http://www.theguardian.com/society/2014 ... ushy-drugs

'What have ya got that has morphine in it?'

So a few months ago Cameron was commenting on sharp elbowed moms and now being sharp elbowed is policy?

Haslam sounds like he's spent too long in America and forgotten what things are like in the UK



In America:

- drugs are marketed and heavily so
- in combination with the above, doctors are courted by drug companies who do things like provide free samples. In the UK, the max a drug company can spend per doctor is £5*.
- American healthcare is private and therefore there is no cost limitation on prescriptions above and beyond the necessary other than the limit imposed by the insurance company

In the UK, drugs are not allowed to be marketed (I think there are specific exceptions to drugs available over the counter). We aren't routinely courted by drug companies. We have a drug budget. The latter is quite important. It means I can only prescribe certain drugs, or that certain drugs must be trialled before more expensive and newer (but not necessarily better) drugs are tried. Pass on the cost of drugs to the patient and you'd see a huge change in prescriptions - poorer patients would opt for the cheapest/not take any meds, rich patients would just want the perceived best, and maybe a sensible group would go for the most cost-effective.

I will prescribe what I feel is appropriate according to: evidence base, local prescribing guidelines, patient allergies, patient disease. I have patients who muddle along with simple paracetamol for arthritis pains where they may benefit from a slightly stronger prescription. I have patients who demand a branded version of a drug purely because they've been led to believe it's better than generic. I will concede the odd person may not tolerate a particular company's version of a drug, but to choose simply based on what's been marketed is ludicrous.

* I've never experienced it but I gather that doctors would often have lush meals in expensive restaurants whilst a drug rep would talk about a particular drug. What I do is go to teaching sessions held by specialists in a field, and there will be a basic lunch provided by drug reps who then come and chat about their drug. The food is very basic.

Back in the 1980s, I remember reading some statistics about the volume of CFCs pumped into the atmosphere by asthmatics using their inhaler. So I asked my GP about this and if there were any alternatives. That’s when I got the diskhaler, which he said were 80% more efficient. So, I asked him, if that are that efficient, then why don’t your prescribe them instead of the aerosols.

His replay: “I can’t - you have to ask for them”. Since then, I’ve asked about alternatives if something new is suggested because I suspect that there may be something better that can only be prescribed if asked for.

That does presume that you know what to ask for.