discussion on NHS vs USA medical facilities This is an interesting discussion. One of the things to remember is that British system uses an evidence based model. The reality is that there are gaps in understanding and also knowing how a treatment works in the big picture. The example that comes to my mind is hormone treatment for post-menopausal women. Yes it appeared to make things better for women and many women and their doctors jumped on the bandwagon and took hormones but what was found later was that there are harms. Women have to balance the benefits to the harms now when deciding what to do. In England they are much less likely have men take the risks about a treatment where we do not have complete information. In the US there are men who may be getting a treatment where the full long term impact is unknown. Funny to me because these are sometimes the same men who would not participate in a clinical trial because they do not want to be in a trial where they do not control their treatment but what they are participating in is a big uncontrolled clinical trial. We need to get the information for other men who come after them to make an informed decision. There seems to be a poor understan ding of what evidence based medicine is by many patients. There are both advantages and disadvantages of using or not using an evidence based model. It is inappropriate to point fingers. What we should be doing it talking about What information is needed to make good choices with a good understanding of both the short term and long term outcomes. What can we do to impact the decisions about what trials we want to see and about what trials are necessary and how do we find the funding to do them. Kathy From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of MetcalfSent: Friday, March 02, 2012 7:14 PMTo: Prostate Cancer Support e-groupSubject: Discussion on NHS vs USA medical facilities I am willing as ever to have a factual discussion on this, for a limited period. < /o>So up to 2400 (12 midnight GMT Sunday) My take is that there is no perfect system. Those who can afford it in the USA can demand the highest level of treatment, but the unemployed or low paid with no insurance strugle to pay for basic drugs. In the UK we don't have this, the NHS provides to both king and pauper. True it is paid for by taxes, generally the rich pay more than the poor (general statement simplifying a really complex tax system - so don't hit me with detail). In the UK we have NHS which as far as I am concerned isn't far behind the USA as far as progress is concerned. Eg We have the cancer drug fund and this allows use of Abirater one now at least up to 2014, time to make the point to messers Cameron, Clegg and Osbourne. Admittedly it has taken some urologists time to catch up but generally things are much better than when I was diagnosed in 1996. In the UK you can opt for private treatment either via insurance or direct payment BUT for emergencies the expertise is in the NHS and not the private hospitals. I suppose the point should be how can we continue to improve our systems to provide consistently modern treatment to all who need it. Each country has its challenges!