Medical paternalism and expensive unsubsidised drugs

doi:10.1136/bmj.331.7524.1075

BMJ 2005;331:1075-1077 (5 November), doi:10.1136/bmj.331.7524.1075

Education and debate

Medical paternalism and expensive unsubsidised drugs

Michael Jefford, medical oncologist¹, Julian Savulescu, ethicist², Jacqui Thomson, medical oncologist¹, Penelope Schofield, behavioural scientist¹, Linda Mileshkin, medical oncologist¹, Emilia Agalianos, research assistant¹, John Zalcberg, medical oncologist¹

¹ Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Locked Bag 1, A'Beckett Street, Victoria 8006, Australia, ² Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford

Correspondence to: M Jefford Michael.Jefford@petermac.org

When discussing treatment with patients, doctors may not mentionnewly licensed drugs that are not yet funded by healthcare schemes.Although their motives are good, the ethics are questionable

The first 150 words of the full text of this article appear below.

Introduction

The development of new drugs can be a lengthy process, requiringinitial laboratory and animal testing and then a course of clinicalstudies.¹ Clinical assessment involves phase I testing, whichfocuses on determination of side effects and an appropriatedose for later study; phase II studies, which assess efficacyin people with a particular condition; and phase III studies,which generally compare a new, experimental treatment with anexisting standard treatment. Once a therapeutic benefit hasbeen shown, the drug company can apply for approval from therelevant regulatory body. An extensive review follows, whichmay take many months or years. If the drug is approved, furtherdelays may occur before funding arrangements permit the drugto be widely available. We consider some of the ethical dilemmassurrounding this process, using the example of drugs to treatpeople with cancer.

Unsubsidised, expensive drugs

In Australia, the cost of most prescription medicines is subsidised. . . [Full text of this article]

Practice of discussing unfunded drugs

Ethics of discussing unfunded drugs

Access to drugs in development

Cost of new drugs

Conclusions

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