Published: 07/06/2002, Volume II2, No. 5808 Page 4

The National Institute of Clinical Excellence's decision to green light the provision of a new wave of anti-psychotic drugs has met with mixed reactions, including concerns over cost and the scientific basis of the move.

NICE's decision ends a longrunning campaign by mental health groups who have accused the NHS of rationing 'atypical' drugs, leaving hundreds of thousands of schizophrenia patients suffering the 'appalling' side effects of older treatments.

NICE said the drugs - which will cost the NHS£70m a year - 'should be considered alongside the existing traditional medicines as one of the first choice options'.

For the National Schizophrenia Fellowship, the decision will finally mean 'real choice' to patients. It claims less than 20 per cent of the 210,000 people who could benefit currently have access to the most modern medicines.

Recognising the financial impact of the new guidance, NSF called on the government to pump more cash into mental health services. It said: 'The new rules mean primary care trusts and other budget holders must implement the NICE decision but without additional resources other mental health services could suffer as funds are diverted.'

Two years ago Dr David Taylor, chief pharmacist at the then South London and Maudsley trust, described the old-style drugs as 'barbaric anachronisms'.

Among the devastating side effects he described were tremors, shuffling, impotence, sedation and hyperprolactinaemia which leads to breast-milk production.

Traditional treatment costs, on average, around£70 a year.

A typicals average around£1,220.

Dr Taylor doubts that the treatments would free up cash by relieving the pressure on inpatient hospital care, as NICE claims.

'Basically, there is a long waiting list for acute beds. This might shorten the queue but I do not think that we are going to see a situation where beds numbers can be cut and the money invested elsewhere.'

The decision has also renewed criticism of NICE's methodology, with claims among academics that there have not been sufficient independent trials to prove the efficacy and cost benefits of the treatment.

Last year, the British Medical Journal published a paper by Professor Nick Freemantle, then of York University, together with Dr John Geddes and Professor Paul Harrison from Oxford University's department of psychiatry, which concluded there was 'no clear evidence' that the new drugs were better than traditional drugs.

Dr Geddes said: 'The jury is still out on the quality of these treatments. There have not been any systematic independent trails - most have been done for licensing purposes.' Two are under way - the CATIE trial in the US and the NHS-funded CUtLASS trial.

Another academic, who didn't wish to be named, said: 'There is not the evidence around on which to base any firm conclusions. [The guidance] has come too soon.

There has been pressure by the drug companies for this treatment, many of whom have targeted patient groups to push it forward.'

Professor Tonmoy Sharma, director of the Clinical Neuroscience Research Centre, said: 'Trials by the pharmaceutical industry are peer reviewed and they are monitored. It doesn't mean they are biased. These drugs do benefit patients.'