Four linked articles discuss the UK multiple sclerosis risk sharing scheme.1 2 3 4 The scheme was set up in 2002 to allow patients access to certain disease modifying drugs (interferons and glatiramer) after the National Institute for Health and Clinical Excellence (NICE) recommended that these drugs should not be used.

No one could say that patients with multiple sclerosis have an easy time. We offer no cure. We cannot tell patients what causes the disease. We are poor at estimating prognosis. And when in the 1990s orthodox medicine did deliver treatments (three interferon beta preparations and copolymer-1), not only were they so expensive as to be virtually unavailable in most of the United Kingdom, but the profession could not—and still cannot—agree on their true efficacy. Now Raftery and McCabe and colleagues argue that either they should be withdrawn from the NHS altogether or have their price reduced to zero.3 4

The disease modifying treatments are essentially prophylactic, and like all drugs whose aim is to prevent events (relapses) that are unpredictable and relatively uncommon (the average relapse rate in multiple sclerosis is around one a year), their efficacy is difficult to assess even in large scale trials and impossible in the real world of clinical practice. If a treated patient is …