Abstract

The future clearly lies in restricting the introduction of new treatments into medical practice unless they are beneficial and an improvement over existing compounds, together with a stepwise re-evaluation of current therapies. The days of analogue development which give 10% or 15% improvement in toxicity over existing compounds are no longer acceptable, and resources should be preserved for real advances. These may require support in their development, particularly at the randomised controlled trial level, by government or research institutions in collaboration with industry.Patients in general are now better informed by their physicians, nurse specialists and self-help groups, although few regions have gone as far as Oregon in information dissemination and involvement of patients in resource allocation decisions. We should take comfort from the fact that in spite of all the difficulty, new treatments continue to be developed, reflecting a commitment from the public, government and the private sector for continued progress. The way forward may be challenging, but the medical profession has to demonstrate leadership by countering the short-sightedness and over-regulation which has resulted from the recent economic recession. We should be seen to be acting with foresight in maintaining the quest for real improvement in the best interests of patients. Governments in turn have a responsibility to ensure they maintain independent bodies of professionals who have the qualities of flexibility, critical ability and vision to ensure continued development of high quality care