If you follow the British news, you might have noticed an ongoing scandal about Scotland releasing the mastermind of the Lockerbie bombing (the bomb at Christmas time of 1988  that destroyed Pan Am 103 and took the lives of 270 people).

Abdelbaset Ali al-Megrahi was released last August at Libya’s request because he was terminally ill with prostate cancer, and he wanted to die at home.

Fast forward a bit, and you find reports, not only that al-Megrahi hasn’t died, but that he was seen, apparently alive and well, months after being released, even though at the time British doctors said he had only weeks to live.

This caused a minor scandal in the UK, with charges that the release was due to politics, not compassion. Many wondered if his medical problems had been exaggerated to justify the release in order to improve relations with Libya (who to this days insists he was innocent).

Now, Fox and the UKSun reports that the reason that Mr.al-Megrahi didn’t die could be that in Libya he was given Taxotere (Docetaxel), a common chemotherapy treatment for advanced metastatic prostate cancer (i.e. cancer of the prostate that has spread through the body), whereas in Scotland, he may not have been given this advanced treatment. (The press is trying to get his medical records released, so it is unclear if he received the medicine or not).

So, it’s extremely likely that the reason that Mr. Al-Mehadi improved, and now could live for months or years, is because he is now able to receive state of the art chemotherapy.

Scotland, like the UK, has socialized medicine, and an organization called the National Institute for Health and Clinical Excellence (N.I.C.E.) devises criteria on what is the best treatment. NICE is full of beancounters who examine studies to see if a drug or treatment is worth funding.

(Technically, Mr. al-Megrahi was in a Scottish prison, and they have their own medical board, but this board usually follows the NICE guidelines.)

The NICE does approve of Taxotere for treating advanced cases of prostate cancer, and they have even calculated the cost to keep one person alive  to the last penny:

£162.75 for a 0.5 ml vial and £534.75
for a 2 ml vial (excluding VAT; ‘British national formulary’, 50th edition). The cost per patient, assuming an average of seven cycles of treatment, would be approximately £8000. Costs may vary in different settings because of negotiated procurement discounts.

But they do add this stipulation:

A man with hormone-refractory metastatic prostate cancer is offered Tocetaxel, within its licensed indications, as a treatment option only if his Karnofsky performance-status score is 60% or more.

(italics mine).

So what’s the “Karnofsky performance-status Score”?

Well, it’s a quality of life analysis. You ask the doctors to scientifically decide if the person is well enough to care for himself or herself before the experts approve of having the government health service in the UK to pay for the treatment.

The N.I.C.E. website politely tells you this:

You will only be able to have this treatment if you are fit enough. NICE say it should be available to men who are able to look after themselves with only occasional help.

Mr. al-Megrahi, when released from prison and flown to Libya, was very sick. If the photos taken at the time are correct, he obviously could not care for himself.

So, the question is: Was this nice, elderly terrorist denied treatment because he was a terrorist, or because he was sick and elderly?

And one wonders: is he alive today because the despicable British government bowed to political pressure to release him, and lied when they claimed he was terminally ill, or was his return to health because Libya was able to arrange for his cancer be treated properly?

Either way, it is a major scandal.

One final note on that Karnosfy performance test, that the NICE says you have to pass to get the medicine.

These measurements sound “scientific” but one article cautions:

Measures of health-related quality of life (HRQoL) are now in common usage in clinical studies. The construction of both generic and condition-specific measures of HRQoL relies heavily on the choice of descriptive domains, a process that often reflects the personal values of the developer of the instrument.

Translation: they measure what the elite culture decides needs to be measured to decide if your life is worth living.

Subjective valuation is a recurring phenomenon in the construction and application of HRQoL measures.

Translation: In theory, this is an “objective” test of one’s ability to care for oneself; but the dirty little secret is that your score depends on who does the testing:

We studied inter-observer variability in the use of the Karnofsky scale when two pairs of physicians scored 60 patients on the scale. Agreement was only 34% for one pair and 29% for the other.

In other words, there is a 60-70% chance your score will be different if you get someone else to test you. (and note: In the sick and elderly, this “score” could vary from hour to hour).

The denial of medical care according to “scientific criteria” (which often isn’t very scientific) is a part of President Obama’s Health plan, which includes details to help doctors decide what treatments work, and which are cost effective.

Since the “cost effective” part often includes criteria such as age, life skills, and IQ, that means that there is a bias against the elderly, mentally handicapped, non English speakers, and chronically ill. Which is why the tart tongued Sarah Palin labeled such committees: “Death Panels”, because they, not the family, would decide if her retarded son or elderly parents would receive care (or would die from lack of that care).

So the ultimate lesson of releasing Mr.al-Megrahi’s miraculous recovery might not be “We are too soft on terrorism” but “we are too complacent on allowing cost control measurements to decide who should live or die”.


Nancy Reyes is a retired physician living in the rural Philippines. She writes on medical issues at HeyDocXanga blog.

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