NICE and its value judgments: Utilitarian values are inadequate

doi:10.1136/bmj.329.7468.740-a

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

Letter

NICE and its value judgments

Utilitarian values are inadequate

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

EDITOR—The values of the National Institute for ClinicalExcellence (NICE) turn out to be utilitarian and economic.¹Predictably, NICE's attempt to use them to generate advice toprofessionals for achieving the highest attainable standardof care often founders on the narrowness of perspective. Highquality care demands an understanding of human suffering thattranscends the urge to fix biological machine faults.

Take obesity. In 2001 NICE approved the prescription of orlistatand sibutramine to obese patients, a tiresome diversion in theface of a developed world pandemic of obesity. Obesity is aboutconsumption, and consumption is woven into the fabric of society.No amount of medical technology or guidelines stands any meaningfulchance of changing this. The problem is cultural, and the solutionsare political and educational.

We might be spared these distractions if NICE added two newquestions to their appraisals.

Firstly, is the problem for which . . . [Full text of this article]

William House, general practitioner

St Augustine's Practice, Keynsham, Bristol BS31 2BN thehouses@supanet.com

David Peters, trustee, British Holistic Medical Association

School of Integrated Health, Euston Building, University of Westminster, London W1W 6UW

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