LETTER: Not all old medicine is good medicine

From Dr Ian McKee

Sir: Your editorial "Old medicine is good medicine" (10 April) argues that doctors are pressurised by pharmaceutical advertising into prescribing new, expensive drugs which may be less safe or effective than those they replace. You suggest that the NHS should institute a strict formulary of drugs that are good value for money and have a long history of safety and effectiveness.

Pharmaceutical companies are strictly limited by government regulations as to the amount they can spend on promotion, and any claims made on behalf of their products need to be backed by hard evidence. The rules governing pharmaceutical advertising are, rightly, far stricter than those in almost any other field. It seems a mite hypocritical for a newspaper that relies on advertising to attack the advertising of pharmaceutical products, particularly as these special safeguards exist. Perhaps you feel that doctors are more gullible than others?

A problem with your idea of a severely restricted national formulary for NHS patients (presumably poor old private patients would still be exposed to the drugs you consider dangerous) is what exactly would be in it. Your editorial was stimulated by a single report from the US, which claimed that drugs like nifedipine, when used in the treatment of high blood pressure, are less safe than beta blockers or diuretics. Yet nifedipine is so old that it has been out of patent for many years, and is used so commonly that it would certainly have a place in even the most restricted formulary.

And just how could any new drug demonstrate the long history of safety and effectiveness you require if no one could prescribe it? Do you intend the British to be limited to the pharmacopoeia of Dr Finlay until the citizens of every other developed country have benefited from major pharmacological advances for many years?

You cite thalidomide as an example of a drug that had unexpected side effects, but for every thalidomide there are scores of new drugs that have saved life or improved its quality for millions of people. Many of these drugs have been invented and developed in this country, boosting our international reputation and enhancing our balance of payments.

Over the past few decades we have seen the decline of British industry and have become a nation of importers rather than manufacturers. Does the sight of one of the few successful manufacturing industries we have left unnerve you so much that you suggest ways of undermining it?

Yours etc,

IAN MCKEE

Edinburgh

10 April