Doctors’ clinical freedom is being undermined by the National Institute for Health and Clinical Excellence (NICE) to the detriment of patients, doctors at the BMA’s annual conference in Manchester heard. Representatives voted in favour of a motion proposed by the Bristol division that the institute is losing its credibility and should become advisory rather than regulatory.
Robin Arnold, a member of the consultants’ committee who proposed the motion, called for greater flexibility from the institute to allow doctors to exercise their clinical judgment rather than its recommendations being proscriptive.
He recounted the story of a colleague who was confronted by a carer whose mother was demented and distressed after her doctors stopped her atypical antipsychotic because of the drugs’ association with an increased risk of stroke. NICE had banned the use of newer antipsychotics because they were judged to be too expensive, he said. However, he suggested that treatment with one of these drugs might have helped to relieve the distress of the patient in question and allowed her to remain at home.
"Atypical antipsychotics have been banned by NICE not because they are ineffective but because they have been through a quality adjusted life years [QALY] assessment and found to be too expensive," Dr Arnold told the conference. "But QALYs are inherently ageist." Although such an assessment might prove a drug to be cost effective for a 35 year old it is less likely to for a 70 year old, he explained.
Norman Vetter from Cardiff defended NICE, however, as putting an end to the postcode lottery of recent years, in which patients were forced to move form one county to another in the hope of being able to receive treatment. John Hyslop from Cornwall also called on the conference to allow NICE, which he considered still a relatively young organisation, to mature. "It is up to the profession to recognise that we have to work with [NICE], that sound clinical input does exist, and that stakeholders’ views are listened to," he said.
Dr Arnold responded, "Evidence based medicine is a limited tool and is being abused. It is bringing NICE into disrepute. There should be some flexibility to allow for clinical freedom."