Clearing 'the fog on the Tyne': can the quality of therapeutics be assessed?

1. The rise in prescribing costs in developed countries is a concern for all physicians, but a particular challenge for clinical pharmacologists. 2. There are wide variations in the amounts and types of drugs prescribed in developed countries. 3. In order to address cost appropriately it is also necessary to address quality. Various aspects of the quality of therapeutics may be considered, including audit of process, patterns of prescribing of specific drugs and reporting of adverse drug reactions. 4. A consensus process is described in which primary care physicians developed criteria of prescribing quality, using data readily available within the UK. Practitioners scores using these criteria did not correlate directly with prescribing costs, indicating that cost alone cannot be used as criterion of quality. 5. The measurement of quality in therapeutics remains an important challenge for the future.