Published: 15/12/2005 Volume 115 No. 5986 Page 10

The Daily Telegraph called it a ‘decision’ and a ‘ruling’, while The Daily Express called it an ‘order’. The more sober Times and Financial Times called it ‘guidance’ while - unusually - The Sun came in with the mildest adjective, describing it as ‘advice’.

However, the National Institute for Health and Clinical Excellence categorically announced on the launch of its report, Social Value Judgements: principles for the development of NICE guidance, that it is ‘not guidance for the wider NHS’, but internal guidelines for its staff and advisory groups.

Media Watch understands that NICE wants to turn up the volume media-wise, and it clearly aimed to grab the headlines in the week of its annual conference. But only it knew whether it bargained for front page screamers such as ‘Treatment ban on fat patients’ (Daily Express).

In fact the report says NICE guidance ‘should not take into account’ whether an illness has been ‘self-induced’, but a patient’s ‘individual circumstances’ should be considered if their weight, for example, would undermine the ‘clinical and cost effectiveness’ of a treatment.

But they would surely have needed to be buried deep inside a sealed bunker to think that making such an announcement would go unhyped just a week after East Suffolk primary care trust hit the headlines for drawing up clinical thresholds for treatments - such as an upper patient weight limit for hip replacements.

To be fair, it was only the Express, as usual, that painted the story in complete idiot-proof, not entirely accurate primary colours - possibly designed to maximise income on its poll: ‘Should smokers and drinkers be denied NHS treatment?’ NICE has clearly decided to live a little dangerously in its dealings with the media, and it has yet to be seen where such risky behaviour will lead the organisation.