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NICE: mostly a bad idea
  1. Alan Leaman
  1. Correspondence to Dr Alan Leaman, Emergency Department, Princess Royal Hospital, Telford TF1 6TF, UK; caleaman{at}

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“Suspect all those who claim that they are authorised to teach the truth”

Karl Popper

No one would disagree that a health service with limited resources needs a body to decide whether or not expensive innovations should be adopted. This was the original role for the National Institute for Health and Clinical Excellence (NICE). Unfortunately, it has subsequently extended its remit to include dictating standard medical practice. The purpose of this article is to explain why this is a bad thing.

NICE is a government body formed in 1999. Its initial remit was to assess the cost effectiveness of new and expensive treatments. However, in 2004 its role was expanded to include “guidance on treating ill health”.1 To date it has published 79 guidelines on topics ranging from antenatal care to venous thromboembolism. The purpose of these guidelines is apparently “to provide recommendations for the treatment of people by health professionals” and “to assess the clinical practice of individual health professionals”.1 Rather surprisingly, there has been little debate about whether a state-sponsored organisation should be dictating medical treatments, or whether doctors wish to be judged by such a body.

Flawed guidance

It is not difficult to find examples in which independent organisations, or acknowledged experts, believe NICE guidance is wrong. There are good examples in the fields of infectious disease,2 paediatrics,3 endocrinology,4 general practice5 and surgery.6

When NICE guidance has been shown to be incorrect it would be reassuring if this led to a rapid revision of the …

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  • Competing interests None.

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