NICE is told to break its close links with drug industry

The National Institute for Clinical Excellence (NICE) has been advised by an independent review to break its close links with the drug industry and to make its processes more transparent.

Figure 1.

Kees de Joncheere, WHO's regional adviser for health technology and pharmaceuticals (left) and Professor Michael Rawlins, NICE chairman

Credit: WHO

Experts from the World Health Organization who carried out the review have advised NICE that, to avoid any possible bias, pharmaceutical physicians should not be members of committees that make judgments on particular drugs or devices.

Kees de Joncheere, regional adviser for health technology and pharmaceuticals at WHO, said that although he understood that pharmaceutical physicians could offer useful input about how and why trials were conducted, a physician from one company on a committee that is appraising another company's product cannot always be independent. Instead manufacturers' views should be represented through the consultation process, he said.

Moreover, if it wished to be truly transparent NICE needed to examine whether it could continue to include confidential materials in its appraisals process, said the review.

“We recognise that NICE has set new standards in the consideration of stakeholder inputs and transparency, including provision of documents and information, via the NICE website. However, to gain access to key information NICE also accepts material designated as confidential. In the main this comes from the pharmaceutical industry,” said Mr de Joncheere.

“Whilst we welcome the steps they have taken to push these boundaries with the industry, NICE should reconcile this inherent contradiction,” he said.

NICE, which has been recommending drugs and devices to the NHS in England and Wales since 1999, invited WHO to conduct an independent review of its work after advice from the House of Commons Health Select Committee last year.

Altogether the review team made 28 recommendations on all aspects of how NICE is run, from its defining principles to its selection of topics and appeals process.

Michael Rawlins, NICE's chairman, said the findings from the WHO team would feed into a review of methods and appraisals currently being conducted by the institute. The board was also considering making three key documents that were currently kept confidential open to the public, he said. These are the overview of each drug or device appraised, comments received on draft overviews, and the contents of appeals.

However, disclosing confidential materials from drug companies might be more difficult, as it might jeopardise any future publication, he said.