The triumph of NICE
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7459.0-g (Published 22 July 2004) Cite this as: BMJ 2004;329:0-g
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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
Competing interests: No competing interests
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Superseded Technology of Yesteryear" (NASTY).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
Competing interests: No competing interests
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
Competing interests: No competing interests