comment: NICE deliberations need to be explained to win support for their decisions

Published: 07/06/2002, Volume II2, No. 5808 Page 17

It could be another case of 'heads I win, tails you lose' for the National Institute of Clinical Excellence, when new guidelines on prescribing atypical anti-psychotic drugs hit the streets (see news, page 4).

Patients' groups will welcome the end of local bans on prescribing expensive drugs such as olanzaopine and risperidone. Many clinicians, however, feel the evidence for these newer drugs' effectiveness is thin, and wonder why they have been accepted.

Patients see it as a victory against the forces that would deny them the choice, largely on the grounds of cost. Treating a patient with a traditional drug costs about£70 a year, while the new drugs average£1,200. Total annual cost: over£70m.

Yet doubt surrounds the scientific trials of these drugs and their benefits. If this decision is to get the backing it should, NICE needs to present a credible audit trail fully explaining not only the process by which a decision was reached, but also the clinical reasons for it.

Without this, NICE is condemned to remain an outsider, handing down edicts that are not understood and not supported. Go to www. nice. org. uk and judge for yourself.