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Can we get back to Brexit?

Brexit is sneaking up on us under cover of COVID-19. The omens are bad. There is still no single argument in favour of Brexit on the basis of health or science. If anybody has a cogent one then please present it? The Brexiteers running the government have shown a poor grasp of detail and judgement in their handling of the pandemic and the subsequent exams debacle. They favour the abstract reality of assumptions and algorithms to the ground reality of people and populations. Public Health England is being reorganised without discussion, debate or public inquiry, and placed in the hands of the person who promised to deliver on ‘track and trace’ and didn’t. None of this bodes well for Brexit. Brexit and indeed climate change are far more complex than the challenges the Brexiteers have failed on so far. It is responsible to be worried. One of those worries is that Brexit will increase NHS costs, which would be damaging for health at any time but especially so in an economic recession. In new research, leading academics from the UK and the US address the question of primary care drug costs. Taking the top 50 brand name drugs in terms of expenditure, they calculate that applying Medicare costs would raise the annual drugs bill by £6bn in English primary care. The US administration is clear that it wants ‘fair’ pricing for the pharmaceutical innovations it sells to the world. But ‘fair’ for the US is inevitably overpriced for everybody else. Cost considerations are important too for individuals when managing personal health budgets and as people move from being consumers to ‘prosumers’, for example by creating and then consuming a customised package of care. Local customisation must play a part in COVID-19 test, trace and isolate strategies. The question here is how to persuade people to follow the rules? Behavioural science is pivotal to success but the service in England has absorbed large costs and fallen short of targets. The impact of increases in costs is ultimately counted in death rates but, as COVID-19 has shown, even counting deaths can be controversial. Excess deaths seem to be the best measure but there is much we do not understand. In the same way, we are yet to fully understand the role of the inflammatory response in COVID-19 or the long-term impact of the disease. There is nothing wrong with a gap in our understanding as long as it is acknowledged. A constant flaw in the ruling elite is a misplaced certainty in their ideas and their solutions. If this is a dangerous trait in a doctor, it is equally so for a politician – with the hollow certainties of Brexit being a prime example.