IN THE land of the free market, the idea of the government influencing the choice and cost of medicines is heresy. But that's exactly what's in store for the US, as it tries to rein in its healthcare costs, which threaten to cripple the economy if left unchecked.
Other countries have already taken steps to deal with such problems. The UK set up the National Institute for Health and Clinical Excellence (NICE) in 1999 to decide which drugs the country's National Health Service could use (see "UK's gatekeeper has the final say"). Similar organisations operate in Australia and Canada, and all claim to be working successfully, allowing governments to just say no to ineffective drugs and haggle with pharmaceutical companies when prices are too high.
Now, at long last, the US is considering a similar proposal in the shape of a proposed Comparative Effectiveness Board (CEB), which would review the evidence on how well drugs work and whether they are costeffective. If necessary, the CEB would carry out its own clinical trials. The idea is to break the pharmaceutical industry's stranglehold on drug prices and stop it peddling marginally effective medicines. The drug industry is already expressing its displeasure at the idea of a government body judging a drug's value for money.
Support for such a body is growing in both the public and private healthcare arenas. "There are cultural differences about how the role of government is viewed, and most Americans tend to be on the side of 'less government'," says Steve Pearson, of Harvard Medical School and a key proponent of the CEB. "But that's starting to change, as people have problems affording healthcare, and something has to give."
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