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EDITORIALS: Ilora Finlay and Nigel Crisp Drugs for cancer and copayments BMJ 2008; 337: a527 [Full text]

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Mogadon Man

L Sam Lewis   (5 July 2008)

No alternative

John Doherty   (11 July 2008)

Mogadon Man 5 July 2008
L Sam Lewis, GP Surgery, Newport, Pembrokeshire, SA42 oTJ Send response to journal: Re: Mogadon Man	I suppose it is inevitable that this moral and political issue will result in an arbitrary, bureaucratic directive, such as that offered by the unelected Lords Finlay and Crisp, which I summarise:- 1: the drug or device is listed as one for which copayment is allowed. 2: the patient should want the treatment ( and have discussed the risks , etc.) 3: the clinician should have a reasonable belief that benefits outweigh the benefits of other treatment. 4: patients who are unable to participate in a clinical trial should be willing for their treatment and its outcomes to be recorded on a register and potentially available to research. Unfortunately, I believe the rules are a sham. Who decides rule 1 , which trumps all others ? Rule 2 seems absurd, unless it is possible that doctors foist unwanted treatments on patients ? Rule 3 is precisely the rational /rationing problem, and begs the whole question. Until NICE has assessed the evidence and ruled the drug in, then only expert specialists ( and their peers) can reasonably anticipate NICE judgements – precisely the situation which NICE was invented to contain ! Rule 4 is high-handed, and authoritarian. If I did not consent, or was otherwise ‘unable to participate’ in a clinical trial, why should I be required to participate in records registers and research ? What if I were to refuse ? Why is it that NHS managers, doctors and politicians want to control what I do with my money in a free society ? They should limit themselves to that part which is taken from me in tax. The question is not new, and a working solution has been normal NHS practice for 20 years. In 1986 the NHS decided to formally ‘blacklist’ a number of drugs deemed of insufficiently evidenced effectiveness. The alternative and presumably effective medications were later to become known as the whitelist. Patients who insisted that Mogadon was superior to Nitrazepam were permitted to pay for it, on private prescription, from the same GP who was forbidden to prescribe it on his NHS pad. The working rules appear to be:- 1: the drug or device is blacklisted ( not NHS funded ). 2: the patient should want the treatment ( and have discussed the risks , etc.) 3: the clinician should have a reasonable belief that the prescription is safe effective and legal. 4: patients who are unhappy are referred to their elected MP or other snake-oil salesman. Competing interests: my money or my life ?
No alternative 11 July 2008
John Doherty, Medical Director IAEA, Vienna 1400 Send response to journal: Re: No alternative	Finlay and Crisp (1) do not resolve the paradox that continued NHS cancer treatment is put at risk if it is topped-up with effective, but very expensive, drugs while topping-up with ineffective complementary therapies is positively encouraged. If aromatherapy were extremely costly would it be proscribed? Or would it be permitted because it was useless? (1)BMJ 2008;337:a527 Competing interests: None declared