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Last Update: Friday 12th November 2004
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NEWS   By PETER GRUNER


From left: GP Dr Simon Wiseman, Narendra Makanji, chairman of the Whittington NHS Trust, Professor Sir Michael Rawlins and Whittington gynaecologist Professor Albert Singer

‘We’ll continue to fight for justice for patients’
THE head of the organisation responsible for deciding if a new drug on the NHS was “cost effective” admitted this week that the decision didn’t take into consideration the “misery” of disease.
Professor Sir Michael Rawlins, chairman of the National Institute of Clinical Excellence (Nice) was guest speaker at the annual Whittington Hospital Oration on Tuesday night.
Nice is the independent organisation responsible for providing national guidance on treatments and care for people using the NHS in England and Wales.
Professor Rawlins set out the three main tenets of Nice which were to improve care standards for patients, to reduce unequal access to innovative treatment and to create guidelines for the uptake of evidence-based medicine.
One of the main tasks of Nice, he said, was to balance clinical effectiveness with cost effectiveness within the NHS, particularly with regard to deciding which drugs and pharmaceuticals should be made available, though he was keen to stress that it was the job of politicians to decide how much the country could afford to spend.
He pointed out, though, that the evidence from controlled trials carried out on drugs is what allows Nice to work out the cost effectiveness of any drug in regard to the benefit for the patient.
On what he referred to as this “controversial” and “touchy” issue of cost effectiveness, he appreciated that this method did not necessarily take account of the “misery of any given disease,” but pointed out that Nice was “quite likely to say yes” to a drug where there was no other treatment option.
For the future, he said it was “important not to deprive patients who have awful conditions” and that Nice would continue to work to address the question of “justice” for patients.
Alluding to the frequent comparisons made between the health services in Britain and America, Professor Rawlins claimed that “just because they do it in America, doesn’t mean we can do it here”.
He said that each country had its own economic factors to allow for.
When questioned on the restriction and control placed upon clinicians by the guidelines introduced by Nice, Sir Michael stated that as “guidelines cover only 80 per cent of patients”, that there must by necessity still be room for health professionals to act on their own judgement.
He also made sure to point out that the guidelines that are instituted by Nice are drawn up by independent groups of healthcare professionals, academics and health economists, and by panels from the Royal Colleges for each speciality.
Professor Rawlins claimed that Nice had “not had an easy ride from the press and medical journals” since its inception, but countered that despite this, a poll of public opinion showed that 27 per cent of the public were aware of the existence of Nice, a percentage of awareness, he stated, that many politicians would be glad to have.
Furthermore, the poll showed that 72 per cent of those people felt ‘very positive’ or ‘quite positive’ about the job that Nice is doing.
In running the largest guidelines programme of any country in the world, Nice accrues a lot of interest from overseas, with both delegation visits and many hits on what Professor Rawlins described as an “active” website – with more than three million of those coming from the United States alone.