In our research we are concerned with the value of medicines. Michael D Rawlins’ account of the National Institute for Clinical Excellence’s early years and founding principles is inspiring. It reminds us that judging value of medicines in the NHS involves judgements about science and social value judgments to do with ‘distributive justice’, here expressed in the form of questions:
We recognised, early on, that the National Institute for Clinical Excellence needed to develop social values and that these should be incorporated into our decision-making processes. The types of social values that were, and still are, important to the Institute include problems such as: Should the National Health Service spend more to prolong the life of a child by a year compared to its parents or grandparents? Should the National Health Service provide very expensive drugs to treat very rare diseases? Should the National Health Service be prepared to spend more on avoiding harms to patients than in treating them for naturally occurring diseases?
Rawlins, M. D. (2015). “National Institute for Clinical Excellence: NICE works.” Journal of the Royal Society of Medicine 108(6): 211-219. http://jrs.sagepub.com/content/108/6/211.abstract?rss=1
Rawlins, M. D. and A. J. Culyer (2004). National Institute for Clinical Excellence and its value judgments. BMJ, 329: 224–227. http://www.bmj.com/content/329/7459/224