The Hastings Center Report has published an interview with a representative of the Orwellian-named NICE (National Institute for Health and Clinical Excellence), the UK’s rationing board. The interview pretends that all NICE does is issue recommendations, that the NHS Trusts are free to take or leave. While that may be technically true, practically it isn’t. That is why NICE is sometimes sued, because what it recommends almost always becomes official policy.
From the interview:
NICE cannot ban anything. It issues guidance, in the form of both clinical and public health guidelines, and on the use of technologies like drugs and medical devices. The guidance specifies the technologies in question, their dosages and frequency of use, the stages of a disease at which their use is most appropriate, counter-indications, and the patient groups for which they are likely to be effective. Local health care purchasers and providers must make any technology recommended by NICE available when it is required by a local physician. In this sense, NICE enables rather than commands – only physicians have powers to command...
NICE’s guidance to professionals is just that: guidance. The general expectation is that most professionals will follow the finest advice and guidance that can be mustered to support their work. This seems the right approach to m - the best way to encourage best practice is to provide the best information.
Needless to say, since it is profoundly utilitarian in outlook, it uses quality of life judgments in issuing its “recommendations:”
NICE recommends the use of a version of the Quality-Adjusted Life-Year as its principal outcome measure (EQ-5D), partly to enable NICE advisory committees to make consistent comparisons between the many possible procedures that could be included in the “benefits basket” and partly to encourage researchers to use that outcome wherever appropriate. The QALY is not itself, a criterion. It is only the denominator of the incremental cost-effectiveness ratio.
NICE understands that it is a trailblazer and that similar “recommending” utilitarian/quality of life/cost containment bodies may soon be coming to a health system near you:
With passage of time – and the likely creation of NICE look-alikes around the world – an important new determinant of research patterns in industry seems likely to emerge. For the first time, strong indications will exist about the types of research-based products entire systems are willing to pay for and which will therefore generate returns for innovators. If this generates, as it should, incentives to invent new products that are cost-effective, then that will be one significant strand in the universal striving for both better health and cost containment.
If that doesn’t scare you, nothing will.
The interview headline asks whether NICE is nice: No, it isn’t. If Hippocratic medical values are to survive, we must fight these natioanl bioethics oversight boards with all our might.
