The Pharmaceutical Journal
Vol 270 No 7236 p241
15 February 2003

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Explores areas of medical ethics neglected by other authors

'Pharmaceutical ethics', edited by Sam Salek and Andrew Edgar. Pp xii+198. Price $90.00. Chichester: John Wiley & Sons Ltd; 2002. ISBN 0471 49057 1

Most ethical issues in pharmacy are perceived as being confined to practice areas where there is direct interaction with individual patients. This collection of essays redresses the balance by exploring ethical issues around pharmaceuticals and the wider community: third world countries, potential recipients of new drugs, purchasers of health care in bulk as well as individual purchasers of over-the-counter medicines.

The 13 chapters range over the values and philosophy underpinning codes of ethics (surprisingly, 1984 is given as the date of the British version current at publication), the ethical perspectives implicit in drug discovery, choice of clinical trials, health economic evaluations and rationing within a state health care system. Several essays explore the values at work in individual choices of treatment by physician or patient, or which criteria to use to measure a positive outcome — clinical, improved quality of life or cost-effective use of resource. The assent of the informed and involved patient is evident in chapters on consent, on holistic treatment and on specific approaches to the treatment of depression.

A useful overview of the values implicit in codes of advertising practice precedes a final and provocative essay on the ethics of state intervention in health care. The author, a consultant pharmaceutical physician, accepts that the state may determine which medicines are safe enough to be marketed and the price that will be paid when reimbursed by the taxpayer. Such tolerance does not extend to decisions as to who or what diseases should be treated within the system; in other words there would be no black list and no National Institute for Clinical Excellence. Such decisions, he suggests, represent unwarranted paternalism and should be dictated solely by the patient-doctor contract.

Overall, this book justifies its claim to explore a "neglected area of medical ethics" and can be recommended as a useful extension to the more familiar scope of ethical issues in pharmacy practice.

Joy Wingfield