“Meagre increments of unenjoyed life” and other stories

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g288 (Published 22 January 2014) Cite this as: BMJ 2014;348:g288

A lot of the research effort of rich countries goes towards providing what the late Roy Porter described as “meagre increments of unenjoyed life.” There is an inverse research law, similar to the inverse care law, according to which those in greatest need receive the least research attention. A study of the association between paediatric clinical trials and global burden of disease shows that this applies to children in general, and to the poorest children in particular (Pediatrics 2013, doi:10.1542/peds.2013-2567). This Harvard/Stanford survey of 5373 trials registered with ClinicalTrials.gov finds that “paediatric clinical trial activity is only moderately associated with paediatric burden of disease, and least associated in low income countries.” Still, what will save most children in the poorest countries is not more research but the dissemination and implementation of existing knowledge.

Ondansetron is a good example of the absurdities of NHS drug pricing. In 2012, the basic cost of a pack of 30 generic 4 mg tablets was £63.06 (€75.67; $103.09); now it …

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