The recent judicial review instigated by the drug companies Pfizer and Eisai concerning National Institute for Health and Clinical Excellence (NICE) guidance,1 which would deny access to three drugs for patients with mild Alzheimer's disease, and a second ongoing inquiry into NICE by the House of Commons Health Select Committee,2 are the latest examples highlighting the importance of NICE and the challenges it faces. The judicial review, which ruled predominantly in favour of NICE, concerned the procedures NICE used to arrive at their judgment, not the outcome specifically. However, NICE has to make a judgment that is more fundamental than the matters at stake in the judicial review—at what point should an intervention be deemed cost effective enough to warrant public subsidy via the National Health Service (NHS)?

An advantage of the way in which the United Kingdom funds the NHS is that its patients do not have to judge whether or not the health benefits of their treatment are worth its costs. But someone, somehow, still has to grapple with the decision over the …