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NICE discrimination

National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA, UK

Correspondence to:
Professor SirMichael Rawlins
National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA, UK; michael.rawlins@nice.org.uk Original version received 29 July 2005

21 August 2005

Abbreviations: NHS, National Health Service; NICE, National Institute of Health and Clinical Excellence; QALY, quality adjusted life year

Keywords: distributive justice; health economics; QALYs; resource allocation

The first 150 words of the full text of this article appear below.

Harris’s recent editorial,¹It’s not NICE to discriminate, is long on both polemic and invective but short on scholarship. He offers nothing to illuminate the debate about allocating health care in circumstances of finite resources; he has no understanding of the quality adjusted life year (QALY) and its use in health economic evaluation; and he makes ill researched, unsubstantiated charges against the institute and its advisory bodies.

ALLOCATING HEALTHCARE RESOURCES
The British National Health Service (NHS), like every other healthcare system in the world, has finite resources. How the NHS’s budget should be most appropriately allocated is a very specific example of the more general problem of distributive justice.²

The NHS, with its requirement³ to provide all care that is "necessary and appropriate", was founded with an egalitarian purpose. Yet despite its laudable emphasis on fairness, the implementation of the NHS’s egalitarian approach remains uncertain. What is necessary? What is appropriate? . . . [Full text of this article]

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				M Schlander The use of cost-effectiveness by the National Institute for Health and Clinical Excellence (NICE): no(t yet an) exemplar of a deliberative process J. Med. Ethics, July 1, 2008; 34(7): 534 - 539. [Abstract] [Full Text] [PDF]

				M. Quigley A NICE fallacy J. Med. Ethics, August 1, 2007; 33(8): 465 - 466. [Abstract] [Full Text] [PDF]

				J Harris NICE is not cost effective. J. Med. Ethics, July 1, 2006; 32(7): 378 - 380. [Full Text] [PDF]

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