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This kind of rationing is different from the sort seen in times of earthquake, flood, or war, where triage sacrifices a few to save many others. This new type is a painful pill for many to swallow. (There has, of course, always been inequity of access to health care in most countries, since geography, education, and personal wealth can determine whether one gets care. An Eskimo on the shores of Hudson Bay will not receive the same care as a resident of Toronto, and, if one is wealthy enough, waiting lines for cataract or hip or coronary bypass surgery can be avoided simply by traveling to another city or another country.) |
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Whatever happens, it is clear that in the future a new drug will need persuasive evidence that it is better, safer, cheaper, or more convenient to takei.e., possesses some comparative advantage over older competitorsif it is to be dispensed by HMOs and paid for by third parties. Pharmacoeconomic studies are the order of the day, even though we are only beginning to appreciate how to do them well and convincingly. Whether the FDA should be engaged in approving the use of such data is now being debated, but the obligation to do the studies is more evident with each passing day. |
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These are troubled times in many ways, but they are also challenging times. We all have a stake in first-class drug development, and it is hoped that this book will in some way contribute constructively to the process. |
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LOUIS LASAGNA, M.D., D.SC.
TUFTS CENTER FOR THE STUDY OF DRUG DEVELOPMENT
BOSTON, MASSACHUSETTS |
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