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Feature Briefing

NICE is dead; long live NICE

BMJ 2013; 346 doi: (Published 24 April 2013) Cite this as: BMJ 2013;346:f2546
  1. Krishna Chinthapalli, clinical fellow
  1. 1BMJ, London WC1H 9JR, UK
  1. kchinthapalli{at}

This month sees a new beginning for NICE, with a new chair and legal status. Krishna Chinthapalli assesses what it has achieved and the challenges it faces in the future

Fourteen years ago, Parveen Kumar was unexpectedly summoned to a meeting in Whitehall. It was on a cold Friday morning, soon after her interview to be one of the directors of a new government body to evaluate medical treatment. After being ushered in she was told that she was to see the health secretary, Frank Dobson. He recalls, “The toughest challenge was to get good people on board. I insisted on seeing all of the nominated directors, with the right of veto if I didn’t take to any of them.”

At the end of this second interview, Kumar asked, “One last question. Will it work?”

Dobson replied, “Probably not, but we’ll have a bloody good try at it.”

He was right to be cautious about the prospects of the National Institute for Clinical Excellence (NICE) back in 1999. It was launched on April Fools’day with “no premises, no money, no staff, and no chief executive,” and an acronym that was “going to get lampooned in the press all the time,” according to Sir Michael Rawlins, the founding chair.

It was “a world where some quangos have disappeared within 18 days of being created,” as Richard Smith, former editor of the BMJ, put it.

Another journal editor, the Lancet’s Richard Horton, pondered its role in rationing, the “most electorally incendiary of subjects.” To provide some of these fireworks, Pfizer was preparing a legal challenge against Dobson’s decision to limit the use of sildenafil (Viagra) across the NHS, patient groups were preparing to campaign about limited access to new drugs, and Glaxo Wellcome was preparing for a “gloves off” fight …

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