BMJ  2004;329:740 (25 September), doi:10.1136/bmj.329.7468.740

Letter

NICE and its value judgments

Option of safe "understudy" treatments should be available

The first 150 words of the full text of this article appear below.

EDITOR—The National Institute for Clinical Excellence (NICE) aims for the highest attainable standards of care.¹ The bedrock of its advice is published evidence of benefits from treatment (mainly pharmaceuticals).

In the report accepted in May consideration of safety issues focused on invasive surgical and diagnostic procedures, and the "judgment" on risk assumed that such risks are small and calculable.² In economic terms, to distinguish between real risk (calculable and potentially manageable) and uncertainty, where judgment of costs is purely subjective, is important.

In July the new health service director of research and development announced a forthcoming national programme of research on drug treatment in children. Given the serious and quite common adverse consequences of paediatric treatment reported,³ a fundamental reassessment of child health interventions is warranted. Adverse drug reactions or interactions between new and existing drug treatments are uncertain in caring for children aged 0-16 years. NICE has . . . [Full text of this article]

APU, Chelmsford, Essex CM1 1SQ a.w.caan@apu.ac.uk

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