EDITORIAL Therapeutic Controversies

Several years ago, a group of disgruntled physicians gath-ered in the house of a Vancouver consultant to discuss the future of health care in the province. They were disgrun-tled because the provincial government had announced plans to reorganize the delivery of health care, expanding the bureaucracy and focusing on the whims of consumer opinion instead of maximizing efficiency in the delivery of services. Coincidentally they had rolled back a fee increase for physicians, citing budget constraints. A guest at the gathering was a physician–scientist who had recently been elected to the provincial legislature. His cam-paign had been supported by sectors of the Vancouver medical community with the understanding that his pres-ence in the government of the day (or even the opposition) would benefit the medical community in general and his supporters in particular. But, of course, once the colleague became a member of the legislature, it became clear he would have little influence on the government’s intended reforms. He dutifully supported his party’s plans for cost-containment within all ministerial budgets, but espe-cially that of the Ministry of Health. He did not dispute the Ministry of Health’s inferences that the pharmaceutical industry was an opportunistic, ethically challenged manipu-lator of medical misfortune. Or that misguided prescribing of expensive medications was a significant contributor to rising costs of health care, even if such prescribing might be reducing costs in other areas of care. These inferences were not, by and large, seen as factual by the disgruntled physi-cians. But they did see value in their colleague’s idea of try-ing to rationalize prescribing patterns, so that any rise in Pharmacare costs could not be laid at the feet of wasteful and unthinking prescribers. Directly or indirectly—it is still unclear which—arising from the gathering of disgruntled physicians, the idea of having a therapeutics review body that was independent of both government and the pharmaceutical industry devel-oped. The Therapeutics Initiative was established in 1994 as

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