NICE chairman hits back at critics
- Published: 18 August 2008 09:00
- Author: Michael Rawlins
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- Last Updated: 18 August 2008 09:00
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Some recent criticisms of NICE's work ignore the realities of modern healthcare and misrepresent the facts. Institute chairman Sir Michael Rawlins sets the record straight
August is a difficult month for journalists, newspaper editors and radio and TV producers. Parliament is in recess, politicians and celebrities have gone on holiday, and there's not much to fill the pages or airwaves. So we have "silly season". And for the past week or so the media buzz has been "silly season" about the National Institute for Health and Clinical Excellence's draft advice on renal cancer drugs, fuelled by the rantings of an ill-informed oncologist (Professor Jonathan Waxman) writing in both The Times and the Daily Mail.
First, for those unfamiliar with NICE's workings, it must be emphasised that this is "draft" advice and does not represent the institute's final position. It is the provisional conclusion of NICE's independent appraisal committee, which is made up mainly of people working in the NHS. Moreover, this provisional conclusion may change - as has often happened in the past - in the light of comments and representations made by interested parties.
"An ageing society, technological advances and public expectations are placing demands that all countries are struggling to meet"
Second, Professor Waxman seriously damages his case by untruthful assertions. NICE has assessed 56 cancer drugs since 1999 and not the 407 that he alleged in The Times and the Daily Mail. Contrary to his claim, made in The Times, no NICE guidance has ever been "overruled by ministers". And his allegation that much guidance has been "stomped on by judicial review" is equally wide of the mark. Only one case (concerning Alzheimer's drugs) has reached the courts and, even in that instance, the issue has yet to be resolved.
Third, Professor Waxman's claim - in the Daily Mail - that at a meeting of NICE's appraisal committee he attended (in 2005) only one out of 43 members was medically qualified is just absurd. Most members work in the NHS. And his statement that "the methods are illogical, often unintelligible" is in complete contrast to the letter he wrote to the committee's chair after that same meeting. In it, he stated: "I was very impressed with the thoroughness and quality of the review."
Finite resources
It really is time that some of my clinical colleagues - Professor Waxman included - woke up to the realities confronting all healthcare systems. An ageing society, technological advances and public expectations are placing demands that all countries are struggling to meet. Countries do not have infinite sums of money to spend on health and the amount they can afford is largely governed by their wealth as reflected by their gross domestic products. The debate is not about whether - but how - healthcare budgets can be most fairly shared out among a country's citizenry.
It is because of these shared problems that many countries - the US included - are watching the workings of NICE with interest and admiration. Some have established their own versions of NICE and many others are planning to do so.
But Professor Waxman seems to live in another world. The NHS has finite resources available for healthcare and those it does have must be used in a manner that is fair to everyone - whether they have renal cancer, heart failure, motor neurone disease, Alzheimer's disease or schizophrenia. I understand, better than most, the miseries of cancer, but NICE has to take account of the interests of all those who depend on the NHS for their healthcare. This is not easy: Professor Waxman's solution would appear to be a free-for-all that would either bankrupt the NHS or lead to the denial of cost-effective healthcare to hundreds of thousands of people who have other conditions but lack powerful pressure groups to bring their problems to the attention of the media. The third possibility would be to return to the covert rationing that was so damaging to patients in the 1980s and 1990s.
Since NICE was set up in 1999, it has recommended over 90 per cent of the cancer drugs it has been asked to look at. These treatments have cost the NHS around £337m a year and improved - if not saved - the lives of tens of thousands of patients.
The BBC is airing a programme on NICE on 18 August. More details...
See this week's magazine for related coverage.
