In November 2008 Professor Mike Richards issued his much awaited review of the British Department of Health's policy on out-of-pocket payments ("top-ups") for drugs not approved as cost effective by the National Institute for Health and Clinical Excellence (NICE). The policy stated, or had been construed as stating, that those who top up thereby became ineligible for further National Health Service (NHS) treatment for the condition targeted by the drug.1 For instance, if a lung cancer sufferer bought Avastin, which is not NICE approved, she could no longer receive free treatment for her cancer on the NHS's tab. Richards, the National Cancer Director, recommended that the policy be repealed. From an ethical point of view, this change should be enthusiastically welcomed.
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