the protestations of its boss the Country wide Institute for Clinical Superiority (NICE) is an instrument for rationing health care. with different guidelines on which treatments they will fund. NICE began with a blaze of publicity by deciding that zanamivir a new drug for treating flu would not be made available in the NHS.6 7 Its decision was based on the lack of evidence that the drug was effective in older people and others most at risk of serious harm from flu. It glossed over the fact that the same could be said for many even most treatments currently available on the NHS. Zanamivir’s manufacturers Glaxo Wellcome were furious and the chief executive threatened to take the company’s research abroad.6 Last week NICE reversed its decision on the drug declaring that it would be available to at risk adults who present within 36 hours of developing symptoms when consultations for flu rise above 50 a week per 100 000 population.8 Just how easy it will be to implement such complex advice remains to be seen but NICE boasted that the reversal of its guidance showed its commitment to evidence. A pooled analysis by the manufacturers showed that the drug would reduce symptoms LY-411575 in those at high risk from 6 to 5 days. It’s easier to say yes than no When NICE approves treatments-such as taxanes for cancer-then there’s little fuss although some cardiologists believe that it oversold the usage of intravenous LY-411575 glycoprotein IIb/IIIa inhibitors in risky patients who’ve had a coronary attack perhaps since it was overinfluenced from the medication companies’ secret proof. NICE’s problems start when it attempts to refuse treatments. It determined against beta interferon for multiple sclerosis and quickly discovered itself facing hostile promotion and an charm from both producers and individuals’ groups.9 Its ultimate decision shall not be accessible before new year. One faltering of NICE can be that it is living a dual lie. The 1st lie-which is really as Orwellian as its name-is to refuse that it is about rationing healthcare that will be thought as “denying effective interventions.” Denying inadequate interventions isn’t rationing; rather it’s the actual Americans contact a “no brainer.” The populace is smart plenty of both to learn that NICE can be rationing healthcare which rationing of healthcare is inevitable. The next and related lay is to provide the impression that if the data supports cure then it’s offered and if it generally does not it isn’t. Quite simply LY-411575 the complete messy issue of determining which interventions to offer can be determined with some data and a pc. It’s a specialized problem. This lay corrupts the idea of evidence based medicine which the BMJ has long championed. The evidence supports decision making but the evidence can’t make the decision. The values of the patient or the community must be part of the decision. Effective interventions have adverse effects. How can benefits be weighed against risks? How for example might an individual woman or society balance the probable cardiovascular benefits of hormone replacement therapy after the menopause against the increased risk of breast cancer? This is not a technical problem. Similarly treatments that are highly LY-411575 cost effective in those at high risk are also effective in those at low risk-but at a very high cost. Deciding where cost effectiveness ends is not a technical but an ethical judgement. These failures with honesty may lead to the ultimate failure of NICE which could be the inability to say no except in obvious cases. Beta interferon is effective in reducing the progression of multiple sclerosis in some patients and donezepil is effective in slowing the progression of Alzheimer’s disease in some patients. A body that is not about rationing and is concerned primarily with evidence might have to promote the wide use of both drugs within the NHS whereas a body that was truthfully about rationing might legitimately state no to both medicines. We will see. One away decisions unbalance program Another failing with Mouse monoclonal to SNAI2 NICE can be it considers problems individually and is mainly worried about what’s fresh and expensive. An improved system just like the one in Oregon would take a look at all interventions. In any other case a fragile body that discovers itself stating yes to many new systems will encourage the original unjust rationing by hold off (waiting around lists) discrimination (against older people and mentally sick).