Cosmetic accountability

Thursday January 19, 2012

Tom Miers says that the breast implant row demonstrates some of the limitations of government healthcare and regulation

The PiP (Poly Implant Prostheses) breast implant case raises some classic issues for the balance between regulation and freedom in society.

The common response (or at least that most reported) has been to decry private clinics for refusing to remove the implants after regulators cast doubt upon their safety. Some commentators have gone further to suggest that the case demonstrates the dangers of private medical care. Writing in the Guardian, Richard Horton said “it shows why opening up the NHS to private providers is such a dangerous and ill-considered venture.”
But in truth the opposite is the case. The confusion shows why government regulation is so problematic, and why state healthcare, subject to political lobby pressure, provides such poor value for money.

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) changed its tune on PiP implants n response to concerns raised by the French authorities, suddenly placing clinics who had used the product in good faith in an impossible position. Even though its new advice does not claim the products are fundamentally unsafe, the announcement placed huge pressure on clinics to replace or remove the implants, because of the public concern caused. The Harley Medical Group, which has fitted some 14,000 women with implants said that it would go bust if it had to replace them all.

Who then should bear the cost of such regulatory caprice? The government compared the situation to one where a car manufacturer discovers a potential fault and recalls its products regardless of cost. But the analogy is inexact. From the point of view of Harley Medical Group, the product is still safe, and the panic is unnecessary. If the government wants to change its advice arbitrarily, it should pay the cost of any surgical implications.

If private companies are at fault it is in that they pay too much attention to the government’s regulatory guidelines. The trouble with such statutory regulation is that encourages providers to obey the letter of the law rather than its spirit. Furthermore, such regulation usually has high compliance costs which provides those who have the resources to comply with an incentive to encourage regulation because it inhibits competition.

In the absence of the state, providers must compete not just on quality and price, but on the trustworthiness of their products or service. This encourages a race to the top, and also prompts innovation on the safety side, something that is precluded by blanket government rules.

As for the idea that the PiP case demonstrates the superiority of the NHS model, nothing could be further from the truth. On the contrary, the situation demonstrates one of the reasons why nationalised healthcare becomes so inefficient. Effectively the NHS (and those who fund it) are being held to ransom by a small lobby group – those who want their cosmetic implants removed or replaced on precautionary grounds. Because of the political fuss this has caused, we are all being burdened by the unnecessary costs of such surgery, as those who have taken the medical risk spread the costs they have incurred on others.

So the accountability arguments do not stack up. For of course the private clinics are accountable to their customers, and would be more so if they had to demonstrate the safety of their products themselves. They are also accountable to their shareholders and responsible for their employees (something forgotten by those agitating for them to be ruined).

Meanwhile the NHS is not demonstrating its accountability to the public. Quite the opposite, it seems to be accountable only to political interests, with public picking up the tab.