Author’s reply to Sundar

Sundar is correct in stating that in a taxpayer funded system the National Institute for Health and Care Excellence (NICE) cannot allow healthcare professionals to prescribe the best available treatment that would suit patients’ preferences all the time.12Healthcare professionals are well versed at providing the best possible advice within the limited resources available to them, and it is appropriate for those limitations to be based on evidence based assessments of value for money. This, however, comes with a couple of caveats. The first is that implementing restrictions through clinical guidelines, as part of a shared decision making process, is likely to be both ineffective and inequitable.3The second is that the values embodied in such value for money calculations should align with those of the taxpayer, rather than commercial values or political priorities. There is a growing suspicion that the pharmaceutical industry may have disproportionate influence on NICE decision making4 and,…
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