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Editor's Choice

A future for NICE, and the world’s poorest children

BMJ 2010; 341 doi: (Published 10 November 2010) Cite this as: BMJ 2010;341:c6422
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}

Given the conflicting messages emanating from the government, it would be great if we could tell you exactly what the future holds for NICE, but we can’t. As Rebecca Coombes says in her Q&A on the subject (doi:10.1136/bmj.c6390), we should know more once the government releases its consultation document, probably by the end of this month. In the meantime, we’ve assembled the opinions of a range of commentators.

In their editorial Alan Maynard and Karen Bloor describe the coalition government’s response to the agency as “puzzling” (doi:10.1136/bmj.c6286). On the one hand the recent white paper talks of broadening NICE’s scope. Yet it also introduced a cancer drug fund to “help patients get the cancer drugs their doctors recommend,” apparently regardless of the views of NICE.

They discuss the shift to value based pricing of drugs, in which prices directly reflect their value in improving patients’ length and quality of life. “Who will evaluate ‘quality’ and how will these estimates be used to negotiate prices?” they ask. “Will NICE lead this process or at least provide evidence for it?”

In his best-of-all-possible-worlds Observation, Joe Collier regards the government’s new proposals as “logical, defensible, and welcome” (doi:10.1136/bmj.c6378). He envisages a new government body, called something like the “Commission on the Value of Medicines,” which will calculate the drug price that will reflect value. Operating at a national level, this body was first mooted in the Office of Fair Trading’s critical 2007 report on the current pharmaceutical price regulation scheme. NICE would be one of a range of agencies advising this new commission: “thus the same people, using the same information, and with the same skills as now would be producing economic evaluations.”

In her Q&A, Rebecca Coombes suspects that patients will have fewer rights under the new system and that conflicts could arise between doctors working in primary and secondary care. Previously, NICE’s rulings were mandatory on primary care trusts. Now it looks like the government won’t compel GP consortiums to make a particular drug available; there will simply be an agreed drug price that the NHS will be willing to pay.

Clashes could arise between primary and secondary care doctors, because secondary care doctors are those more likely to start patients on the drugs that GP consortiums will say they can’t afford. (To read how such conflicts played out in Germany recently, see Roswitha-E Goetze-Pelka’s letter doi:10.1136/bmj.c6309). Coombes quotes the BMA as saying that “GPs will hate being in the position of having to say no . . . It is at odds with their patient advocate role and they will struggle. It is much easier to blame a third party, such as NICE.”

Viewed from much of the world these problems look like luxury. Save the Children’s Justin Forysth explains the challenges for his organisation’s main international campaign next year (doi:10.1136/bmj.c6313).

“Every year over 8 million children die under the age of 5 years. The stark reality is that there is often no doctor or drugs on hand to treat a child with pneumonia or diarrhoea. As a consequence, 3.5 million children die each year from diarrhoea or pneumonia, and 90% of under 5s die from a small number of diseases, including malaria and measles.”

It’s why the BMJ and our sister journal, Archives of Disease in Childhood, have chosen Save the Children as their Christmas charity this year. Using feature articles, blogs, and films, we’ll be telling you more about Save the Children’s campaign to secure the health of the child. And we’ll be telling you how to get involved in the campaign and how to donate. Save the Children would like us to raise £30 000—that’s less than 2p from each reader of our print and online journals.


Cite this as: BMJ 2010;341:c6422


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