Sir, Jonathan Waxman (“We need cancer drugs. NICE (the National Institute for Health and Clinical Excellence) must go”, August 8) is clearly upset at the institute’s draft recommendations on the use of treatments for renal cancer. However, he undermines his argument with an inaccurate assessment of the contribution NICE has made to promoting effective treatments for cancer and with some factual errors.

Since 1999 we have assessed 56 treatments (not 407) for cancer. In only four cases has either the clinical or cost-effectiveness of the treatments caused us to recommend against general use in the NHS. It is because of NICE guidance, not despite it, that thousands more patients with cancer have been treated and are benefiting as a consequence.

Professor Waxman suggests that many of our recommendations have been “stomped on by judicial review or overruled by ministers”. Our guidance has, so far, only been judicially reviewed once and it has never been overruled by a government minister. Rather mystifyingly, he misunderstands the regulatory role of the medicines licensing agencies in this country and abroad. They do not assess the “value” of new drugs. Their role is to assess the safety and efficacy of new treatments. What they do not do, but precisely what NICE does do, is to assess their value to patients and as a good use of NHS funds, compared with current standard care. Our advisory bodies are not “patrolled and staffed by health economists” either. Such experts make an important contribution, but all our advisory groups contain a majority of practising health professionals.

Cancer is a devastating illness and it is right that the NHS should make treating it a priority. But it is because the NHS has a responsibility to spread its resources fairly that it is essential that we should assess cancer drugs as rigorously as the other treatments we are asked to look at.

Andrew Dillon
Chief Executive, National Institute for Health and Clinical Excellence

Sir, In any publicly funded healthcare system, there will always be a mismatch between health needs and what effective treatments can be afforded, so whether there is “rationing” is not the real issue, nor is whether it will be controversial or that it means inequity for those who cannot afford private treatment.

The key issues are how much rationing there is — which depends on overall health spending and the price of new treatments. These are the responsibility of politicians and pharmaceutical executives. A misplaced focus on the tools, process or institutions of rationing lets both players off the hook. If clinicians want more treatments made available on the NHS they should call on politicians to raise taxes for health spending or prioritise such spending and find incentives for cheaper drug development or cost-sharing.

A second issue is whether the rationing is done objectively and fairly. Objectivity is critical — otherwise expensive cancer treatments will always be funded ahead of effective preventive measures. A third issue is how transparent and rational the process is. Professor Waxman is right to complain that the workload of NICE is set for it by the Government, which also dictates the timetable and decides whether to endorse the recommendations. This distorts the process, means political interference and results in insufficient attention being given to the need to stop the NHS wasting money on less effective or unsafe treatments.

It is time to rename NICE the National Institute of Cost- Effectiveness and Rationing, to give it more freedom to act rationally and fairly and to hold politicians responsible for their decisions on funding.

Dr Evan Harris, MP
Lib Dem Science Spokesman

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