"The language of priorities", the godfather of the NHS, Nye Bevan, said in its early days, "is the religion of Socialism." The great Welshman would probably dismiss Nice, the body set up to decide on the cost-effectiveness of drugs, as the work of a desiccated calculating machine. So, understandably, might every patient in the early stages of Alzheimer's disease, and every carer too. By broadly upholding Nice's methodology in assessing the efficacy of Aricept, Reminyl and Exelon for this group, the high court yesterday gave the beleaguered Nice a pat on the back for work properly done.
This was Nice's first legal challenge and it was vital that its work should be upheld. But it will not stop the attacks on the principle of using a sophisticated system of number-crunching to come to enormously sensitive and individual decisions that most clinicians would prefer to take without counting the cost.
The brutal truth is that in a cash-limited health service, which delivers so much to so many, one person's cancer drug might mean another patient going without. This government set Nice up to bring transparency (not enough, say campaigners, including the drug companies) and systematic thinking to the formerly opaque process of drug rationing. It commissions economic models to weigh up every new drug's cost-effectiveness.
Some sceptics wonder if they factor in the real, rather than the financial, costs. The cost, for example, of the social isolation of the Alzheimer's sufferer and their carer, or the emotional impact of knowing there is a drug that might help, but cannot be tried because Nice says it does not work well enough in enough cases - although it works very well in some - to be justified. They point to what looks just a bit like a trend at Nice against drugs that are of particular benefit to elderly patients. It is to avoid this kind of attack that Nice's assessments are so painstaking - and so slow. ("Nice blight", it is known as in the trade.) One improvement would be to allow prescription until the Nice assessment is completed, making more clinical evidence available.
But in this case, the Alzheimer's drugs were formerly available, which is why so many people know how well they can sometimes work. In theory, health professionals can get permission to use a drug against Nice's recommendation. In reality, a Nice veto is just that. It is a tough call, but Nice is meant to take tough calls on the basis of the best information available and within the restrictions of the current system. Bevan thought the NHS would spend less as the population got healthier. Instead we live longer - and we cost more. It is nasty work that Nice does, but it has to be done.
