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Curb the powers of the National Institute for Clinical Excellence to restrict feedom of choice in medicine

Comment 6th July 2010

The National Institute for Clinical Excellence (NICE) should be providing guidance and suggestions for treatment protocols, not dictating precisely what doctors are and are not allowed to do. The position of NICE needs to be clarified so that doctors who believe that it is appropriate in specific cases to deviate from the NICE guidance feel able to do so without fear of repercussions. Patients should be free to make an informed choice for the treatment approach they want where supported by their doctor, even if this is not currently considered 'best practice' by NICE. The current regime is stifling innovation and harming patients.

Why does this matter?

Medicine needs to be based on science. The scientific approach is based on the concept that you construct a series of models, each of which attempts to explain one part of the world's behaviour. In medicine, these models should help to guide the right approach to diagnosis and treatment in each individual case.

However, models are never perfect and need to be constantly refined or updated. This is inheritent in the scientific approach to knowledge. A key part of the approach is that, as evidence becomes available that contradicts a model, that model needs to be replaced or refined to take account of the new evidence. Without such constant refinement of models, the scientific approach ceases, and you move instead into a system controlled by dogma and superstition.

For a model to be refined, people have to try new approaches and variations on what the model predicts – to push the boundaries of the model and find its flaws. What is currently happening in medicine is that the existing models are becoming enshrined in NICE 'guidelines'. Doctors are being made to feel that any deviation from 'best practice' is likely to result in them being hauled in front of the GMC and struck off. There are some high profile cases of this that have happened recently and more in the pipeline – so these doctors have grounds for their fears. The result is that medicine is stagnating, with only those doctors in particular positions of power within the profession feeling enabled to challenge existing 'best practice'. Patients are suffering as a result.

A good example of this is the case of Dr Sarah Myhill, who has championed an evidence-based approach to the treatment of ME. She has demonstrated very clearly that the current 'best practice' in this condition is flawed and has helped many hundreds of patients to recover their health. No patient has been harmed in the development of her techniques and yet she has been in front of the GMC disciplinary process 7 times in the last 10 years. The most recent has resulted in the suspension of her right to prescribe – something which is having a direct negative impact on her patients. At her GMC hearing it was made clear that one of her 'crimes' was to use approaches that differered from NICE guidelines, despite these approaches being more effective.

I have also had a different doctor (a professor in a medical department of a university) tell me that 'treatment X is the most likely to help your condition based on the available evidence, but I don't dare prescribe it because of the risk of being struck off by the GMC'. This is madness.

The rigid adherance to NICE guidance is killing medical advance and harming thousands of patients. It has to stop.

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