Rapid Responses to:

EDITOR'S CHOICE: Richard Smith The triumph of NICE BMJ 2004; 329: 0-g [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

The need for nasty

Robert C Peveler   (25 July 2004)

Valuing Life Years

Bill Kirkup   (25 July 2004)

One of the Britain's greatest cultural exports

Arturo Salazar, Mario Tristán PhD   (28 July 2004)

The need for nasty 25 July 2004
Robert C Peveler, Professor of Psychiatry University of Southampton SO14 0YG Send response to journal: Re: The need for nasty	On Oct 12 1999 as vice-chair of the late lamented Wessex DEC I sent the following response to an editorial at that time: "Your excellent editorial highlights one of the main drawbacks for NICE which we in the DECs have also highlighted, namely its exclusive concern with NEW treatments. Some months ago I proposed the need for a sister organization with the remit of examining existing health technologies using the same framework, in order to identify suitable targets for dis- investment which would yield the necessary resources to afford the new treatments supported by NICE. The neat solution is to set up a complementary organization, the "National institute for Assessment of Superseded Technology of Yesteryear" (NASTY). This would nicely complete the yin and yang of health technology assessment for the NHS." Hate to say "We told you so" Professor Maynard, but we did...but I suppose 5 years is not really a long time for the penny to drop? Competing interests: None declared
Valuing Life Years 25 July 2004
Bill Kirkup, Regional Director of Public Health (North East) Government Office North East, Wellbar House, Gallowgate, Newcastle upon Tyne, NE1 4TD Send response to journal: Re: Valuing Life Years	Richard Smith writes: "NICE, supported by its Citizens Council, has also decreed that 'an additional adjusted life year is of equal value for each person.' Confronted with a grandmother and her granddaughter drowning you should toss a coin to decide which to rescue." Er, no, not really. All other things being equal, the granddaughter will gain many more adjusted life years from being saved from drowning than the grandmother, whose life expectancy will generally be shorter. Of course, you don't know that all other things are equal, but in the absence of any knowledge otherwise and without the means to find out in time, that would be the best basis for your decision under these imaginary 'NICE Guidelines on Rescuing Drowning People'. Supposing, though, that you knew that both grandmother and granddaughter had one year of life left to them, of similar quality. Then NICE would, by implication, have you toss a coin to decide which to rescue. Quite right too. I hope that Dr Smith is not suggesting that the granddaughter's one year of life is to be valued more highly than the grandmother's. Competing interests: None declared
One of the Britain's greatest cultural exports 28 July 2004
Arturo Salazar, MD, Training and Research Coordinator Central American Branch of the Cochrane Iberoamerican Network. SnJose, CostaRica. PO Box 1677-2100, Mario Tristán PhD Send response to journal: Re: One of the Britain's greatest cultural exports	"Satisfactory, but could do better," writes the retiring headmaster and we cherish this constructive thought towards a better healthcare for all. NICE is well known in Central America by health care professionals and is getting disseminated to Politicians by a Central American Evidence Based Working Group; who looks for a critical appraise, adequate rationing of our declining resources and equity in our health care. We were aware it was necessary to contextualize NICE information to our social, cultural, and budgets differences; but the truth is we never gave so much thought about contextualizing NICE to Britain. We wrongfully assumed Britain should not need to do this process, because NICE is indeed, one of the Britain's very own products. Competing interests: None declared