'Relenza is destined to be the treatment which will firmly establish the National Institute for Clinical Excellence in the public consciousness.' That was our prediction eight weeks ago when NICE announced its first work programme, with Glaxo Wellcome's flu drug heading the list for a fast-track assessment which would provide GPs with guidance on how to prescribe it - if at all - in time for winter.
And so it has proved. The weekend newspaper headlines brought forcefully home the impact NICE is going to have on how the health service operates. Unfortunately, the coverage was incomplete: the leak of the news that NICE was to recommend that Relenza is not made available on the NHS seems to have caught the new body wrong-footed. Hamstrung by proprieties, NICE felt unable even to confirm the gist of the rumour, let alone explain its reasoning. The media - like nature - abhors a vacuum, and into it rushed the pharmaceutical industry's side of the story, replete with warnings of the dire consequences which NICE would precipitate - from companies quitting the country to Glaxo's chair resigning from government advisory committees.
We will not know until tomorrow the official verdict on Relenza. If the reports are accurate - and if neither the company's appeal nor health secretary Frank Dobson reverse the apparent recommendation - NICE will have set down a formidable marker. It will clearly be seen to have refused to balk at saying no, despite the intense scrutiny and publicity which will inevitably attend its first judgement, and even when the case involves a giant British company marketing a high profile drug. No concessions to expediency here. If the recommendation is that Relenza should not be prescribed on the NHS, no-one will be left in any doubt that NICE means business. Mere assertions and assumptions about a treatment's worth will no longer do, only evidence - and evidence of an uncompromisingly high order.
Managers would find that reassuring. But NICE needs credibility with the public too, and here it faces a massive task made all the harder by the ground it has lost since the leak. As we also pointed out eight weeks ago, scepticism about scientific opinion has reached epidemic proportions, and suspicions will run rife that cost above all else governs NICE's decisions. Convincing this winter's thousands of flu sufferers that NICE acts in their interests, not just the exchequer's, will take quite some finesse.