It Isn't Easy Being NICE

 In late October, the UK announced its intention to rein in what many observers viewed as a model for the sensible rationing of health care.  For nearly a decade, the National Institute of Health and Clinical Excellence (NICE) had employed rigorous expert assessments to decide whether new drugs or other medical treatments were sufficiently cost-effective that they should be covered by the National Health Service.  But denying coverage for new therapies is bound to provoke controversy, and NICE received its share of criticism.  Hence, the UK government plans to eliminate the power of NICE to make coverage decisions based on its analyses.  Of course, Congress withheld that kind of power from the Patient Centered Outcomes Research Institute that will be created under the Patient Protection and Affordable Care Act.  The change in policy at NICE reminds us of the discussion by Calabresi and Bobbitt in "Tragic Choices" that society deals with life-and-death decisions implicitly because of the social conflict that results from efforts at explicit resolution.

David Orentlicher