Abstract
A case study is presented which examines the political and organizational processes associated with the attempt by the Department of Health, through its appraisal body NICE, to regulate the introduction of a new drug treatment (beta interferon) for patients with multiple sclerosis on ‘cost-effectiveness’ grounds. Underpinning this case is a concern to engage critically with the claim that we are witnessing the emergence of a de-regulated contractual form of health care provision within ‘postmodernity’. A general assertion of this paper is that New Labour’s NHS modernization programme has produced more rather than less central regulation over the activities of health trusts and the work of health care professionals. However, in this case study the Department of Health is shown to have ultimately failed in achieving its goal of regulating the introduction of beta interferon precisely because it involved social and economic factors beyond its direct control. These factors included the clinical needs of patients, the prescribing activities of doctors and the refusal of the pharmaceutical companies to reduce their profit margins.
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