EDITOR, — Andrew Herxheimer is unstinting in his praise for the recommendations of the House of Commons health committee but does not say why he thinks that they would control drug costs. All his hopes are pinned on the cost effectiveness of prescribable drugs being established.

Some of the drugs listed in the British National Formulary are now widely regarded as not efficacious for anything. These may be deemed not cost effective, but they do not make up much of the drugs bill and their deselection would do little to control it. Other drugs are efficacious when used appropriately and would therefore have to be deemed cost effective unless widely overpriced, but they are not cost effective if they are misused or given when a cheaper alternative would serve the purpose equally well.

Unnecessary costs in prescribing in general practice arise in two main ways. The first is through too much prescribing. This is a complex …