I was puzzled by David Lock's advice in NICE rulings to PCTs to have a policy to refuse to fund emerging treatments except in exceptional circumstances.

I was puzzled by David Lock's advice in NICE rulings to PCTs to have a policy to refuse to fund emerging treatments except in exceptional circumstances.

The.Herceptin case decision at Swindon PCT seemed to be founded on the basis that such a policy was irrational, and that the PCT could not contemplate in advance what circumstances would be regarded as exceptional.

But if the PCT sets a policy, such as that suggested by Mr Lock, then could there be a risk that it would be unable to find rational distinctions between different patients within the eligible group when new drugs come along?

Jonathan Turner, executive assistant, Redbridge PCT.