Abstract
Michael Rawlins1Rawlins M In pursuit of quality: the National Institute for Clinical Excellence.Lancet. 1999; 353: 1079-1082Summary Full Text Full Text PDF PubMed Scopus (141) Google Scholar lists four difficulties with health-care guidelines produced so far: variable quality, contradictions, ignoring of cost-effectiveness, and inaccessible formats. NICE should be able to avoid three of these, but I am intrigued to know how contradictions will be avoided. Guidelines are needed only when there is uncertainty; they are consensus, not truth. If NICE's guidelines for a treatment differ from a Royal College's or from someone else's systematic review, from whose guidelines should health professionals “be wise to record their reasons”? Why should NICE's guidelines necessarily be the “best practice”? If there are existing guidelines from other bodies, will NICE in some way decide which are the right ones and give them a NICE kitemark? If NICE is effective, then there will be explicit rationing—and about time too. Rawlins cites the New Shorter Oxford Dictionary in his belief that National Health Service rationing is abuse of the language. The usage is in common parlance and usage defines meaning, not the other way round, but he is confusing the noun ration with the participle rationing. It is true that each of us does not have a “ration” of health care, but “rationing by the purse, raising the price of a commodity so as to restrict the number of people who can afford to buy it. Similarly rationing by price” is the definition in the full Oxford English Dictionary.
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