What Can We Expect from the Current Review of NICE Guideline CG53 - Nancy Blake

[Barry]

Can somebody think of examples of what they are referring to in the bits in bold e.g. what would take precedence over economics?

Not at this moment. But what stands out to me is that nothing - absolutely nothing - confines their statement here to medicinal drugs treatment, but would seem to cover any kind of treatment. And the phrase "and harm of alternative courses of action" seems to embrace pretty much anything harmful, as of course it should.

So to me it seems we are talking about balancing:

• The good we do know - pacing - which limits harm and provides best chance of a tolerable life. Need to somehow analyse / demonstrate how, until ME is better understood, this is the most financially optimal solution for the NHS. Versus ...
• GET, and CBT a la GET. Would be handy if we could factor in the risk of future damages claims, but not sure if that is a bridge too far for this. But there are litigation lawyers keeping an eye on this I've noticed, and as is their way, will be diving in with no-win-no-fee offers I'm sure for suing the medical establishment if they get a chance.

 

[Barry]

A huge difference this time around (surely?) is that NICE cannot plead ignorance. And they must be keenly aware of that.

 

[Barry]

Can somebody think of examples of what they are referring to in the bits in bold e.g. what would take precedence over economics?

Again, not at the moment. But NICE's glossary entry on social value judgements includes:

The decisions in NICE guidance are based on the best available evidence. Sometimes the available evidence is not of good quality or can be incomplete, so the committees involved have to make scientific value judgements and social value judgements.

[My bold]

Surely if NICE decide to accept evidence on the basis of it being of good quality, then the onus is on them to demonstrate the rigour they have applied in order to arrive at that decision. Part of that I would think must be a preparedness justify themselves if that decision subsequently proves flawed. They have clearly not done this in the past ... trials assessed by reading only the abstracts being one of the most glaring lack of rigour. But this time around for ME ... they must surely realise they really do need to get their sh*t together.