Editor's blog 17th August 2008: Rawlins bites back

Hello again, after another unwanted and unexpected workload-enforced interregnum of absence. What a lot of medals Team GB have got. It's great! There may be hope for the obesity crisis yet if this turns sport and exercise back to something we as a nation do rather than something we just watch (with all the associated pornographic connotations).

As Tom Smith has brilliantly tracked in the last week of Health Policy Today, NICE has not spent a second out of the news, policy and political headlines since its intellectually consistent and courageous decision to do the job that we set it up to do and refuse to recommend the use of non-cost-effective drugs.

The latest on the debate has come from NICE's chair, Professor Sir Michael Rawlins. In a high-profile intervention in today's Observer that will set the tone for the next week of health policy discussion, Rawlins has pointed out that pharmaceutical companies are seeking to sustain recent year-on-year growth of 10%+ to maintain the value of senior executives' share options; that the currently-sought retail costs of the kidney cancer drugs which caused the latest furore represent a 90% mark-up on the production costs; and that pharmaceutical marketing costs are double pharmaceutical R&D costs.

Rawlins is a figure with international credibility. Between himself and NICE's candid and politically deft chief executive  Andrew Dillon, NICE has acquired a reputation for taking difficult decisions fairly and with transparent processes.

It is interesting to note that every other developed healthcare system is already emulating what NICE has led the world in doing, or is setting that process in motion.

The R word
What NICE is doing is a key part of  the unpopular but essential R word: rationing. NICE is trying to make rationing rational.

To begin at the beginning (in the words of the other, drunker Dylan), a healthcare pound (euro, dollar or yen) cannot be spent twice.

NICE's credibility as a guiding and deliberating body can be measured by the fact that both the Darzi Review and the first statements from Baroness Young, chair-in-waiting of the new Care Quality Commission launching next April, placed NICE in the box seat as an  honest broker of healthcare rationing.

NICE have been asked to assess the clinical and cost-effectiveness of new technologies and to recommend whether ther NHDS should adopt them wholesale. The success of the 2008 appeal against NICE's sole legal challenge to date on ineffective Alzheimers' drugs (on the basis of NICE's refusal to provide its whole executable modelling methodology to drug companies, as opposed to a read-only version) remains a mystifying decision by the Appeal Court. If the Appeal Court were to turn around to a drug company and tell them to hand over their intellectual property in the same way, the PR outcry would be due to end some time at the 2236 Olympics.

The latest instalment in our essential Maynard Doctrine series points out that annual cost-inflation in the US healthcare system is running at 10%.

The UK healthcare system has more than enough inflationary pressures on its plate without simply rolling over and giving in to the critics of NICE.