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Should NHS patients be allowed to pay extra for their care?

BMJ 2002; 324 doi: (Published 12 January 2002) Cite this as: BMJ 2002;324:109

Patient payments bring new resources into system

  1. Karol Sikora, visiting professor of cancer medicine (
  1. Hammersmith Hospital, London W12 0HS
  2. Saionara, 31 Regent Street, Rowhedge, Colchester CO5 7EA
  3. Dorset Cancer Centre, Poole Hospital, Poole, Dorset BH15 2JB,
  4. Dental Practice, Haworth, West Yorkshire BD22 8NL

    EDITOR—Richards et al in their article raise the issue of patients contributing to payments for cancer drugs in Britain's NHS.1 It is pleasing to see that times are changing for ethics committees even if the pervasive tone of self righteousness is a bit grating. If British politicians cannot manage to improve the NHS, why should a patient not pay for drug treatment perceived as beneficial? Would the group consider it unethical for a patient to pay for vitamin pills, special diets, alternative medicine, or a second opinion?

    Over the next three years there is going to be a major shift in cancer care. New molecularly targeted medicines that block specific signalling pathways and angiogenesis will become available. These will take the form of simple tablets, to be taken once a day. They will prolong survival by a few months in many cancers, but as the predictive power of genomics and proteomics bites, cancer will become a chronic, controllable disease. The cost will exceed the budget of Britain's national cancer plan, which is just a catching up exercise on 30 years of underinvestment by successive governments. In a global society no group of armchair ethicists sitting in Nottingham can stop people ordering these new drugs through the internet and paying with their credit card. Debating the issue is futile.

    What we can do is …

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