Sometimes the letters in the British Medical Journal give me the shivers. Just two weeks ago, all the consultant neurologists in the Institute of Neurological Sciences at Glasgow's Southern General Hospital wrote to complain about the way budgets for drugs are being forced upon them. The gist of their complaint is that their patients with Alzheimer's disease, multiple sclerosis and other devastating brain and nerve diseases are being prevented from receiving the drugs that could help them.

The decision on who should get what is being decided by local rules set by Glasgow's local drugs budget committee. If the hospital specialists, such as the neurologists who wrote the letter, in the committee's area cannot show that a treatment gives benefit in their own patients, then the committee will not allow it to be prescribed under the NHS. That places a near-impossible burden on the specialists. They cannot hope to prove benefit beyond doubt simply from the cases they see. These drugs were given licences all over the world only after being studied for years in huge international trials in thousands of patients under very strict controls. No single doctor or group of doctors could hope to match them.

The result? When people with these diseases leave the hospital after diagnosis, their GPs will not be allowed to prescribe the drugs that the specialists advise, and that they sorely need. Except, of course, to their private patients - who will have to pay the market price for them. The wealthy will still benefit from the new research, the great mass of people will never be able to afford it.

Glasgow's drugs budget committee say they have patients' interests at heart. The Institute's doctors feel that patients' interests are taking second place to cost cutting - and the Health Authority is using the new rules simply to cut drug costs. The doctors accept the need to keep health service costs down - but say this is the wrong way to go about it. The drugs prolong the time for which people with these diseases can remain independent, and shortens the time they are wholly dependent on others in the home, or need hospital and nursing home care. The savings in costs of care outweigh the price of these drugs to the NHS. And that does not begin to take into consideration the massive benefit for patients and their carers, that we cannot put a price on. Which, of course, is the real aim of any humane medical treatment.

I've reported meetings in the United States and throughout Europe where these same doctors from the Southern General have made absolutely vital contributions to new understanding and treatments of diseases of the brain and nervous system. They are second to no one on the surface of this planet in their medical care and their results. So when they all make this protest together something must be far wrong.

So, for the record, there are new drugs that have been proved to slow the deterioration in people with early Alzheimer's disease (they don't work when the disease is too far advanced). And there are drugs that slow the progress of nerve degenerative diseases in many young adults with much to gain in terms of time with family and friends. These are drugs that are licensed for these diseases because they have passed years of trials. Today it depends on where you live whether you receive them or not - and the decision is not taken by your doctor or even by your specialist, but by some committee that knows nothing about you.

Another letter in the same BMJ puts medical costs in perspective. It is from a doctor in Uganda. It refers to a Jehovah's Witness (in America or Europe - the report doesn't say) who survived emergency surgery for a severe internal bleed without a blood transfusion. He lost four-fifths of his blood in the process - and he had to stay in a modern hospital for 14 weeks, at an estimated six-figure sum, before he could return home.

The Ugandan doctor points out that this money, spent on one person in the developed world, would cover his costs of treating 25,000 outpatients, 7,000 in-patients, delivering 1,000 babies and performing 1,500 operations in one year.

Of course doctors in Britain are happy to respect the wishes of Jehovah's Witnesses on transfusion. This article is not anti-Witness. But if costs are to be the prime motive for prescriptions and treatments in the future, they, too, may be in the firing line, along with our Alzheimer's patients.

Converted for the new archive on 30 June 2000. Some images and formatting may have been lost in the conversion.