The Pharmaceutical Journal
Vol 270 No 7230 p5
4 January 2003

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National Institute for Clinical Excellence (www.nice.org.uk)

NICE should not ask if illness is "self-induced" — citizens council

The National Institute for Clinical Excellence should not consider whether a disease or condition is "self-induced" when drawing up guidance for the National Health Service, the institute's citizens council has decided.

The citizens council, which was established in November 2002, published its first report on 20 December 2002. The council considered the question: "What should NICE take into account when making decisions about clinical need?" It focused on the most important features of diseases or conditions, additional factors relating to individual patients and the weight that should be given to the views of groups representing patients, carers and health care professionals. During its meeting, the council took advice from a range of expert witnesses from academia, health care organisations and NICE itself.

Among the most important features of diseases the citizens council believes should be considered are: the severity of pain or symptoms, fatal or contagious disease, lack of alternative treatments, long-term effects, number of patients affected, effects on quality of life, fluctuations in the condition, side-effects encountered and the resources available. Whether or not is is self-induced should not be an issue.

Patient aspects that are of significance include: values of the patient, ability to make informed decisions, age, fitness to undergo treatment, ability to self-manage conditions, family history and consideration of a holistic approach.

The citizens council says that factors which should not be considered include social and economic attributes and how loud the "voice" of the patient is.

Citizens council member Bob Osborne, a retired airline pilot, said: "We realise that the NHS has professionals who are more than qualified to make decisions on clinical need. What is sometimes missing is a common sense viewpoint that the public can relate to."

The report will be considered by the NICE board at its next public meeting in Lancaster on 15 January. A formal response will then be issued on the NICE website alongside the council's report (www.nice.org.uk).