Senior Doctor Disappointed Over Charity's Legal Challenge Against NICE

Armen Hareyan's picture
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In this week's BMJ, a senior doctor describes his disappointment with the Alzheimer's Society's recent alliance with drug makers in bringing the first legal challenge to judgements reached by the National Institute for Health and Clinical Excellence (NICE), the body that recommends which drugs are available on the NHS in England and Wales.

On 10 August, the High Court ruled against the alliance and upheld NICE's decision to limit treatments for Alzheimer's disease.

NICE is an independent body established to tackle the difficult - some would say near impossible - but essential task of trying to judge how the resources of the NHS can be used effectively and equitably, writes Professor Iain Chalmers.

This process is bound to result in "winners" and "losers," but those like the Alzheimer's Society that now regard themselves as losers must make it clearer whether they support the principles upon which NICE was established, he says.

He finds it disturbing that, in response to the legal judgement, the society's chief executive questioned whether NICE had lost public confidence.

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But how might the Alzheimer's Society's close alliance with drug manufacturers erode its own authority as a charity subsidised by the public - which thus also needs to retain the public's confidence, he asks?

There are steps he believes the society could take to restore his respect for and confidence in it.

First, he says, it should declare clearly on its website the sources and amounts of support it receives for its work. Second, having challenged NICE's judgements, the society should make clear what alternative distribution of limited resources it regards as more appropriate, and why.

Thirdly, he says, it should campaign for treatments for dementia to be evaluated using outcomes that are meaningful to patients and carers, and challenge the licensing and use in the NHS of any new drugs that fail to conform to these expectations.

Finally, it should insist that all data from clinical trials are published and that anonymised data for individual patients are made available, so that researchers can try to identify which patients are most likely to be helped by treatments and which patients are unlikely to benefit or may be harmed.

"These steps would be more effective and enduring ways for the Alzheimer's Society to serve the interests of people with dementia and their carers than forming alliances with organisations with vested commercial interests to take a public body to court," he concludes.

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