In May 2005 the annual conference of the American Society for Clinical Oncology included a powerful speech by a US patients' advocate that highlighted the damage from “access advocacy,” whereby drug companies undermine research, licensing, and appraisal (PLoS Medicine 2005;2: e358). Also presented were fast tracked abstracts of preliminary results for trials of trastuzumab (Herceptin) for localised breast cancer. Publicity for the society's annual conference is stage managed by its drug company sponsors, and the trastuzumab story buzzed through news wires worldwide.

Unlicensed, expensive new drugs without peer reviewed published data do not jump the queue over other priorities. If patients want drugs for cancer that are unlicensed or not approved by the National Institute for Health and Clinical Excellence (NICE), and hence not funded by the local primary care trust, they generally pay for them themselves. This, though regrettable, does not normally attract media comment. When trastuzumab hit the …