Unequal access to medicines


Sir, – As we reflect on the news that certain new cancer treatments may now be provided to privately insured patients but not to their uninsured counterparts in the public system (“Access to cancer drugs for private patients ‘incredibly unfair’”, April 14th), the recent Access to Medicines Ireland conference was timely. Hosted by the Royal College of Surgeons in Ireland, it provides food for thought to all of us who care about fairness and human rights in healthcare. Three observations struck me in particular.

First, on a basic level, it is encouraging that that this news has been met with outrage, both among medical professionals and from the general public: that patients struggling with the same life-threatening illness should be treated differently by our health system based not on need but on their ability to pay extra for their healthcare. We all intuitively recognise this as wrong. Perhaps this lends support to the notion that most people in our society support the idea of a universal healthcare system, in which all are equally entitled to receive an excellent, timely standard of care.

Second, even though cases of restricted or unfair access to medications seem of late to be growing ever-more frequent, the array of expert speakers enlisted by AMI this year seek to remind us: there is another way.

There are better ways to harness the dual values of fairness and of innovation in medical research than at present, where they often seem to placed in direct competition – with patients stuck in the middle. Unless we reform the politicised, monopolistic, profit-focused system by which we currently evaluate new medicines and technologies, it will only become more unfair and more financially unsustainable.

Third, and perhaps most importantly, although the public-private disparity created by this latest cancer drug funding controversy has been denounced as unprecedented, in truth it is only really without precedent in that it illustrates the unfairness and inequities deeply entrenched in our healthcare system in a rather more blunt way than we are used to. We may not like to think about it, but in Ireland we have a two-tier health system. We have a system in which those of us who can afford private health insurance are seen earlier, diagnosed quicker and – it would now seem – eligible for different medicines and treatments than those patients who cannot. These disparities are unfair, and they affect the life and death of real patients, every day, all year round. This is wrong.

Healthcare is a human right, not a privilege, to which all of us are entitled: and equally entitled. We must regard it as our collective, urgent responsibility to bring about an excellent, well-organised and genuinely universal healthcare system, of which we can be proud. – Yours, etc,



Coombe Women and

Infants University Hospital,

Dublin 8.