BRIEWE

Medicines: effectiveness or cost

To the Editor: Regarding the article by Chris Bateman,¹ I was horrified to see that I am readily identifiable as the journalist's 'source', as I had officially withdrawn and dissociated myself from all aspects of the article. The article is flawed and does not reflect the collegial nature of the discussions at provincial and national levels. It is ironic that the article attempts to debate the ethics of breast cancer drug allocation - but there has been a lack of ethical due-process in its publication. The lack of peer review is highlighted by the spelling of one of the prominent agents involved (i.e. the taxanes), which are spelt 'texanes' throughout the article.

This letter, however, allows me the opportunity to highlight the need for a formal review process for medicines in a resource-constrained health care sector, such as our own.

The way in which medicines are usually evaluated in the various sectors in South Africa is based on two criteria: effectiveness and cost. However, in reality, decisions are invariably based on expert opinion. Unfortunately, the emphasis is usually on either effectiveness or cost, and hardly ever on a systematic analysis that incorporates both considerations. There are a number of reasons for this behaviour: (i) lack of appreciation of the role of cost-effectiveness analysis in decision making; (ii) scarcity or absence of individuals with the necessary critical appraisal skills; and (iii) a short-term view of the consequences of health care decisions.

It is imperative that this kind of independent systematic analysis takes place for all medicines, so ensuring access, an equitable distribution of resources, and justice in the health care industry. Such a process will go a long way towards establishing an appropriate standard of clinical excellence, open to scrutiny. This is a critical ethical imperative in a resource-constrained health care system such as South Africa's, and for societal trust in the process.

Marc Blockman

Department of Internal Medicine
Division of Clinical Pharmacology
University of Cape Town and Groote Schuur Hospital
blockman@mweb.co.za

1. Bateman C. Vital breast cancer drugs highlight funding ethics. S Afr Med J 2008; 98: 833-836.         [ Links ]