THE LANCET
POLICY AND PEOPLE
UK Labour government would “scrap” proposed prescribing system before, with up to five “general” treatment options for each diagnosis—and a choice of up to five possible drugs in each treatment category. Guidelines for the final product, due in 1999, are likely to be developed through a model similar to that of the British National Formulary, in that a national controlling committee would appoint specialist editors to draft guidance for each therapeutic field. These drafts would then be sent out for comment to interested parties before formal acceptance. Professional bodies such as the Royal College of General Practioners are expected to put themselves forward for this central validating role, although Dobson indicated that the NHSE would insist on having an observer on the committee. The procedure will be finalised in June. Prodigy’s use “will always be voluntary” and it will be simple for a GP to override its recommendations at any time, said Dobson.
he UK National Health Service Executive this month begins a second phase of live trials of its prescription-guidelines computer system for general practitioners. This is despite a warning that a Labour government would either scrap the project, or send it back to the drawing-board. The NHSE hopes the system, Prodigy, will be ready to provide comprehensive prescribing advice to all GPs within 2 years. It has already invited independent organisations to tender for the role of overseeing the national guidelines, Charles Dobson, head of the NHSE prescribing branch, said in London last week. But the drug industry, now backed by Labour, continues to criticise the project—on which about £2·5 million has been spent so far. Kevin Barron, the shadow public health minister, told a February meeting of the Association of the British Pharmaceutical Industry: “I do not want the Prodigy experiment in its present form to go any further”. A
Labour government would insist on immediate changes to the “very badly implemented” project, if it were to continue at all, he said. Barron criticised the NHSE’s lack of consultation with industry and with patient groups. His other complaints, expressed in several parliamentary questions this year, including a charge that Prodigy’s guidelines are not properly evaluated and do not take individual patients’ needs into account. He particularly questioned its recommendations for epilepsy, hypertension, and diabetes therapy. Its wider use could slow down the introduction of new therapies, and might discourage industry investment in Britain. The NHSE tests are not checking health outcomes, only GPs’ drugs bills, implying that the system is just a money-saving measure. The new version of Prodigy has now been heavily revised to placate the industry, and to accommodate the comments by GPs in the initial trials last year. It gives a wider choice than
Cholera hits Z aire
Drug firm buys up chain of US cancer clinics
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This is the first time a drug firm he UK drug company Zeneca, has got into care delivery. David which raised US$9 billion in Barnes, Zeneca’s chief executive, says sales in 1996, has become the first the purchase was linked to a desire to in the USA to buy a chain of clinics broaden opportunities that uses its products. “to provide services Zeneca makes goserelin and expertise as well (Zoladex), one of bestas pharmaceutical selling prostate and products to the healthbreast-cancer drugs care industry”. worldwide. In a deal Departing chairman worth $438 million, Salick has said he worZeneca is now full ries about the effect of owner of the Los the alliance on physiAngeles based Salick cian autonomy. But the Health Care, which company insists that runs the largest doctors affiliated with for-profit cancer-clinic the Salick chain will chain in the USA. Package-deal cancer care? not be forced to preIn the process, comscribe only Zoladex, saying it would pany founder and chairman Bernard be “impossible and wrong” to get in Salick, a kidney specialist, will leave the way of competition. after rejecting an $800 000 a year job Some view Zeneca’s purchase as a as “senior adviser”. Zeneca and smart business move, one that will Salick, who had a reputation for help it compete in the managed-care supporting his physicians, reportedly market. Others worry this could did not see eye-to-eye. set a precedent for the formation Through its 11 outpatient cancer of similar partnerships, prompting clinics, Salick Health affiliates with concerns about the implications for some of the country’s leading hospicare when a company controls drug tals including St Vincent’s Medical manufacturing and use. Center in New York. The company also runs ten outpatient kidney dialysis centres. Janet Firshein
s rebel forces continue their march through Zaire, fleeing refugees are hit by further hardship. United Nations officials report that close to 150 cases of cholera have been recorded in the past weeks. Most are said to be refugees of the civil war in neighbouring Rwanda, some of whom have not been home in 3 years. The reports come as repatriation efforts continue in an attempt to return these Rwandans to their homeland. On the way back, however, these victims of one of Africa’s bloodiest civil wars have found themselves caught between Zairian President Mobuto Sese Seko and the advancing rebel troops. Over 100 refugees are said to be dying daily, most from malnutrition. Both relief workers and African government officials insist that the cholera can and will be contained, and they stress the need to continue with the efforts at repatriation. A spokesman for the UN High Commissioner for Refugees announced that medicine and supplies will be expedited to the cholera-affected regions. Rober t Ivker
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Pete Mitchell
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Science Photo Library
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Vol 349 • April 26, 1997