Research published today says the National Institute for Health and Clinical Excellence, which evaluates treatments for the National Health Service, needs to be insulated from external financial, political, and emotional pressures. The article in the BMJ reviews NICE’s recommendations between 1999 and 2005 and says it has faced growing pressure to influence its decisions. .The Institute was set up in 1999 as an independent and was charged with getting the best from the Health Service’s health resources in England and Wales. Since then it has examined the value of treatments and recommended whether or not they should be used. The researchers say NICE published 86 guidance notes on 117 topics. Its recommendations, they found, were fairly evenly distributed. In 22 cases- 19 per cent – it ruled a treatment should not be used, agreed to the unrestricted use of 27 (23 per cent), approved 38 with major restrictions, equivalent to 32% and gave the go-ahead to 30 treatments (28 per cent) with minor restrictions.
The researchers conclude that overall, NICE has been fair and consistent in carrying out its remit to ensure equity but they say equity is not in everyone’s interests and the Institute has faced growing pressure from patients, drug companies, and politicians trying to influence its decisions.
The authors, Robin Ferner and Sarah McDowell, cite the example of the promotion of the drug trastuzumab, known as Herceptin, which, they say, shows how drug companies raise awareness of new drugs, including using the media to support their views in battles with NICE.
The researchers also found that patients and patient groups have a strong influence. The advice on treatment for Alzheimer’s disease and osteoporosis were changed after vocal campaigns. Similar campaigning has put trastuzumab at the forefront of public and political consciousness, leading to a feeling that NICE approval and licensing of the drug for use in early stage cancer are a foregone conclusion. Politicians, the research found, also seem to undermine NICE’s work by making decisions before the publication of its guidance. This, they say, is illustrated again in the case of Herceptin where Patricia Hewitt said Primary Care Trusts “should not refuse to fund Herceptin solely on the grounds of its cost”.
The paper says it is easy to understand why patients want to make their voices heard and companies are clearly motivated by the need to make a profit but is less easy to understand the way politicians seem to undermine NICE