Authors’ reply to Ryan, Menzies-Gow and Alexander, and Littlejohns

Ryan is sceptical about the role of the National Institute for Health and Care Excellence in producing guidelines, but judgments about the relative cost effectiveness of diagnostic approaches and treatments are important if we are to provide the best possible care with limited resources.12

We are encouraged that Menzies-Gow and Alexander3—and Baker in his remarks quoted in the accompanying news piece4—are in favour of a single collaborative and comprehensive UK guideline and hope that negotiations to achieve this will proceed swiftly.

We question Menzies-Gow and Alexander’s statement that “objective testing is shown to be cost effective in NICE’s primary care pilot …