It has been 3 years since I wrote an editorial on the topic of uncertainty around new cancer treatments (issue 4 of volume 2009). Has this field progressed in 3 years? I think the answer is both yes and no. Yes because we now have a clearer picture of why cancer drugs can sometimes act differently (usually worse) in real life situations than they seem to in pre-registration clinical trials. No, as due to this, they continue to be overpriced. Drug prices are initially based on pre-registration trials, which often intend to achieve licensing rather than demonstrate added value for the average patient under real life conditions.

At the EAHP 2012 annual conference in Milan several presentations looked at how the traditional drug market seems to be stuck in a dead end street, and that governments—on behalf of patients—increasingly refuse to follow the brutal price settings of companies. Dr Paul Cornes from Wales (UK) made a particularly strong case in a seminar sponsored by the European Generics Association. He talked about the three E's: efficacy (‘can it work’), effectiveness (‘does it work’) and cost-effectiveness=efficiency (‘is it worth doing compared with …