Nav: Home

Should gluten-free foods be available on prescription?

January 10, 2017

In The BMJ this week, experts debate whether gluten-free prescriptions for people with coeliac disease should be removed.

Removing prescriptions for gluten-free products unfairly discriminates against people with coeliac disease, argue gastroenterology experts David Sanders and Matthew Kurien, and Sarah Sleet, Chief Executive of Coeliac UK.

They explain the NHS is facing unprecedented financial pressures, and gluten-free food prescriptions might seem like an easy target for clinical commissioning groups (CCGs) trying to make savings.

However, annual prescriptions costs for gluten-free foods were £25.7m in England last year - just 0.3% of the total NHS prescribing budget.

They argue that "a gluten-free diet is the only treatment for coeliac disease and adhering to this diet is challenging."

The average cost of gluten-free products are 3-4 times the price of standard equivalent products, and there is limited availability of such products in shops.

The National Institute for Health and Care Excellence's quality standards for coeliac disease highlight the role of prescriptions to ensure that the diet is affordable and accessible for all patients.

Despite this, around 40% of CCGs in England are restricting or removing these prescriptions, while Scotland, Wales, and Northern Ireland are not following suit.

The experts say there is no other example in the NHS of a disease having its treatment costs cut by 50-100%, and ask if CCGs would consider this if the treatment for coeliac disease were an immunosuppressive drug and not food?

The alternative gluten free products being suggested by CCGs contain nutritional deficiencies - an isocalorific portion of rice contains 90% less iron and 82% less calcium than bread.

They warn that "targeting gluten-free food prescriptions may reduce costs in the short term but there will be long term costs in terms of patient outcomes."

On the other hand, James Cave, a general practitioner, argues that "it's ludicrous for the NHS to be treating a food product as a drug and to require GPs and pharmacists to behave as grocers."

He says the "complex rules" imposed by the NHS governing what can be prescribed and how often are stressful for people with coeliac disease and their GPs.

"It's a time-consuming rigmarole and, for the NHS, a very expensive one," he argues.

"The eight basic gluten-free staples advised for people with coeliac disease are all cheaper from a supermarket than the NHS price," he explains. "This is a scandal."

The NHS pays up to £6.73 for 500g of pasta, yet 500g of gluten free pasta will cost £1.20 at a supermarket. Additionally, there is a dispensing fee which is charged on top of all prescriptions.

"If we stopped prescribing gluten-free products tomorrow GPs would shout for joy and the NHS would stop being ripped off," he says.

He suggests an alternative would be a national voucher scheme or a personalised health budget for patients so they receive the difference between the cost of gluten free products and the prescription.

"This could be funded from the money saved by no longer paying for overpriced NHS gluten-free food," he says, and "the price of gluten-free food might fall further once proper market forces were in play."

"Most importantly, people with coeliac disease who currently struggle with the logistics of a lifelong gluten-free diet and a cumbersome and antiquated supply system, would have the convenience and choice we all enjoy," he concludes.
-end-
Head to head: Should gluten-free foods be available on prescription?

http://www.bmj.com/cgi/doi/10.1136/bmj.i6810

About BMJ

BMJ is a healthcare knowledge provider that aims to advance healthcare worldwide by sharing knowledge and expertise to improve experiences, outcomes and value. For a full list of BMJ products and services, please visit bmj.com

BMJ

Related Diet Articles:

A plant-based diet boosts weight loss twice as effectively as a traditional diabetes diet
Hana Kahleova, M.D., Ph.D., presented 'The effect of a vegetarian versus conventional hypocaloric diabetic diet on thigh adipose tissue distribution in patients with type 2 diabetes,' at the American Diabetes Association's 77th Scientific Sessions in San Diego on June 12, 2017.
Healthy diet? That depends on your genes
A recently published Cornell University study describes how shifts in the diets of Europeans after the introduction of farming 10,000 years ago led to genetic adaptations that favored the dietary trends of the time.
Diet and global climate change
Eating healthier food could reduce greenhouse gas emissions, says a new study by environmental scientist David Cleveland.
Could a ketogenic diet alleviate gout?
Recent work from the laboratory of Vishwa Deep Dixit, Professor of Comparative Medicine and Immunobiology, has shown that the ketone body β-hydroxybutyrate can specifically inhibit the NLRP3 inflammasome.
Fasting-mimicking diet may reverse diabetes
In a study on mice and another study on human pancreatic cells, researchers discover that a scientifically designed fasting diet can trigger the generation of new pancreatic cells to replace dysfunctional ones and stabilize blood glucose.
Time to put TB on a diet!
The tuberculosis bacillus is growing resistant to antibiotics. For this reason, biochemists at UNIGE are attempting to identify the mechanisms that enable the bacterium to reproduce, spread and survive in latent form in our macrophages.
Changes in the diet affect epigenetics via the microbiota
Researchers have known for some time that diet affects the balance of microbes in our bodies, but how that translates into an effect on the host has not been understood.
How your diet can influence your environmental impact
The impact of our dietary choices on the global phosphorus footprint shouldn't be neglected, shows a new study.
Diet and back pain: What's the link?
As part of a collaboration between Rensselaer Polytechnic Institute and the Icahn School of Medicine at Mount Sinai, researchers are exploring the link between diet, obesity-linked type 2 diabetes, and intervertebral disc degeneration.
Your best diet might depend on your genetics
If you've ever seen a friend have good results from a diet but then not been able to match those results yourself, you may not be surprised by new findings in mice that show that diet response is highly individualized.

Related Diet Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...