Rising costs of drugs is universal. From 1998 to 2001, prescription costs in the United States and England increased by 62% and 30%, respectively. Could the essential drugs concept help rich countries to control the rise in drug costs? Hogerzeil1 cites Australia as an example, although experience there is hardly encouraging: spending on medicines rose by 69% between 1998 and 2002,2 and the political difficulties of the process have been widely reported.3 But containing costs is not the only aim of the essential drugs concept, which primarily aims to increase access and efficiency and to promote better health and equity. These are also aims in rich countries, which already apply many of the principles of …