NICE workBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7552.1266-a (Published 25 May 2006) Cite this as: BMJ 2006;332:1266
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EDITOR – The review of NICE’s work1 and its frustrations2 miss the
point: NICE has failed the objective of “…a leading role in healthcare
priorities” because it cannot do otherwise.
The evidence of failure is bio-economic: because new drugs risk
physical and financial harm, recently shown dramatically with an immune
stimulant, the pharma industry now mostly produces timid variants of
existing drugs. Even when novelty is sought but fails, the high cost of
production ensures that a poor drug is taken to market instead of being
scrapped. Since, therefore, most new drugs have little or no advantage
over those already available, NICE’s acceptance of 80% 1 is clear evidence
of failure; success would be rejection.
The reason NICE cannot but fail is bio-social – society’s won’t allow
definition of a worthwhile level of benefit, let alone cost-benefit: to
the sick patient, one chance in a million, one extra life saved, even one
extra day’s health, are all equally desirable – try anything, regardless
of its worth or cost, for the dubious reason that “worth” can only be
personal and “anything is better than nothing”. From these absurdities,
it follows as surely as a politician follows a vote, that anything becomes
desirable, regardless of cost and quality – from a new, dubiously more
effective, anti-cancer agent, to an old, not-yet-shown to be equally
ineffective, to something from Prince Charles’ medicine chest.
If Government’s objective had been therapeutic quality, NICE might
have helped educate society about the infinite uselessness of the infinite
statistic, though the great effort needed by the antismoking lobby with
its very finite statistic, shows it wouldn’t have been easy. Now, apart
from the small cost savings of bureaucratic delay, NICE even fails in its
original political purpose as a cost-cutting exercise; it’s not a nice
Sam Shuster, Emeritus Professor of Dermatology,
University of East Anglia Medical School,
1 Raftery J. Review of NICE’s recommendations, 1999-2005. BMJ
2006;332:1266-8 (27th May).
,P>2 Ferner RE, McDowell SE. How NICE may be outflanked. BMJ 2006; 332: 1268-
71 (27th May).
Competing interests: No competing interests