Primary care trusts are failing to effectively involve the public in decisions over drugs not approved by the National Institute for Health and Clinical Excellence, according to a Picker Institute review.
The report, Not NICE, concludes that citizens' juries and advisory panels could be effective ways to make PCTs more transparent and locally accountable.
The institute's research showed that more intensive processes would make the public less "reticent".
But PCTs were most likely to use those public involvement processes that were the least systematic and time consuming.
Also important were agreed channels for opinions to feed into decisions; absence of conflict between local views and national policy directives and reaching a clear guide to action.
PCTs were hindered by a lack of resources; inability to reach some groups; the public's lack of scientific knowledge; and fears of giving false hope or of being attacked over decisions taken.
Picker Institute head of policy Don Redding said: "Public involvement could get PCTs through the three hurdles of demonstrating rationality, being transparent, and being accountable."