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An Ethical question relating to Libre...

Discussion in 'Ask A Question' started by tim2000s, Oct 8, 2018.

  1. tim2000s

    tim2000s Type 1 · Expert
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    So then, here's a question for the forum:

    Is it ethical to take the Libre on prescription as a T1, sell it to a T2 at NHS cost and use the proceeds to fund a Real Time CGM system?

    What are your thoughts?
     
  2. xfieldok

    xfieldok Type 2 · Well-Known Member

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    First thought is no.
     
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  3. Rokaab

    Rokaab Type 1 · Well-Known Member

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    I'd say no.
    In essence when signing to say you get free prescriptions, you are saying it's going to be used by you, and only you, and in this case the item (the libre) is not actually going to be used by you (it's replacement is but it is not)
    Wish I could get the libre on prescription :(
     
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  4. Squire Fulwood

    Squire Fulwood Type 2 · Expert

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    It sounds a bit too close to the medical items being sold on Ebay which are of doubtful origins. I admit that I have benefited from such deals in the past but since you ask if it is ethical I would have to say no.
     
  5. Antje77

    Antje77 LADA · Moderator
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    No. You get it on the NHS and then you sell it for a profit. Doesn't matter what you do with the money.
    On the other hand, I could get my concience to shut up on this one as long as I used the money for a CGM only. My concience would be happier if I just bought the toys to turn my Libre in a CGM though.

    My concience wouldn't shut up if there was a faulty sensor and the only way to get it replaced was lying about who wore the sensor, so the buyer would have to buy at his own risk. Which would make me feel rotten in return if there was a faulty sensor.
     
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  6. Guzzler

    Guzzler Type 2 · Master

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    No. It is fraud. Would I buy a hookey libre for my child under those circumstances? Yes of course I would.
     
  7. LooperCat

    LooperCat Type 1 · Expert

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    I’d agree with @Antje77 there. And you’d probably get your prescription stopped pdq when the uploads show you’re using a different device...
     
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  8. urbanracer

    urbanracer Type 1 · Moderator
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    Interesting discussion and I guess the simple answer is no, it's not ethical.

    But then I started to (over) think about it. If a T2 who (perhaps) couldn't afford the full list price was able to get it at cost and then saw improvements in glucose control as a direct result - thus potentially saving the NHS money in the long run - I think I could kind of justify it in my head. It's a bit of stretch though!
     
  9. slip

    slip Type 1 · Well-Known Member

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    You should put your thinking forward to the NHS :D Cut out the middle man out! It does raise another question though - has anyone who uses a libre (of any type D) not improved their control in one way or another?
     
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  10. Brunneria

    Brunneria Other · Moderator
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    No, it is fraud, and if the NHS knew that the patient was selling its prescription on for profit (maybe not monetary, but getting a cgm out of the transaction is still profiting) then I am sure the prescription would be withdrawn.
     
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    #10 Brunneria, Oct 8, 2018 at 1:31 PM
    Last edited: Oct 8, 2018
  11. Diakat

    Diakat Type 1 · Moderator
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    @tim2000s is this purely hypothetical or re you basing it on knowing such a case?
    It's unethical but highly inventive.
     
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  12. tim2000s

    tim2000s Type 1 · Expert
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    Purely hypothetical.

    It's nuts though, if you think about it. The letter of the rules state"improved outcomes" as a key measure. If you get better outcomes with RT-CGM, and provide a better outcome for the T2 involved by using flash, then you sure as hell save the NHS money.

    If the user were selling the Libre on purely to make money, and not to fund a better therapeutic model, then yes, I'd say it was unethical.

    Given the NHS reticence to provide better therapeutic models where technology is involved, I don't see it as unethical. Especially as it is effectively improving the model for both people. Ethically I think it is sounder than prescribing Libre to T1s and not prescribing Libre or test strips to T2s.

    I don't consider whether it breaks the arbitrary guidance an ethical question.
     
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  13. miszu

    miszu Type 1 · Well-Known Member

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    In Hungary theres a law which states how many test strips a T1 diabetic person can get on prescription per month (the amount is not enough to cover all testing, so I always need to buy a box or two on full price each month). Even if consulting with a doctor, theres no way to get more test strips on prescription, because our laws dont allow it. When I asked in the pharmacy why dont we get the needed amount of support, they said its because some would take advantage of it and for example get their meds on prescription then sell it.

    I understand that many people think about doing it for a reason and some even go as far as commiting it. Its easy. But Im struggling partly because of them. Sorry for saying this, but yes very unethical and even the question upsets me.
    I hope there are other ways to go for everyone with such things in their minds. Have a good day everyone. X
     
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  14. Gaz-M

    Gaz-M Type 1 · Well-Known Member

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    no, I got the libre on prescription a month ago and bought a Miao Miao and using xDrip+ (still can't figure out how to get the readings on my pc though) and so long as I calibrate it twice a day its as close to the G6 I had and far more accurate than the libre readings from the Abbott reader, so Miao Miao £164 libre on prescription = real life CGM
     
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  15. mike@work

    [email protected] Type 1 · Well-Known Member

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    Ethical - no
    But you will probably both win on the deal. The other gets his/her Real Time CGM, and the T2 in question gets his/her equipment and better control...

    Edited to say: Sorry, "urbanracer" - didn't mean to steal your thoughts. I noticed a bit too late, that your post was similar to mine...
     
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  16. JohnEGreen

    JohnEGreen Other · Master

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    No it's not ethical and highly suspect from a legal stand point.

    But then is it ethical for the NHS to withhold prescriptions fron T2's who may benefit from it's use.

    Is it ethical for the NHS to say it's not necessary for T2's to test.

    All on the basis of cost.

    So I would not do it my self but would not blame some one if they did.
     
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  17. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    @tim2000s , whilst the sentiment of your musing is all very noble, for me, I don't think it's ethical and I feel quite confident it would be viewed as prescription fraud.

    As a secondary issue, it would be far better that the powers that be could awaken to the fact that T2s deploying some form of informed testing, at least for the early days post-diagnosis, could be a decent money saving.

    I use the term informed testing deliberately. Just handing a T2 a meter and some strips isn't going to work any better than a DSN applying a Libre sensor to a T1's arm, then sending them off to work it all out for themselves, will get the best out of a Libre for such T1s.

    I cite that last incident as being factual, as I had a T1 friend (from our local DUK group) call me to ask what to make of the Libre, how to see anything other than the wiggly lines on the reader screen, and what she could interpret it.

    She hadn't been warned of the 15-ish minute lag blood > IF, or anything. This woman is a Chartered Accountant, so it's not like she would be a bit slow on the uptake or be unable to handle the numbers, or data. It took no time to just chat through an overview of what she could do for herself.

    I don't grudge any person with diabetes, of any flavour, the tools they need to manage their condition, and be the healthiest they can be, but for heaven's sake, at least enable them to use what they are given.

    Sorry to go off onto a bit of a tangent. I'll go give myself a stern verbal warning.
     
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    #17 DCUKMod, Oct 9, 2018 at 7:48 PM
    Last edited: Oct 9, 2018
  18. becca59

    becca59 Type 1 · Well-Known Member

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  19. tim2000s

    tim2000s Type 1 · Expert
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    So here's an alternative approach.

    Is it ethical to give the Libre you were prescribed to your T2 friend, at no cost, and for them to gift you an item on an irregular basis for doing so, because you use the Dexcom platform and can help the T2 manage their condition by providing them the Libre?

    What if that "gift" were a box of three Dexcom G6 sensors?

    I'm not interested in the "letter of the law" - I know what the rules are and they are not necessarily about being "morally right".
     
  20. Diakat

    Diakat Type 1 · Moderator
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    I would still feel that it was somehow "wrong".
     
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