Editor—Emery and Buch‘s editorial about drug treatment for rheumatoid arthritis states that after 10 years 50% of people with the disease no longer work, most losing their jobs in the first 12 months after diagnosis.1 But it is not necessarily rheumatoid arthritis that causes job loss; it is likely also to be due to the barriers in society that exclude disabled people from full employment.
I have had rheumatoid arthritis for over 10 years, and have written this letter using voice-activated software, originally provided through the government’s Access to Work programme. This provides funding for equipment and other means of overcoming barriers that would exclude people from work. Health professionals and employers generally aren't familiar with such provision. Thus some people probably give up their jobs without knowing about any of the support and funding that are available, or about protection afforded them by the Disability Discrimination Act 1995.
My continued employment is also influenced by the fact that my job attracts a high salary. I can therefore pay for what I need to overcome barriers to employment and to live a full life outside work. For example, my car has automatic gears and power assisted steering; I can afford taxis; I live in a flat in the city centre with a lift that works; I pay a cleaner; I eat out a lot.
Tumour necrosis factor α blockade costs about £6000-8000 a year per patient.1 If every year that money was given direct to the patient tax free I expect that, for most, their quality of life would improve far more substantially than it does if they take the drugs.
The government recently required every local authority, in conjunction with health authorities, to develop a Welfare to Work plan for disabled people, to increase their opportunities for employment. In Liverpool this was drafted mainly by disabled employees of the local authority, health service, and voluntary agencies.2 Disabled people discussed the barriers they face in society.3,4
According to the editorial's subheading, the drugs discussed might be only “a small expensive step.”1 A giant leap would be to address the disabling barriers in society; this approach is increasingly recognised as important in tackling inequalities faced by disabled people, but health professionals—the medical profession in particular—are slow to recognise this.5
References
- 1.Emery P, Buch M. Treating rheumatoid arthritis with tumour necrosis factor alpha blockade. BMJ. 2002;324:312–313. doi: 10.1136/bmj.324.7333.312. . (9 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Liverpool City Council; Liverpool Health Authority. Liverpool's joint investment plan on welfare to work for disabled people. Liverpool: LCC; 2001. [Google Scholar]
- 3.Liverpool Independent/Integrated Living Project. Report to the joint care planning subgroup for disabled people. Manchester: Greater Manchester Coalition of Disabled People; 1999. [Google Scholar]
- 4.Liverpool Association of Disabled People. What disabled people need to achieve independent and inclusive living. Conference report. Liverpool: LADP; 1999. [Google Scholar]
- 5.Carter JM, Markham N. Disability discrimination. BMJ. 2001;323:178–179. doi: 10.1136/bmj.323.7306.178. [DOI] [PMC free article] [PubMed] [Google Scholar]