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NICE proves itself to be far from infallible

Clinicians have long realised NICE is anything but infallible when it comes to advising on clinical matters, and to blame the BMA for the MMR disaster, as Sir Michael Rawlins does (News, March 22), quite takes one's breath away.

The BMA is our trade union. It has thankfully always had a strong ethical dimension and has from time to time given guidance on health to the profession, the public and the Government. I am not aware it has ever suggested routine MMR immunisation was anything but recommended in the strongest possible terms.

Many GPs have protested about the rigid attitude taken by the Department of Health in resolutely refusing to consider any relaxation of target payments to doctors for MMR immunisation. This has resulted in many GPs' incomes being significantly reduced through no fault of their own as they were unable to include refusniks in their target numbers.

Sir Michael seems to believe this is acceptable. Perhaps he feels financial pressures are a more effective spur to GPs than clinical indications.

I feel this view is ethically unsound and unsupported by evidence, but it does help to explain some of the apparently counter-intuitive decisions from NICE that are clearly based on cost-effectiveness not clinical care.

Practising clinicians focus on the needs of each patient at the time of consultation. I believe this is what patients and politicians desire.

Sir Michael might even agree if he ever troubled to descend from his ivory tower.

Dr Lewis Miller


 · I was appalled to read the reported view of NICE chair Professor Sir Michael Rawlins that the 'BMA should take the blame for MMR' (News, March 22). The BMA has vigorously campaigned to promote the safety and effectiveness of MMR. We have taken part in broadcast after broadcast saying MMR is the right option for children and their parents and have repeatedly issued statements to the press on this issue.

The BMA is fully aware of its responsibility ­ and the responsibility of doctors ­ for public health. In fact we published a major report 'Childhood immunisation: a guide for health care professionals' in 2003 which again reaffirmed the BMA's view that the triple vaccine is the most effective and safest way to immunise a child against measles, mumps and rubella.

Dr John Chisholm

Chair, GPC, London

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