Mesothelioma is a particularly nasty form of cancer. Always terminal, it usually affects the membrane covering the lungs causing severe shortage of breath, making the final stages extremely distressing, not only for the sufferer but also for the family. That follows the initial devastating blow of being given a prognosis of only a few months to live because it is often not diagnosed until advanced. Alimta is the only chemotherapy drug available for the treatment of malignant pleural mesothelioma in patients who are not suitable for surgery. It is not a cure but it can both improve the quality of life and extend life for appropriate patients. It was approved by the Scottish Medicines Consortium and doctors here have been prescribing it for about 18 months.

However, the National Institute for Clinical Excellence (Nice) has since issued a draft recommendation that it should not be given to patients in England other than for clinical trials. As a result, NHS Quality Improvement Scotland (QIS), which oversees the SMC, is reconsidering what should happen in Scotland. This situation raises important questions over the devolution of health service decisions and clinical guidelines. Dr David Dunlop, Glasgow's lead clinician for chemotherapy, has described the expected reversal of the Scottish decision as "staggering".

At a purely human level, every patient in Scotland will agree with him, especially when they read of the Orkney farmer, Gordon Norquoy, who was given only months to live, but two-and-a-half years later - as a result of being prescribed Alimta - has been able to visit Australia. Other forms of chemotherapy had no effect on his advanced mesothelioma. Faced with such spectacular improvement in health, it is difficult to disagree with Professor Andrew Watterson and Tommy Gorman, health researchers at Stirling University, that to deny access to such a drug is inhumane, or with Dr Marianne Nicolson of Aberdeen Royal Infirmary, who has no doubt "we must do everything possible to maintain our patients' opportunity to access Alimta".

Yet the chief executive of NHS Greater Glasgow and Clyde, Tom Divers, has said it would be "unwise" for Scotland not to follow the English advice. It is difficult to conclude that this view owes more to economics than medicine, not least because the incidence of the disease in Glasgow is more than double the UK average. As an asbestos-related cancer, these high rates are one of the remaining legacies of the city's heavy industry, yet because the disease can take a long time to become acute, the number of cases is not expected to reach its peak until 2015. Its treatment is, therefore, of particular concern in Glasgow and in Scotland as a whole. Every drug needs to be evaluated properly for effectiveness and cost as well as safety, and the Nice process is a more exhaustive one than that of the Scottish Medicines Consortium. In Scotland we need to take proper cognisance of their findings, but that does not mean we cannot come to a different decision.