NICE work in nasty conditions
Earlier this month the National Institute for Clinical Excellence produced
its 50th health technology appraisal. Since the original appraisal of
zanamivir (Relenza), which was fast-tracked through the system in 1999
without pleasing anyone, NICE procedures have matured and, although it
will always have its detractors, the institute manages to do a tricky
job effectively in difficult circumstances.
The health technology appraisals are only part of its job, although they
do attract the most publicity and give NICE, we imagine, the most headaches.
The biggest headache must come when newspapers and the broadcast media
report NICE provisional recommendations as definitive statements.
Although everyone involved in the NICE process knows that these recommendations
are subject to consultation, and that NICE makes these consultations as
open and as transparent as possible, it does not stop patient groups and
pharmaceutical companies alike having a go. They jump up and down, blow
their trumpets, and create as much noise as possible if they do not like
the direction in which the provisional recommendations seem to be pointing.
Within a matter of hours, NICE will be painted as the bad guy, depriving
patients of some life-saving treatment that could save misery for hundreds
of thousands of people and cost two and sixpence.
It must be hard for the NICE appraisers to ignore the hullabaloo. The
transparent consultation is designed to give an opportunity for new data
to be produced and to encourage new arguments to be put forward. That
patient groups and the industry manage to persuade the media to campaign
on their behalf must be disappointing to NICE officials doing their best
to reach a reasoned conclusion.
And it must not be forgotten that the NICE appraisal process was partly
designed to end postcode prescribing, although NICE itself lacks the statutory
muscle to ensure that National Health Service trusts in England and Wales
are providing the treatments it recommends.
There must be parts of the country where funding for recommended treatments
is not forthcoming. The Journal would like to hear from any pharmacist
who has such evidence on a local basis that we can look at nationally.
That is what papers and television companies with a consumerist slant
ought to be creating a stink about — and leave NICE to do its job
properly.
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