Funding for Champix: Should the NHS be Paying for Changes in Lifestyle?

by Dr. Nileema Conlon Vaswani in

The dangers of smoking have been widely established. Yet, a number of people who are fully aware of these dangers continue to smoke. This week, the National Institute of Health and Clinical Excellence (NICE) has granted approval for use of a new drug, Champix, that can help smokers quit. The drug is the best of its kind so far. Clinical trials have shown it to have a success rate of 22.5 %. It beats the nicotine patches and other known remedies, and not only does it help with withdrawal but also lowers enjoyment of a stray cigarette if a person who is trying to quit gets tempted to smoke one. Notwithstanding its side effects, this wonder drug cannot be faulted on medical grounds. All the information known to date indicates that it deserves to be approved. But where does this medical marvel sit in relation to other drugs on the moral landscape?

Some smokers smoke as a means of relieving stress. As promising as Champix might be, one must ask what means of stress relief might be available to those who stop smoking. Champix is not intended to relieve stress but merely to serve as a way of helping a smoker to stop smoking. Therefore, those who cannot turn to smoking as a means of stress relief might possibly turn to drugs or alcohol if there is no support system or alternative way for them to deal with stress. Champix in isolation, without other means of help and support, might curb one problem but end up creating another. Our aim is for a healthy individual, not for one who does not develop lung cancer but, for example, alcoholism instead. To prevent one serious medical problem but create another one instead does not achieve health for the individual; it only makes the smoking statistics look good. The success rates with regard to helping people to stop smoking ought to be considered in conjunction with their lifestyles after they have stopped smoking.

The compelling moral question surrounding the use of Champix is whether or not it ought to be made available on the NHS. The economic benefit of providing Champix is clear. A short drug regimen of 12 weeks costs £163.80 and compares favourably to the economic costs of treating a patient who has lung cancer. However, if the issues surrounding stress are considered, and the individual is offered counselling or other methods to cope with stress, the financial costs will be higher. Even if, after considering all the financial costs, we find that it is financially prudent to provide Champix on the NHS, one must ask whether other doing so would compromise other treatments on the NHS. Instead of comparing the costs of funding for the same patient, i.e., a smoker, we ought to look at the cost of funding Champix and the cost of funding treatments for medical conditions. If, as a result of funding Champix, treatments for medical conditions were compromised, we would need strong moral reasons to show why this is right.

One does not need to look hard to see all the restrictions that the NHS has had to make because of lack of funds. Mothers-to-be are not always offered choices with regard to where to have their babies; elderly patients are denied breast cancer screening, patients in hospitals cannot be guaranteed same-sex wards, infertile couples are often denied IVF, waiting lists are long, hospitals are often crowded, and the list goes on. These shortcomings are often explained away by lack of funds. So why is the same NHS that is short of money extending its primary purpose, i.e., treating those who are unwell, to help people cope with bad lifestyle choices? Why do we feel it necessary to molly coddle adults who have chosen to smoke when funding for actual medical treatments is limited?

Although smoking can lead to cancer, i.e., a medical condition, smoking is not a medical condition in itself. Its moral status for NHS funding, therefore, ought not to be higher or even the same as that of a medical condition. A person who has lung cancer ought to be treated on the NHS because he is suffering from a medical condition, regardless of the cause of his cancer. To turn him away because he made a bad decision at some point in the past would be harsh because the purpose of the NHS is to treat people who are unwell. But for the NHS to help alter the choice of an unhealthy lifestyle when lifestyle choices ought to be the responsibility of the adults who make them is a different matter entirely. If the NHS funds Champix, then any move to bring about a healthy lifestyle ought also to be funded. If I decide to visit the gym as a measure to contain becoming obese, I can’t imagine the NHS would be willing to fund my gym subscription even though the State constantly promotes healthy eating and is concerned that Britain may be on the brink of an obesity crisis. And likewise, for all the advice that we are given about our "five a day", it is unlikely that they would be happy to pay for my fruit and vegetables.

I do not believe that the State ought to pay my gym subscription, my grocery bill or anything else that I spend money on to make myself healthier. I should be responsible for these expenses. But for the State to fund Champix leaves it open to criticism as to why it won’t also fund other moves to promote a healthy lifestyle. If it is wrong to pay for my gym subscription, it ought also to be wrong for it to pay for Champix. To argue otherwise would commit the State to the view that obesity is less important than cancer.

One could argue that the State makes an investment by helping people to stop smoking because if Champix is successful, it won't have to bear the financial burden of these patients should they develop lung cancer in the future. If this is so, and as a result funding for other patients and other medical conditions suffers, one must ask whether the NHS is a health service or a business.

There is nothing wrong with Champix per se and NICE is right to sanction its use. Its approval is important not because it will save the NHS money in the long run but because people who might otherwise develop cancer might be saved from this disease. However, smokers ought to pay for their own tablets. If the worry is that some smokers won’t be able to afford the drug regimen, one must ask how they pay for their cigarettes. Averaging at no more than £1.95 per day for a course of twelve weeks, the cost of quitting seems less than what the average smoker spends on cigarettes and the drug yields a much higher return. If we are concerned that smokers won’t take Champix unless it is free or at least on prescription, our worries are misplaced. Anyone who can afford cigarettes and is worried about their own health will pay for a drug that can help them stop smoking. Just as adults choose to smoke, they alone can choose to stop. Champix is only a form of help. It is important to remember that smoking is a matter of choice and, regardless of the benefits of Champix, to have the taxpayer pay for an alteration of lifestyle at the cost of treatment for medical conditions is both morally wrong and inconsistent.