say you should only add the so-called statins that are about to come off patent. But trials only capture average effects. What is the point of all my training and experience if I cannot prescribe the most modern treatments like Beta blockers, ACE (angiotensin-converting enzyme) inhibitors, and now angiotensin receptor blockers, when in my clinical judgment they are best for a particular patient? My colleagues in other departments feel the same. Either the teaching hospital should be exempt from the rules, or the rules should be changed.” • Economist from the finance ministry: “These decisions are very difficult, I know. But all of us in government have to consider our country’s limited resources. The only responsible way to do this is to do it scientifically: to use cost-effectiveness analysis. You need to set a cut-off level in terms of Quality Adjusted Life Years per unit of money spent, the way they do for the National Institute for Health and Clinical Excellence in the United Kingdom. Then the ministry should only approve treatments that have objective clinical evidence to prove they are above that line. Anything else will open up the process to endless lobbying for special treatment, and charges of favoritism from those who lose out. On the other hand, a clear rule can be explained and defended to everyone in the society exactly because it is based on sound science.” The hearing continued for several hours, and for the most part, the committee was reasonably attentive to the witnesses throughout. The TV crews packed up and left after a few of the early star witnesses had spoken. Print reporters stayed longer, trying to get interviews with civic group representatives after they had made their statements. The next day the committee and its consultants met again in the conference room to review and discuss the views presented and to begin the process of actually deciding on changes to the essential medicines list.
Reference Heuser, Stephen. 2009. “One Girl’s Hope, A Nation’s Dilemma.” Boston Globe, June 14, A1.
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Case Study A