BMJ  2004;329:1003-1004 (30 October), doi:10.1136/bmj.329.7473.1003

Commentary

Is NICE delivering the goods?

¹ University of Birmingham, Birmingham B15 2TT N.Freemantle@bham.ac.uk

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

Those of us concerned with the ability of organisations such as the National Institute for Clinical Excellence (NICE) to influence clinical practice in line with their guidance will read this paper with great interest.¹ But what conclusions can we draw from it? If NICE was an unqualified success, clinical practice in the NHS would reflect its guidance—so use of implantable cardioverter defibrillators would have gone up smartly, laparoscopic hernia repair would have stopped, and so on. This was demonstrably not the case.

In contrast with randomised controlled trials, where the intervention is under the control of the investigator, the quasi-experimental method necessarily used by the authors is weak in attributing cause and effect. So we cannot even conclude that changes that occurred apparently in line with the NICE guidance were actually caused by it, either in part or in whole.

Some may find it surprising that prescribing of (two of . . . [Full text of this article]

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• Schlander, M (2008). The use of cost-effectiveness by the National Institute for Health and Clinical Excellence (NICE): no(t yet an) exemplar of a deliberative process. J. Med. Ethics 34: 534-539 [Abstract] [Full text]  

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