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Gold, incentives and meh

Don't dismiss NICE so lightly

From Professor Peter Littlejohns

Clinical and public health director


I refer to the letter from Dylan Kay ('Get real over ASCOT study', 2 March). We wouldn't wish to get into a debate about possible flaws in ASCOT as issues relating to the quality of evidence considered during the development of a NICE guideline are fully explored by the Guideline Development Group (GDG), and are thus reflected in the guideline recommendations.

However, Dr Kay's comment that 'NICE has cowed to self-interest and ignored scientific order and method' deserves comment.

The primary responsibility of the GDG is that it should make recommendations based on the best available evidence of both clinical and cost effectiveness.

In this case, the GDG have considered the new evidence relating to ASCOT in the context of other evidence in the original guideline, and evidence published since July 2003 and conforming to the criteria for consideration in the original guideline.

For example, adverse events data and issues of patient concordance were particularly noted and the group also had access to a detailed health economic analysis comparing the cost-effectiveness of the main drug classes, something that had not been available to the original NICE guideline group.

To suggest NICE has cowed to self-interest and ignored scientific order and method is at best to misunderstand NICE's process.

The guideline, when published, will have the potential to influence and improve the treatment of a significant proportion of the adult population of the UK.

It should not be so lightly dismissed.

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