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LETTERS: Julian Tudor Hart Call for shake up in NHS funding: A reply to 900 doctors BMJ 2006; 332: 973 [Full text]

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Something somewhere has to give

Somnath Mukherjee, Cardiff, CF14 2TL   (6 May 2006)

Re: Something somewhere has to give

L S Lewis   (8 May 2006)

Something somewhere has to give 6 May 2006
Somnath Mukherjee, Consultant Oncologist Velindre Hospital, Cardiff, CF14 2TL Send response to journal: Re: Something somewhere has to give	Sir, While the concept of NHS as seen by Nye Bevan was no doubt brilliant, it is neither sustainable in the current environment of rising costs, nor does it provides the impetus to the public to lead a healthy life style. So, I can smoke like a chimney and drink like a fish secure in the thought that someone somewhere is taking care of my liver transplant and surgery for lung cancer. Oh yes, I can sue the NHS for the 6 week delay in my operation and die in the comfort of knowing that I have paid off my gambling debts and provided for my family's future. Shouldnt forget to thank my next door neighbour, the hard working tax-payer who runs 6 miles a day and lives on fruits and vegetables! From the practical point of view, costs for drugs are set to rise. In oncology alone, Herceptin costs £25000 per person per year, drugs like cetuximab, bevacuzimab and erlotinib are already available to private patients and many more monoclonal antibodies are around the corner. If all these drugs are to be available in the 'perfect' NHS, something somewhere has to give - thus thousand more NHS staff needs to be sacked to balance the books. Good news for my friend Smokey, though, he will get more compensation as the waiting for lung surgery is now 10 weeks! So we have to ask ourselves the question, should we have a NHS which promises clean, adequately staffed hospitals with high level of clinical expertise, where the public will need to have 'top-up insurance' to supplement what is a reasonable service provided by the NHS,or should we opt for an NHS which will finally have to sack all the doctors, and replace them with a team of highly trained chimpanzees administering monoclonal antibodies? As for me, I will have to re-train to be a vet, hopefully with a special interest in chimpanzees... Competing interests: NHS employed Hospital Doctor
Re: Something somewhere has to give 8 May 2006
L S Lewis, GP Surgery, Newport, Pembrokeshire, SA42 0TJ Send response to journal: Re: Re: Something somewhere has to give	Smokers do give more than their lives .. It still remains legal to smoke, as it does to Drink Alcohol, Hang- glide, Bunjee-jump, and Box. perhaps you would set a premium against 'risk-behaviour'.. But Smokers and Drinkers pay hefty extra taxes ! Alternatively, the NHS Surgeon could politely say that in view of continued drinking or smoking he was going to demote the culprit in the waiting-list , because his risks didn't meet 'the relevant criteria'.. Alternatively, rich smokers could buy a heart, and rich drinkers could purchase a liver.. Isn't that so ? Competing interests: None declared