NICE and its value judgments

Editor—The role of the National Institute for Clinical Excellence (NICE) in reducing the postcode lottery is limited by the denial of its legitimate role in healthcare rationing.¹,² The focus on new and expensive drugs, and the requirement by the government that NHS bodies implement NICE guidance within three months, seriously skew local priorities.

The use of sales data to monitor the uptake of a NICE approved drug militates against an orderly and considered uptake of new technologies. A favourable NICE appraisal amounts to a compulsory purchase order. The agenda is therefore set not by NICE but by those who apply to NICE for their products to be appraised.

The reason why NICE has not appraised yoga or transcendental meditation for stress and hypertension, or a lifestyle intervention involving 3-4 kg weight loss and 150 minutes of moderately vigorous physical activity a week as a “technology” that cuts the risk of overt diabetes by 50% is obvious. It would have been interesting to see how the implementation of such technologies would have been enforced.

The excessive focus on drug treatments also ignores the real postcode lottery of life—a lottery that applies far more to the determinants of health (housing, education, job opportunities, healthy food) than to health care. The mandatory requirement to implement expensive and marginally effective NICE appraised treatments means that we in the NHS have less time and no resource to devote to other public health interventions that may well yield a far bigger health dividend for a larger number of people.