Canadian Medical Association Journal 1996; 155: 512
They state that expenditures on drugs have grown to 15% of the total health care budget, surpassing expenditures on physician services. Most miss the point, made in this article, that expenditures on drugs include those for prescriptions and for all over-the-counter drugs. The point not made in the article is that the expenditures on physician services include the money paid to physicians for fee-for-service billings but do not include the expenditures for salaried, academic or physician services included in hospital global budgets.
It is not surprising that the expenditures on drugs are increasing as new discoveries and products, many of which make a major difference in patient care, come on the market. Furthermore, the article alludes to the fact that new drug therapy often replaces more expensive technologic treatment, reducing the overall cost of treatment. For example, the introduction of cimetidine for peptic-ulcer therapy markedly reduced the overall cost of therapy, although the drug costs increased by 6 1/2 times (Table 1).
I hope that Holbrook and colleagues can bring some sense to the evaluation of the effectiveness of various drug therapies in patient management and disease outcome. If they can facilitate meaningful interaction among prescribing physicians, academics responsible for medical teaching programs and the drug industry, they will have helped provide more efficient overall care. It is refreshing to read Holbrook and colleagues' approach, especially compared with the Orwellian, "head-in-the-sand" approach recommended by Drs. Gordon Guyatt ("Guidelines for interaction with the pharmaceutical industry," CMAJ 1995; 152: 1041-2) and Robert F. Woollard ("Opportunity lost: a frontline view of reference-based pricing," CMAJ 1996; 154: 1185-8 [full text / résumé]).
William W. Arkinstall, MD, FRCPC, FACP
Kelowna, BC