Inhaled insulin

Editor—Morton-Eggleston and Barrett give a useful, timely description of inhaled insulin to coincide with the recent recommendations from the National Institute for Health and Clinical Excellence (NICE).¹,² But why issue an editorial by authors from the United States, a country not known for its wise use of health resources? And, why from an author heavily involved with Pfizer, the makers of the first inhalable insulin preparation (see competing interests)?

A more balanced and less promotional editorial was published in the BMJ only two years ago,³ and the questions raised at that time—concerning lack of additional benefit, long term safety, lung complications, questions on patients' preference, and the cost implications for the care of other patients—remain unanswered.

In the same issue of the BMJ questions were raised in a commentary about the worrying and increasing influence of the pharmaceutical industry in the academic research agenda.⁴ Should we not have the same concerns about industry driven medicine?

Doctors working in the United Kingdom and striving hard to continue the, arguably, best health service in the world, tend to agree with the NICE recommendations and would be concerned with any change of opinion without further, non-industry based, evidence.