The latest episode of Panorama—one of the most respected investigative current affairs programmes on UK television—delved into the key issues surrounding the recent decision to make trastuzumab (Herceptin) available free on the NHS for selected women with early breast cancer. As it unravelled, the story was of policy making determined at a raw socio-political level rather than on the more traditional clinical grounds.

On one side of the debate were enthusiasts arguing that trastuzumab was a “wonder” drug, and a “must have” medicine for the early treatment of women with an aggressive form of breast cancer in which the malignant cells are HER2 (human epidermal growth factor receptor 2) positive. On the other were more wary prescribers who saw the drug as costly and of unproven value and one that still needed careful cost effectiveness and benefit/harm evaluations before the NHS could adopt it wholesale. The debate began to involve a vociferous patient group, the law courts, and the health secretary, and was played out in public through headlines in a hungry national media. The National Institute for Health and Clinical Excellence (NICE), remained some-what aloof throughout, and there …