Why it isn't always easy being NICE
I like NICE. Charged with a difficult job, in the main, they do it well. I particularly like their guidelines for best care. I like the fact they exist and that they tend towards being thorough, well constructed and patient-centred.
I'm not saying they make my summer top 10 holiday reads but I'd be prepared to reconsider if they included some Sudoku and a colouring-in bit at the back.
But NICE do tend to get a bit of a kicking, don't they? And I'm not sure why. It seems if they recommend a drug not considered economical by a PCT, they are accused of being financially careless. If they recommend a care strategy for an illness that is deemed 'unrealistic'
because of staffing shortages they are labelled as out of touch. And if they suggest a drug is not demonstrably value for money and don't recommend it, they are derided as cruel. It's not easy being NICE.
NICE have to deal with an awful lot of interest groups. Patients, not unreasonably, insist on wanting the best care available, PCTs want value for money, the Department of Health would quite like a quiet life, and the pharmaceutical companies want to be able to turn a tidy profit because without it, they may suggest, where would innovation come from?
There remain certain fundamental things within our society that go unchallenged. Many of them – Prince Andrew, morris dancing, James Blunt – are largely benign. Some of them – chicken nuggets, oil company profits and the power of the pharmaceutical companies – are not.
Of course, the drug companies can claim the right to make profits, and to invest in research and develop products that continue to make them thrive. But does it make sense that the power they have over drug pricing and development can have such a far-reaching and largely unchallenged impact on all areas of the health service?
In psychiatry, drugs – expensive drugs – are pretty much a given. If you want to research, for example, the best way of treating schizophrenia, it will inevitably be tested with medication as opposed to a non-drug treatment like cognitive behavioural therapy. Is that due to funding? Ethics? Or because we assume that drugs must always be the first-line treatment?
The drug companies produce some truly remarkable things, and their capacity to develop ideas offers hope for people with many incurable diseases. But in an age when we question everything from the cost of hospital parking to the number of band 5 nurses we can afford, are we sure the power and glory ascribed to the drug companies is as transparent as it should be? NICE may be an easy target but that doesn't make them the only organisation worth questioning. n
To read more of Mark Radcliffe's columns, click the 'more by this author' link at the top of the page