By Tim Bierley

Many doctors beginning strikes this week will have felt aggrieved when Keir Starmer described their demands for pay restoration and more training places as a “fantasy”.

They may feel even angrier if they compare Starmer’s statements on the strikes with his government’s softball approach to recently concluded negotiations with the pharmaceutical industry.

In the last few months, the pharmaceutical industry has been at war with the government over medicine prices, with industry lobbyists demanding the UK water down pricing mechanisms that help to control NHS spending. Donald Trump has also weighed in, threatening tariffs on UK medicines exports to the US if we don’t spend more on medicines.

Currently, the state can claw back some revenues from firms if the drug bill rises rapidly. But big pharma companies have pushed to significantly water down that rebate scheme - and effectively lift the cap off spending. Even more shocking was the demand that the NHS increase the threshold at which it considers new medicines good value-for-money by 25 per cent. To be clear, this is not about buying more medicines, but simply about the NHS agreeing to worse value for money.

If ever a set of demands sounded like a fantasy (and a dark one at that), it was this from the pharma industry. While Trump’s tariff threats make the situation more difficult today, just this September, Downing Street said the NHS will “never be on the table” in a trade deal with........

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