The impact of pharmacoeconomics on the practitioner and the patient: a conflict of interests?

It is very easy to polarise the debate between clinicians and economists by asserting that clinicians regard the needs of individual patients as paramount, whereas economists are more interested in the priorities of society as a whole. Economists have criticised clinicians for failing to recognise the scarcity of resources relative to wants and also for being unable to appreciate the diversity of individual preferences. Furthermore, economists will assert that the wants of patients are not the same as their needs. A clinician may use degree of illness as a guide to relative need for treatment, whereas an economist would ask for information about response to treatment, explicitly acknowledging that the most severely ill patient may not derive the greatest benefit from treatment. We believe that the key to this problem lies in the differences in the definition of terms by the 2 sides, and in fact that there is some confusion over the primacy of the individual versus society. Both clinicians and economists are liable to assert that healthcare resources should be distributed equitably. However, clinicians have a somewhat imprecise appreciation of the concept of equity, whereas economists have developed a set of explicit definitions of equity, which clearly show the consequences of shifting the balance of resources to achieve equitable distribution. Inevitably, this leads to diversion of resources from one segment of society to another. At present, any transfer of resources is liable to be viewed as a sacrifice of an individual patient's needs in the interests of society as a whole. This paper shows that clinicians already accept that there is a conflict of interests between the wants of individuals and the needs of society. We believe that progress can only be made by increasingly explicit debate about the merits of different treatments. Economists have developed the theoretical framework; it is up to clinicians to turn theory into practice.