Thursday, 27 September 2012

NICE & PCORI - a Match made in heaven

The National Institute of Health and Clinical Excellence (NICE) is a Jewel in the Crown of the UK National health Service, the NHS. It examines the evidence for different treatments and makes recommendations to commisioners of healthcare in the NHS.


A facility like NICE is necessary for every healthcare system in the 21st century. Recently, the NHS has been encouraged by the British government to peddle its services abroad and earn some badly needed extra income. NICE is an excellent example of an NHS service that healthcare systems around the world would pay good money to use.
Although I am an admirer and fan of NICE, it has its faults and detractors. Occasionally, it has made what IMHO are bizarre recommendations that are clearly not based on available evidence. This has led to the frequent accusation that NICE is nothing more than a cost cutting arm of the government or NHS executive.
One issue that limits the scope of NICE is the lack of evidence for many treatments - lack of evidence does not necessarily mean a particular treatment does not work. Such absence of evidence and recommendation from NICE is regrettably used by commisoners to deny payment for treatments. I imagine that one aim of the National Institute for Health research (NIHR) (research arm of the National health Service) when it was set up was to try and encourage research to produce good evidence. In fact one of the funding streams of NIHR is the quaintly but accurately termed Research for Patient Benefit (RfPB).
I think that NIHR are doing a good job - I even do Peer reviews of applications for them. However when one browses through their website, one cannot help but feel that they have become a wee bit bloated, they may even lost sight of what they are supposed to achieve within the bigger picture.
On the evidence of their website, the recently established US outfit, PCORI (or Patient Centered Outcomes Research Institute) are to me everything that NIHR and RfPB are not - exciting, approachable and enthusing. Even their name (which may seem to some a bit of a mouth full!) explains what they do on the tin - And like NICE, a must for every health service in a mature economy in the 21st century. NICE & PCORI - they really are a perfect match - separated unfortunately not just by an ocean but by different systems.