Why not adopt the blacklist of yore?

doi:10.1136/bmj.a807

Published 14 July 2008, doi:10.1136/bmj.a807
Cite this as: BMJ 2008;337:a807

Letters

Cancer drugs and copayments

Why not adopt the blacklist of yore?

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

I suppose it is inevitable that the moral and political issueof copayment for cancer drugs will result in an arbitrary, bureaucraticdirective, such as that offered by the unelected Lords Finlayand Crisp,¹ whose rules I summarise:

(1) The drug or device is listed as one for which copaymentis allowed.

(2) The patient should want the treatment (andhave discussedthe risks, etc).

(3) The clinician should havea reasonable belief that benefitsoutweigh the benefits of othertreatment.

(4) Patients who are unable to participate in aclinical trialshould be willing for their treatment and itsoutcomes to berecorded on a register and potentially availableto research.

The rules are a sham. Who decides the first, which trumps allothers? The second seems absurd, unless doctors foist unwantedtreatments on patients. The third is precisely the rational/rationingproblem, and begs the whole question. Until the . . . [Full text of this article]

L Sam Lewis, general practitioner

¹ Surgery, Newport, Pembrokeshire SA42 0TJ

sam@garthnewydd.freeserve.co.uk