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Wickedness or folly? The ethics of NICE’s decisions
  1. K Claxton1,
  2. A J Culyer2
  1. 1Centre for Health Economics, University of York, Yorkshire, England
  2. 2Institute for Work & Health, Toronto, Canada
  1. Correspondence to:
 A J Culyer
 Institute for Work & Health, 481 University Avenue, Toronto, Ontario, Canada M5G 1T4; aculyer{at}


A rebuttal is provided to each of the arguments adduced by John Harris, an Editor-in-Chief of the Journal of Medical Ethics, in two editorials in the journal in support of the view that National Institute for Health and Clinical Excellence’s procedures and methods for making recommendations about healthcare procedures for use in the National Health Service in England and Wales are the product of “wickedness or folly or more likely both”, “ethically illiterate as well as socially divisive”, responsible for the “perversion of science as well as of morality” and are “contrary to basic morality and contrary to human rights”.

  • NHS, National Health Service
  • NICE, National Institute for Clinical Excellence
  • QALY, quality-adjusted life year

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  • i Harris somewhat disingenuously claims that this charge does not apply to those people who make NICE’s recommendations, but to their “ways of thinking”, regarding which his offensive charge was really an invitation to offer alternatives. The editorials are littered with other personally abusive charges, including one of hypocrisy.

  • Competing interests: KC is a member of the National Institute for Clinical Excellence (NICE) Appraisals Committee and was a member of the working party which recommended NICE’s current methodology for the conduct of economic appraisals. AJC was a member of the NICE Board, which commissioned and accepted this work and, although no longer on the Board, he remains a member of NICE’s Research and Development Committee.

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