Thursday, 10 January 2008

C'mon, c'mon. I need an answer!

Towards the closing minutes of each episode of University Challenge Jeremy Paxman ups the ante by putting panels under pressure to answer as quickly as possible. Sometimes this pushes a team to greatness. Sometimes it results in spectacularly wrong answers, or a set of three straight "we don't know"s.

On the Today programme this morning the decision making of NICE was discussed. Apparently they make very good decisions but take forever over them - two years compared with four months for similar decisions to be made in Scotland. NICE, MPs say, should make decisions faster - we need an answer! (The Today programme website is not helpful. It gives no details of this discussion. Luckily the story is now on the BBC news website.)

When you look at how NICE make decisions it's no wonder it takes time - the process is lengthy and involves a wide range of organisations, as this example on how clinical guidelines are developed shows.

NICE does more than churn out guidelines. Each piece of guidance is accompanied by tables of evidence, search strategies, excluded studies, background information and patient leaflets. The patient leaflets carry Plain English Campaign crystal marks and are very good.

You can search for NICE guidance on their website or through the National Library for Health . The NLH search covers guidance from overseas, too.

NICE aren't the only ones issuing guidance. In Scotland there is the Scottish Intercollegiate Guidelines Network. Decisions about what drugs can be used are made by the Medicines and Healthcare Products Regulatory Agency. In the USA this job is done by the FDA - Food and Drug Administration.

MHRA focuses on benefits and risks, NICE tends more towards benefits and costs. Neither type of decision should be made in a hurry. When drugs are used or tested too early the results can be devastating - perhaps not immediately, but in the long term. Last summer there were concerns that diabetes drug rosiglitazone could cause heart problems. Other research considered a possible link between cancer and statins - the drugs that lower cholesterol.

Rush into a decision too soon and people could get hurt. Dither over a decision and people could die while you're at it. Either way Jeremy Paxman wont be there to say "too late! I'll tell you."

(c) creative commons attributed image 1, image 2, image 3

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