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Although I feel we are bound to be shot down as hopelessly out of date, I support James Woodcock's views: > I am serious about nationalisation. If the NHS is state owned then why not > its major suppliers? The UK is the worlds second largest drugs manufacturer, > giving a lot of scope for producing a lot of drugs. Research costs could be > covered by sales abroad or agreements with other countries. For insance, unbounded "private enterprise" leads to the production of vast numbers of "me too drugs" touted on the grounds of minor clinical advantages (and these from what I have seen sometimes based on trials too small or too flawed to stand critical appraisal). So, if the Green Pill Co. introduces an ACE inhibitor, costing 700 million pounds to develop and test, the Purple Potion Co will go out and spend 600 million pounds putting its ACE inhibitor in the market. In other words, priavte enterprise results in the use of limited resources (time, expertise, laboratories, clinical trials) to produce duplicate drugs. I suggest that, say, three NSAIDS (a mild one available over the counter, a moderate one for general physicians, a strong one for supervised use by Rheumatologists) would suffice for that class of drugs: how many are there in the latest BNF? While such duplication may benefit sharholders and executive staff, I am not convinced it benefits patients, especially those (speaking globally if not nationally) whose illnesses are inadequately profitable to attract a fair share of the scare development resources. Maybe the answer is that drug companies should have to seek licences before developing a new product, and these would be with held if they could not identify an unmet clinical need. I suppose they would as usual find ways around this (such as moving to less regulated countries). Once again, I fear the mantra that "the free market is good" will triumph, but just maybe in twenty years time, researchers will be writing well founded articles on how such a culture cost health services billions and delayed the development of effective treatments for some illnesses. Regards Alan O'Rourke Alan O'Rourke Information Officer Wisdom Centre for Network Learning http://www.wisdom.org.uk/ Institute of General Practice Community Sciences Centre Northern General Hospital Sheffield S5 7AU Tel: 0114 271 5095 Fax: 0114 243 3762 E-mail: [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%