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Logo of brjgenpracThe British Journal of General Practice
Br J Gen Pract. 2006 December 1; 56(533): 981.
PMCID: PMC1934074

Nice as Oxymoron

NICE is, at last, coming of age. At the time of its inception, I was critical. My main argument was that we already had lots of bodies telling us best treatments. Specialist societies issued guidelines, and amendments to guidelines; Royal Colleges did the same; while the Cochrane Collaboration trumped them all. I thought that NICE as the National Institute for Clinical Excellence was not needed, but NICE as the National Institute for Clinical Expedience was sorely needed. In the last year NICE has started to do what it should explicitly have been set up to do: not to decide whether this β-blocker or that ACE inhibitor is the best treatment for hypertension, but whether new expensive drugs that don't seem to do very much good at all should be prescribed on the NHS. Even if they are the only drugs available.

Things were tricky while the trastuzumab (Herceptin®) storm raged. Perhaps the special appeal of breast cancer turned heads in the Department of Health in ways that myeloma, colon cancer and Alzheimer's disease are less able to do. Patricia Hewitt was dangerously close to making NICE look irrelevant. Sensibly, the Department's only comment when NICE pronounced about the Alzheimer's drugs was to say that it was not for the government to interfere.

Of course, NICE has upset those directly affected. An excellent commentary by Polly Toynbee (Guardian, October 24) prompted letters (October 26) from carers and sufferers, and also from doctors, but they all managed — inevitably — to ignore the wider picture. If you are watching a loved one slowly disintegrate from Alzheimer's, or you are an oncologist denied a new agent that may give your patient a few months more, it is impossible to stand back. But that is precisely what NICE has to do. ‘It's not Nice, but someone has to do it’ was the title of NICE Chief Executive Andrew Dillon's counter-letter (October 28), and he is right. I just wish that he had explicitly used the word ‘rationing’ in his letter.

A sad letter in another newspaper complained about the unfairness of an elderly man receiving Viagra® on the NHS while the writer's partner was denied an Alzheimer's drug. The unfairness, which I would not expect the writer to see, is that Viagra® works, whereas the Alzheimer's drugs don't seemto work very well. This is an unfairness over which we have no control. Given the ageing population, we really do need a drug that works in Alzheimer's, but if wishes were horses …

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners