Editor—The values of the National Institute for Clinical Excellence (NICE) turn out to be utilitarian and economic.1 Predictably, NICE's attempt to use them to generate advice to professionals for achieving the highest attainable standard of care often founders on the narrowness of perspective. High quality care demands an understanding of human suffering that transcends the urge to fix biological machine faults.
Take obesity. In 2001 NICE approved the prescription of orlistat and sibutramine to obese patients, a tiresome diversion in the face of a developed world pandemic of obesity. Obesity is about consumption, and consumption is woven into the fabric of society. No amount of medical technology or guidelines stands any meaningful chance of changing this. The problem is cultural, and the solutions are political and educational.
We might be spared these distractions if NICE added two new questions to their appraisals.
Firstly, is the problem for which the technology is intended best dealt with by a medical approach delivered in the NHS?
Secondly, would receiving the technology be likely to benefit the health (broadly defined) of the individual patient?
These questions demand values that clarify the purpose of the NHS and the nature of health. They must recognise that illness occurs in a network of relationships: with ourselves, society, and nature. The difficulty here reflects what MacIntyre calls the grave disorder in the language of morality.2 But we must try, or accept that medicine will choke on its own trivial non-solutions for enormous problems.
Competing interests: None declared.
References
- 1.Rawlins MD, Culyer AJ, National Institute for Clinical Excellence and its value judgments, BMJ 2004;329: 224-7. (24 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.MacIntyre A. After virtue. London, Duckworth, 1985: 2.