On 10 August, the High Court upheld a decision by the National Institute for Health and Clinical Excellence that new Alzheimer's drugs should only be offered to people in the moderate stage of the disease. This was the first time a judicial review had been sought on NICE guidance.
The High Court's decision, following a case brought against NICE by the pharmaceutical manufacturer of the drug, will have far-reaching implications for the relationship between pharmaceutical companies, health services and, ultimately, patients.
I believe this is an important decision in the interests the NHS and the public. The NHS has finite resources and there will always be a tension between two forces: the desire to treat sufferers of diseases and the reality of cost-effectiveness. Every pound spent on one treatment is a pound that cannot be spent on anything else.
These are difficult issues and they are not well suited to legal argument. That is why it was a vital result that the court upheld NICE's procedures, and its judgements, in this case. The challenge of ensuring cost-effective use of NHS resources will not go away because of this case, but I hope it will continue to be addressed by experts in the field, rather than being made the subject of litigation.
As with all difficult subjects, mature, sensible debate is critical. To throw words and phrases around such as ‘betrayal’ and ‘morally reprehensible’, as certain official comments on this judgement have done this past week, is, at best, indicative of a lack of understanding of the big picture and, at worst, careless - even dangerous.
This debate is one of long-term importance. It is complex and affects a number of emotive, difficult issues. It asks awkward questions and demands decisions that are, inherently, divisive. In short, there is no way to make all parties - the commercial pharmaceutical sector, the NHS, government, patients and their representative bodies - happy.
That being the case, it is logical and, I would argue, morally right, to acknowledge that it is the good of the many that must be considered first and foremost. And that means taking a position that protects the interests of all patients.
Unfortunately, economics dictates that with finite financial resources, not every drug can be bought and paid for by a publicly funded health service. To focus funds in one area, on one drug, will inevitably mean that another area, and another set of patients, receives less funding. It is an almost impossible balance to strike.
The long-term picture must be one of redefinition. One implication may be that pharmaceutical companies will need to re-examine their relationship with health services worldwide. It is no longer enough to show that a drug is safe and has some effect: purchasers now demand to understand whether the drug is a good use of limited resources. The court in this case accepted and endorsed that new reality.
Research trials into the clinical and cost-effectiveness of drugs may need to be made more powerful. New ways of using existing drugs may need to be identified. In the long term, I believe that this is the right decision for the NHS, which, if it is to offer the best service to patients, must operate cost-effectively.