I was surprised at the perspective chosen from your interview with Andrew Dillon, chief executive of the National Institute for Clinical Excellence ('A dose of scepticism', news focus, pages 11-12, 20 July).

While considerable copy was devoted to the concerns of patient representatives in the NICE appraisal process, I was confused by the graphic in the table.

The 'smiley faces' reflected neither a health service manager's perspective nor a patient perspective but those of the sponsors of the technology - for example, the pharmaceutical industry or treatment advocates.

The table would look a little different from a manager's or patient's point of view (the exact facial expression could be debated for hours).

Clearly the challenge for NICE is to get a row of 'smileys' in future appraisals: rapid access to modern health interventions that delight patients, fit within the NHS's financial and service framework constraints yet also enable the manufacturers of these technologies to make sufficient profits to fund future research.

At the moment, NICE can't please all the people all of the time.

Whether it will ever be possible to please all of the people whom an appraisal decision affects remains to be seen.

John Kerrigan Managing consultant Heron Evidence Development Ltd