Britain rations cortisone treatments for back pain

posted at 11:38 am on August 3, 2009 by Ed Morrissey

Not too long ago, a man in the UK pulled 13 of his own teeth rather than live in agony because the National Health Service didn’t have a dentist to treat his chronic teeth problems.  His fellow Brits won’t have the option of using a pliers on their backs after the most recent rationing decision by the NHS.  In order to save £33 million ($55.6 million), the British single-payer system will no longer give cortisone shots for nonspecific back pain despite the effectiveness of the treatment:

The Government’s drug rationing watchdog says “therapeutic” injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known.

Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy. …

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

Recall when Barack Obama promised that ObamaCare in the US would use the “best practices” of the medical industry, as determined by government panels, in order to dictate treatments and save costs?  The actual experts in British medical circles warn that this will wind up increasing costs.  Instead of offering new-age treatments rather than effective methods of pain control, the decision will push many to get surgery for relief instead:

But the British Pain Society, which represents specialists in the field, has written to NICE calling for the guidelines to be withdrawn after its members warned that they would lead to many patients having to undergo unnecessary and high-risk spinal surgery.

This demonstrates both the pretense and the folly of allowing the government to make these decisions in a noncompetitive environment, or really at all.  The NICE, the supposed expert panel tasked with “clinical excellence,” isn’t concerned about the excellence of care at all.  It’s concerned about spending money.  Its priority is to reduce its budget, not to ensure that patients have effective pain relief.  Cortison shots cost more than acupuncture and osteopathy, so they want to cut back by 95% on cortisone shots regardless of whether the shots are effective or the replacement treatments are not.

And what will that produce?  More back surgeries, which cost a lot more than cortisone shots. That’s NICE.

ObamaCare supporters will argue that insurance companies make the same kinds of determinations about coverage of treatments.  That’s certainly true, but they also have to compete with each other for business.   They will lose customers if they make too many capricious and arbitrary decisions based solely on cost rather than effectiveness of treatment as those customers find insurers who provide better service.  With no competition, as in the UK, the system never has to account for its caprice or its heartlessness.

Now, only the rich will get cortisone shots in the UK, because only they have the resources to get private medical care.  The rest of the nation, which pays through the nose for the NHS, will get locked into those NICE decisions that focus on the bottom line rather than proper treatment.  That’s what ObamaCare will deliver as well.


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And the best part? It’s just cortisone. It’s not a narcotic, it’s not anything worth getting all worried about. It’s a frigging steroid.
That’s just sad beyond all belief.

mjk on August 3, 2009 at 11:39 AM

The rational is that you should not treat pain if you do not know the cause of it. Well, that pretty much describes lower back pain. However, the cortisone helps these people, it’s not addictive, stop torturing people.

Blake on August 3, 2009 at 11:41 AM

should no longer be offered to patients suffering from persistent lower back pain when the cause is not known.

By this logic, why offer any treatment since the cause is not known?

Because there is a cost difference.

Bishop on August 3, 2009 at 11:42 AM

Plus, they can’t even photograph a naked chick right!

lorien1973 on August 3, 2009 at 11:43 AM

ObamaCare supporters will argue that insurance companies make the same kinds of determinations about coverage of treatments. That’s certainly true, but they also have to compete with each other for business.

Insurance companies don’t deny treatment. Given that they don’t provide treatment. Duh.

They may refuse to pay for it – which if you pay your bills, won’t happen anyways.

Why are you accepting a false premise, Ed?

lorien1973 on August 3, 2009 at 11:44 AM

This isn’t rationing. They’re just being “cortisone neutral”.

LibTired on August 3, 2009 at 11:45 AM

That picture always gives me the heebie-jeebies.

TXMomof3 on August 3, 2009 at 11:50 AM

Maybe the Labour appointed bureaucrats at NICE are looking to give the Winston-Churchill-bust-rejecting, Ipod giving, wrong-zone-DVD, Queen-shoulder-rubbing Obamas a little payback.

It’s not that I actually think this is the case, but I can dream, can’t I?

applebutter on August 3, 2009 at 11:50 AM

You might get those cortizone shots, if you vote properly in the upcoming election. *wink*wink*

lorien1973 on August 3, 2009 at 11:51 AM

ordering doctors to offer patients remedies like acupuncture and osteopathy.

So you wait four months to see a doctor about your pain, then he tells you that your only option is to wait six months to see an acupuncturist. By that time you are so much pain that you can’t leave your bed.

Bishop on August 3, 2009 at 11:51 AM

By this logic, why offer any treatment since the cause is not known?

Because there is a cost difference.

Bishop on August 3, 2009 at 11:42 AM

Another example are mental disorders. We have a general understanding of them with neuro-transmitters but don’t really what the exact cause is. If mental disorders were to stop being covered, I can’t imagine what would happen.

Luthien on August 3, 2009 at 11:51 AM

This really is the crux of the problem. ESI probably are not cost effective, but under governmental health care the government will take our money and pay for worthless treatments and refuse to pay for useful stuff and it will have more to do with who has the best lobbyist. And yes a lot of money is wasted on mammograms and colonoscopes. The question is “who decides”.

tmitsss on August 3, 2009 at 11:52 AM

My comment in the Rasmussen Poll headline:

Just now: I didn’t care for my doctor. Made one phone call–got an appointment with another doctor next Monday–Lady on the phone asked me if I needed to get in right away.

Called the insurance company: no sweat, “Can I help you with anything else today, Sir?”

Crisis. What crisis?

Dhimmicrats, don’t mess with my healthcare.

davidk on August 3, 2009 at 11:30 AM

davidk on August 3, 2009 at 11:57 AM

a move which would save the NHS £33 million.

It’s not saving anything, the money will be spent somewhere. My questions is; “on what pet project will the £33 million now be spent”?

Tommy_G on August 3, 2009 at 11:58 AM

Another example are mental disorders. We have a general understanding of them with neuro-transmitters but don’t really what the exact cause is. If mental disorders were to stop being covered, I can’t imagine what would happen.

Luthien on August 3, 2009 at 11:51 AM

What? No Ritalen? You won’t like me without my Ritalin.

davidk on August 3, 2009 at 11:59 AM

Obama is either evil, stupid, or both.

Or he thinks we are Kenyans.

tarpon on August 3, 2009 at 12:02 PM

We need to keep a close eye on this amendment that will be brought to the floor by Anthony Weiner – it will gut the existing bill and replace it with single payer.

http://speakmymindblog.com/2009/08/03/single-payer-will-be-brought-to-the-floor-per-nancy-pelosi/

sherryande on August 3, 2009 at 12:04 PM

If mental disorders were to stop being covered, I can’t imagine what would happen.

Liberalism would be unstoppable. Only psychotropic drugs stand between us and mandatory interpretive dance lessons.

Bishop on August 3, 2009 at 12:08 PM

LibTired on August 3, 2009 at 11:45 AM

HA! Good one.

Rhinoboy on August 3, 2009 at 12:09 PM

pain builds character…suck it up…the government cares and knows whats best for you…

right4life on August 3, 2009 at 12:13 PM

I will say this much: I had cortisone injections for about six months. I got relief from the pain, but it was rather short-lived. To be nonest, the injections were extremely painful, and I finally decided to try alternate means because of that. The one drawback to the injections, besides the pain involved, is that cortisone will also eventually soften the bones in the area where the injections are given.

But all of that is beside the point. the Brits decided to simply not give anyone the choice whether to have them or not. I had the choice, and exercised my option to choose.

It’s it ironic that the party which loudly proclaims itself to be the “Pro-Choice Party” wants to deny everyone else the right to, you know, CHOOSE?

AW1 Tim on August 3, 2009 at 12:23 PM

This picture must be on every topic about ObamaCare.

faraway on August 3, 2009 at 12:24 PM

those videos on drudge of protestors confronting politicians on obamacare really brightened my outlook

Chiasmos on August 3, 2009 at 12:25 PM

I just got that shot in in my neck. Honestly a huge diffence maker. The constant pain was driving me insane. It was around $5,500 for the whole procedure, but now I can work and play with my kids with out feeling like my bones were on fire.

Alden Pyle on August 3, 2009 at 12:27 PM

As a chronic lower back pain sufferer, this “hits home” for me. Cortisone shots are a GODSEND for me. I’ve tried chiropractic and acupuncture and they don’t work. Cortisone does. I’ve had it for mild rotator cuff injury as well and it is the best.

My mother had severe back pain with occasional leg paralysis 40 years ago and the only known treatment then was spinal-fusion surgery, which was expensive and painful, and a hysterectomy so she could not have any more children. If they knew about cortisone back then I might have had a little brother or sister!

rockmom on August 3, 2009 at 12:33 PM

You might get those cortizone shots, if you vote properly in the upcoming election. *wink*wink*

lorien1973 on August 3, 2009 at 11:51 AM

Or contribute to the right candidate.

JustTruth101 on August 3, 2009 at 12:36 PM

Sorry socialists man can not bring about utopian heaven on earth. But man can bring about hell, which is what socialism seeks to do. Socialism is the greatest lie…

alohapundit on August 3, 2009 at 12:41 PM

Another example are mental disorders. We have a general understanding of them with neuro-transmitters but don’t really what the exact cause is. If mental disorders were to stop being covered, I can’t imagine what would happen.

Luthien on August 3, 2009 at 11:51 AM

This has already happened, the Congress is full of them.

hip shot on August 3, 2009 at 12:44 PM

Thank goodness I have a herniated disc so that I don’t fall under the “non-specific” category?! I am leaning more and more towards artificial disk replacement NOW while I can still get it, instead of waiting until my kids have outgrown the need to be picked up. We’ll just be homebound and relegated to our first floor for six weeks.

Which reminds me, I need to make that appointment for a cortisone injection in my spine.

Again, we’re screwed if ObamaCare comes to pass. Get all your ailing parts fixed now, folks.

citrus on August 3, 2009 at 12:46 PM

I’m reposting this from the headline version as it’s already scrolled off:

Beware of politically selected “experts”.

zmdavid on August 3, 2009 at 8:57 AM
This is one of just many concerns everyone should have with Universal Health Care. How can they POSSIBLY justify making a desicion about chronic pain treatment that affects tens of thousands of people, and have a “Committee” that doesn’t include a pain management specialist on it?

I can see the glorified DMV employee deciding on who gets treatment and who doesn’t in our near future.

It’s all right there, in front of our eyes. Too bad those who are willing to see it are relatively powerless to stop it.

DrAllecon on August 3, 2009 at 12:11 PM

DrAllecon on August 3, 2009 at 12:47 PM

And what will that produce? More back surgeries, which cost a lot more than cortisone shots. That’s NICE.

No surgeries will be approved, they’ll just give them the blue pill. You know the blue coated placebo.

chemman on August 3, 2009 at 1:30 PM

I can’t wait for a more expensive, less effective medical program in the U.S.! And it better get passed as quickly as possible!

Grafted on August 3, 2009 at 2:09 PM

NICE have pointed out, their guidance only applies to people who have had back pain for for less than a year without cause

The alternative is to treat the apparent problem without investigating the underlying cause. That means that any of the people mentioned, with chronic back problems that have been receiving injections will still get injections Guidelines don’t replace clinical experience and clinicians can over-rule them, even recovering funding in some cases.

And probably most importantly,
D. The guidelines recommend clinical practices because it’s based on evidence.

The guidelines don’t recommend steroid injections in the case of non-specific lower back pain because they have no proven benefit. Accupuncture, osteopathic manipulation, muscle relaxants and painkillers all are recommended because they all have a proven benefit.

It just also means that the doctor needs to figure out WHY your back hurts and try and solve it, as opposed to instantly giving you a shot and treating the symptoms, and NOT the cause. I don’t think I’d WANT to go to a doctor that didn’t try and find the cause before treating me.

mags on August 3, 2009 at 2:18 PM

As a chronic back pain sufferer who has periodic relapses and whose back now curves as much as the tubular Windows screen saver used to, I say this is only more proof of what would come under healthscare.

If Hussein’s kids get cancer, do you think he’ll limit their treatment?

madmonkphotog on August 3, 2009 at 4:09 PM

There’s a basic principle here. If private industry does something ridiculous like denying the most cost-effective care, one can appeal to the government. If the government is the first-line, and the government denies treatment, to whom can you turn?

njcommuter on August 3, 2009 at 4:13 PM

pain builds character…suck it up…the government cares and knows whats best for you…

right4life on August 3, 2009 at 12:13 PM

Pain is Patriotic!

Ozwitch on August 3, 2009 at 7:09 PM

Let me get this right….In a socialist run healthcare system, they are going to save 33,000,000 pounds a year by cutting off 3000 shots of cortisone??? That comes out to 11000 pounds per shot. All things being relative, that brings the cost to roughly $18500 (USD) per shot. I thought these systems were built to save money and reduce costs! Ain’t no way in hell you are going to pay that much here NOW for a cortisone shot!

I am just the village idiot, but that there just don’t seem right to me, bubba

lsutiger on August 3, 2009 at 7:13 PM

I hope they all rot in the hottest depths of Hell for every nanosecond people remain in pain unnecessarily the rotten sons of bitches!

What ever happened to the balls of you average Brit? Who cut them off and how did they do it without them noticing?

TheBigOldDog on August 3, 2009 at 11:01 PM

TheBigOldDog on August 3, 2009 at 11:01 PM

Does it not occur to anyone that maybe YOUR knowledge of the N.H.S might be the problem.
We are not stupid and the health care is supported here.

I work in the NHS have done for 20yrs.NICE is to recommend guildlines based on research and results.

Why don’t people read it before hurling abuse at us?

The guidelines don’t recommend steroid injections in the case of non-specific lower back pain because they have no proven benefit. Accupuncture, osteopathic manipulation, muscle relaxants and painkillers all are recommended because they all have a proven benefit.

NICE have pointed out, their guidance only applies to people who have had back pain for for less than a year without cause.

The alternative is to treat the apparent problem without investigating the underlying cause. That means that any of the people mentioned, with chronic back problems that have been receiving injections will still get injections .

Guidelines don’t replace clinical experience and clinicians can over-rule them, even recovering funding in some cases.

What is the problem with that?

mags on August 4, 2009 at 6:56 AM