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GPs go forth

Give GPs the choice

The UK's troublesome introduction of inhaled insulin has been an epic struggle from day one, with all the ingredients for plenty more drama to come. We have a treatment hailed to the skies by patients – and manufacturers – ever since those first overhyped whispers of an end to the daily chore of insulin injection. But we also have a sceptical medical establishment, unconvinced over its cost-effectiveness or side-effect profile. In the ensuing battle, it has been far from clear who would prevail.

But this week, the Scottish Medicines Consortium thrust its head above the parapet by rejecting Pfizer's Exubera outright. It was a brave decision, but not a welcome one for GPs, particularly as they now look likely to have to deal with a UK-wide lottery. NICE is set to provide access for patients in England and Wales who are needle-phobic, which might have been welcomed as a sensible compromise had the institute not added the unworkable proviso of assessment by a psychiatrist or psychologist.

What the whole mess highlights is the ridiculous, overly bureaucratic approval process, and above all, the lack of trust it displays in doctors. It is impossible, as NICE and the SMC have attempted to do, to definitively weigh up the conflicting priorities of cost and patient preference. Far better to express the doubts, make clear inhaled insulin should not be a default treatment – but leave the final choice to GPs.

When did clinical judgement fall so out of vogue?

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