title: Paternalism in practice: informing patients about expensive unsubsidised drugs.
abstract: Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73-99% in New Zealand and 72-94% in Australia depending on the scenario) the percentage who would not discuss expensive unfunded drugs was substantially lower in New Zealand (6.4-11.1%) than it was in Australia (28-41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians' decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced.
authors.affiliation: Department of Philosophy, The University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand. t.dare@auckland.ac.nz
authors.forename: Tim
authors.initials: T
authors.lastname: Dare
authors.forename: Mike
authors.initials: M
authors.lastname: Findlay
authors.forename: Peter
authors.initials: P
authors.lastname: Browett
authors.forename: Karen
authors.initials: K
authors.lastname: Amies
authors.forename: Sarah
authors.initials: S
authors.lastname: Anderson
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000191:economics* / Q000600:supply & distribution; D001291:Attitude of Health Personnel; D000068258:Bevacizumab; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000191:economics; D016527:Drug Costs; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000941:ethics*; D009520:New Zealand; D026706:Paternalism; D010353:Patient Education as Topic; D000069283:Rituximab; D000077204:Temozolomide
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000068258:Bevacizumab; D000069283:Rituximab; D003606:Dacarbazine; D000077204:Temozolomide