Editor's Choice

Half a billion here, half a billion there

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c3072 (Published 10 June 2010) Cite this as: BMJ 2010;340:c3072
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}bmj.com

    To improve access for patients to costly medicines the Department of Health is looking at joint payment schemes with drug companies (doi:10.1136/bmj.c2832). This week we publish an object lesson in how not to run one.

    As James Raftery explains, the UK’s first risk sharing scheme began in 2002 as a ruse to get round NICE’s ruling against use of interferon beta and glatiramer acetate in multiple sclerosis (doi:10.1136/bmj.c1672). The NHS would pay for the drugs, but cost effectiveness would be closely monitored, with an agreement to reduce prices if patients’ outcomes were worse than predicted. However, although outcomes were much worse than predicted (BMJ 2009;339:b4677, doi:10.1136/bmj.b4677), the prices haven’t come down.

    The monitoring team says that to make a final judgment on the scheme now would be premature. But Christopher McCabe and colleagues say that its caveats have been known about since the beginning (doi:10.1136/bmj.c1786). If these limitations weren’t important enough to stop the scheme being launched, “how can they justify such an expensive divergence from the scheme rules?” More damning comments come from George Ebers over the scheme’s methodology (doi:10.1136/bmj.c2693).

    In another commentary, Alistair Compston, who was instrumental in developing the underlying concept of the scheme, argues that regardless of its outcome, the scheme has advanced the lot of people with multiple sclerosis (doi:10.1136/bmj.c2707). Our editorialist Neil Scolding concurs: “If the scheme turns out to have been no more than a clever wooden horse, then the army of multiple sclerosis healthcare specialists it delivered may make it more than worthwhile” (doi:10.1136/bmj.c2882). Good value for £0.5bn? I don’t think so.

    Coincidentally, £0.5bn was the value of antivirals stockpiled by the UK government by the time last year’s influenza A/H1N1 “pandemic” had claimed its first victim. In their feature article and video, Deborah Cohen and Philip Carter pass their magnifying glass over WHO’s decision making process around the new influenza strain (doi:10.1136/bmj.c2912). The issues are depressingly familiar: the management of conflicts of interest among advisers and the transparency of the science underlying their advice.

    As Fiona Godlee says in her editorial, WHO isn’t the only body under scrutiny for its handling of the pandemic (doi:10.1136/bmj.c2912). The Council of Europe has just issued its report blaming national governments and EU agencies, along with WHO, for the “waste of large sums of public money” and unjustified health scares (doi:10.1136/bmj.c3033)

    Dr Margaret Chan, director general of WHO, has dismissed allegations of industry influence over WHO decisions as “conspiracies.” In a response to the BMJ she has written that “At no time, not for one second, did commercial interests enter my decision-making” (www.bmj.com/cgi/eletters/340/jun03_4/c2912#236800). At her suggestion an independent review committee was set up to evaluate WHO’s performance during the influenza pandemic. Its report should dispel some of the uncertainties around WHO’s decision making.

    In their personal view Luc Bonneaux and Wim Van Damme point out that if resources were infinite, all possible measures could be taken to fight disease (doi:10.1136/bmj.c3065). But “money spent in stockpiling antivirals with hypothetical effectiveness against a hypothetical pandemic is not available for health care, or for education, or for any other important human need.” To shake off experts’ potential conflicts of interest, they believe that such public health decisions should be handed over to independent, rational decision making organisations, such as NICE.


    Cite this as: BMJ 2010;340:c3072


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