The most surprising revelation in this week’s BMJ is that there’s a website that lists drugs that can be “orphaned” and exploited for profit. In an open letter to Britain’s prime minister, 21 neurologists and paediatricians call for an urgent review into the pricing of orphan drugs (doi:10.1136/bmj.c6466). Legislation meant to encourage development of new treatments for rare diseases is instead severely limiting availability of existing treatments, they say, costing the taxpayer unnecessary millions and reaping massive profits for drug companies.

As Nigel Hawkes and Deborah Cohen describe (doi:10.1136/bmj.c6459), a company needs only to find an unlicensed drug and license it for use in a rare condition, citing little more than pre-existing evidence of …