Article Text

Download PDFPDF
NICE is not cost effective
  1. J Harris
  1. Correspondence to:
 John Harris
 The Centre for Social Ethics and Policy, Institute of Medicine Law and Bioethics, School of Law, University of Manchester, Williamson Building, Oxford Road, Manchester M13 0JH, UK; john.m.harris{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Claxton and Culyer1 (see p 373) have written an interesting and considered response, as people intimately connected to the National Institute for Health and Clinical Excellence (NICE), to the two editorials that I wrote on recent NICE decisions. Before commenting on their response, I would like to consider a point they made, which echoes a point already made by Rawlins and Dillon,2 about the tone of my editorials. Claxton and Culyer accuse me of making “personally abusive charges”. In my original editorial, I criticised an institution, NICE, in robust terms, but in doing so I was continuing a long and respected tradition in English philosophy. Consider the following extract from Jeremy Bentham:

 In English law, fiction is a syphilis, which runs in every vein, and carries into every part of the system the principle of rottenness...Fiction of use to justice? Exactly as swindling is to trade...It affords presumptive and conclusive evidence of moral turpitude in those by whom it was invented and first employed.3

My remarks were not an ad hominem criticism of anyone but directed at the published, but anonymous statements of an institution—a body corporate. In robustly criticising NICE, I no more attacked any individual associated with NICE than I attacked Tony Blair or the various ministers of state who are ultimately responsible for NICE. And, contra Claxton and Culyer’s claims, I have not denigrated the views of people who beg to differ from me.i If the apologists for NICE, whether they are Tony Culyer or Tony Blair, choose to identify themselves with criticism of NICE, that is entirely a matter for them. The only ad hominem remarks in this entire exchange have been made by Rawlins and Dillon, and Claxton and Culyer. The idea that criticism of the anonymously authored publications of …

View Full Text


  • i Claxton and Culyer say “the editorials are littered with other personally abusive charges, including one of hypocrisy”. Such charges I make against NICE may be personally abusive if they were directed at any individually identified person. I was using “hypocrisy” according to the definition in The shorter Oxford English Dictionary,4 to mean “the assuming of a false appearance of virtue or goodness” by NICE in its published, but not individually authored, material. I do not think that to say of a corporation that its stance is “assuming a false appearance of virtue or goodness” and to explicitly state why this appearance is false could be called “abusive”, let alone “personally abusive”. I stand by this charge against NICE. The reasons that justify the use of the term “hypocrisy” against this corporate body, but against no individuals, are clearly set out in my editorial.

  • ii Contra what Claxton and Culyer seem to believe, this point has nothing to do with whether those who have to forgo benefits are personally identifiable or not.

  • Competing interests: None.

Linked Articles

Other content recommended for you