Consultant physician appointed to top NICE post

Dr Amanda Adler, consultant physician at Addenbrooke's, today becomes chair of the technology appraisals committee for the National Institute for Health and Clinical Excellence (NICE).

 

Far from being a remote, ivory-towered quango, the decisions taken by the 30-strong committee are noted by hospitals, drug companies and patients around the world. Dr Adler has sat on the committee for three years, alongside Addenbrooke's consultants Colin Watts and Bill Turner. This year she was appointed to replace Prof David Barrett

 

So what does the National Institute for Health and Clinical Excellence – otherwise known as NICE – actually do?

 

"When a drug has been approved, the Medicines and Healthcare products Regulatory Agency (MHRA) tells Britain when they can use a drug; NICE tells us whether we should use a drug," expained Dr Adler.

 

The committee asks one of several university-based research groups around the UK to pull together all the studies on whether an intervention is effective, both clinically and cost-wise, then makes a decision.

 

"You want to be sure that what is spent represents good value for money for the NHS and for UK taxpayers, who fund the drugs. So you might spend more on cancer drugs, but this means less for hospice services; it's important in a situation of limited resources."

 

In a speech earlier this year, David Cameron, leader of the Conservative Party, called for unelected quangos to be more transparent and accountable to voters. Does NICE meet and make decisions behind closed doors?

 

"No – NICE makes a huge effort to be transparent. All our meetings are open to the public. We invite clinical experts as well as patients who have been affected by the specific disease to attend, and before guidance is issued there is a period of public consultation."

 

But isn't this a self-selecting group – women who want Herceptin will be lobbying to get the drug on the NHS?

 

"Possibly, but the crux of it is that one has to have the resources to pay for any drug – so we assess whether it is effective, good value – and desirable. Once we've recommended a drug, the PCT can't say no, so they'll have to find the money from existing budgets."

 

They do, too – a recent report in the Financial Times showed that the NHS is prescribing newly approved medicines at high levels.

 

But there are ethical issues to bear in mind. Many "orphan" illnesses such as rare forms of cancer are very costly for pharmaceutical companies to run trials on, so NICE will consider recommending more expensive drugs to treat them: "It might not make sense to an economist, but it's reflecting societal values – all illnesses deserve equal treatment."

 

As well as weekly trips to London for NICE, Dr Adler will continue her duties as a consultant for diabetes at Addenbrooke's, honorary clinical epidemiologist with the Medical Research Council epidemiology unit, deputy clinical lead for the Eastern Diabetes Research Network, and helping to run a multidisciplinary clinic for cystic fibrosis-related diabetes at Papworth.

 

"I'm very excited about this appointment. I think it's important work. Britain is at the forefront globally of technology appraisals. It can make a genuine difference to people's lives. As a taxpayer I want the NHS to be paying for effective treatments."

 

 

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