Abstract

UK neurologists have been slow to prescribe beta interferon and other potentially disease-modifying drugs for multiple sclerosis (MS). We have been constrained by our notorious conservatism, which is in part based on our demand for good evidence before changing practice, particularly when it comes to very expensive therapeutic interventions such as beta interferon. But there has been another constraint – the UK National Health Service (NHS) has a centralized command and control system (which I personally rather approve of) that would not sanction the prescription of beta interferon because of its very high cost. After all, to prescribe even just to those patients conforming to the Association of British Neurologists (ABN) guidelines would cost roughly £120 million per annum, enough to fund about 1200 new consultant neurologists (which would quadruple our present number), or 4000 physiotherapists, or 8000 medical secretaries. It is all very well for individual neurologists to stamp their