The High Court ruling upholding the National Institute for Health and Clinical Excellence's decision over medication for Alzheimer's is just the latest skirmish in what promises to be protracted manoeuvring over drug use and pricing.

The High Court ruling upholding the National Institute for Health and Clinical Excellence's decision over medication for Alzheimer's is just the latest skirmish in what promises to be protracted manoeuvring over drug use and pricing.

Over its eight-year life NICE has been widely regarded as a success; its model of objective assessment of benefit versus cost is now being copied in other countries. It brings rationality and fairness - which sometimes feels like equal unfairness - to the politically explosive issues of rationing healthcare and postcode lotteries.

The chances of NICE losing the case were remote. The fact that this was the first judicial review brought over its guidance indicates its procedures are not easily contested. The judges dismissed all the substantive points, including claims of irrationality and procedural unfairness.

The media portrayed this as a battle between the institute and the Alzheimer's Society, but it was actually brought by the pharmaceutical company Eisai.

The drugs firms are, of course, entitled to argue their case; it was inevitable that with NICE having profound influence on people and companies, it would have to defend itself in court.

If the High Court route to pressurise NICE is largely a dead end, the pharmaceutical companies are left with trying to exert political pressure. But they are doing this from a difficult position. In the public and media's minds the words 'drugs company' are often a term of abuse.

The costs and risks of developing and manufacturing new treatments are little understood, while rows over the provision of antiretroviral drugs to developing countries, the NHS Counter Fraud Service's settlements last year over allegations of anti-competitive behaviour, and the Office of Fair Trading's recent condemnation of the pharmaceutical price regulation scheme which determines how drug companies set their prices, have harmed the reputation of one of the country's most successful industries.

Last year's row over Herceptin demonstrates the risks for a minister of being led into this territory. Then health secretary Patricia Hewitt's intervention over the refusal of North Stoke primary care trust to prescribe Herceptin undermined the whole point of NICE and risked repoliticising drug treatments.

But the lobby groups also need to think through their position. It is difficult to imagine a more driven group; swathes of the people working for and supporting the charities involved have intimate knowledge of the devastating impact of the illnesses they are campaigning about. They rightly hold NICE to account for its decisions, but they also need to strive to be objective, weighing the evidence more carefully and taking a more realistic stance on price and benefit.

That will increase, not diminish,.their influence.