Editor's blog Saturday 30 October 2010: The demise of NICE - hate to say I told you so
Hate to say I told you so …
But we did; and also earlier here, too. Or indeed, originally here.
And I do – hate to say I told you so. No amount of short-term ‘feeling a bit clever for getting a judgment call right’ compensates for the stratospherically stupid policy decision that has very clearly been taken to do away with NICE.
Now Health Secretary Andrew Lansley has told The Guardian"s Sarah Boseley, "We need a system that encourages the development of breakthrough drugs addressing areas of significant unmet need. And we need a much closer link between the price the NHS pays and the value that a new medicine delivers, sending a powerful signal about the areas that the pharmaceutical industry should target for development. Most importantly, using our cancer drugs fund in the interim, and value-based pricing for the longer-term, we will move to an NHS where patients will be confident that where their clinicians believe a particular drug is the right and most effective one for them, then the NHS will be able to provide it for them".
Lansley's concept of 'sending a powerful signal about areas the pharmaceutical industry should target for development' is an interesting one.
What signal could be more powerful than telling the pharamacetical industry its price is too high and a drug will not be advised for NHS use?
That is NICE's power. That is the sensible arrangement from which Mr Lansley plans to liberate the NHS.
Onwards, comrades! Back to the days of the postcode lottery.
Once upon a time, there was going to be a NICE conference this year. But if you go to the NICE link, surprise, surprise! It’s broken.
There are bad and stupid decisions; and then there are really bad and really stupid decisions.
And then there is the idea that value-based pricing (whose mainstream exemplar hitherto is notable because it was judged “a costly failure”) is fit or ready to replace NICE’s hard-but-crucial assessments of whether the clinical effectiveness of new drugs is in proportion to their cost-effectiveness.
Much bullshit is going to be written in the next few days and weeks about the concept of rationing. The Unique Selling Point on offer will be that rationing is ‘so 1940s-60s, darling!’ No; let them eat Herceptin and Avastin … or whatever the next bio-chemical brioche that the Marie Antoinettes of marketing have to sell.
And of course, in the interest of balance and good sense, all the bullshit articles will be at pains to emphasise that NICE recommends 75% of cancer medications. Won’t they?
What do you mean, no they won’t?
Still, it’s sure to work out fine. It’s not as if money could be tight in the NHS for a while, no?
Marketing trumps rationing.
The Coalition Agreement promised three guiding principles for the NHS: "freedom, fairness and responsibility".
Removing NICE's power to decide that certain drugs are of such slight clinical effectiveness and high price as to be unfit for NHS use will deliver freedom for the price-setters in pharmaland: expect a nice share price bounce on Monday.
NICE was invented to deliver fairness regarding the postcode lottery.
This policy to remove NICE's power to ration drugs that effectively don't work or are too expensive is the opposite of responsibility.