Wednesday, 2 May,
2001, 05:06 GMT 06:06 UK
By BBC Health Correspondent Richard Hannaford
A key part of the government's reforms of the NHS is increasingly coming under attack by disillusioned doctors and angry patients.
The National Institute for Clinical Excellence (NICE) is supposed to decide which new treatments are cost effective for the NHS and end what ministers call postcode rationing.
However, some doctors are openly disagreeing with the Institute's medical assessments, while others are questioning its political independence.
Dr Stephen Jenkins, a leading cardiologist at St Thomas' Hospital in London, together with his colleagues, is ignoring NICE guidance on the use of an anti-blood clotting drug called Reopro - and as an acknowledged expert in the field, has written his own.
He said: "My concern about Reopro is that it is very expensive and it isn't necessary to use it to the extent that NICE guidelines recommend.
"Because there isn't sufficient money around to treat the angioplasty patients we have to do now - this will actually result in us not treating so many patients if we really follow the guidelines religiously".
At St George's Hospital in south London, Professor Joe Collier is critical of the way that the institute first refused to recommend the anti-flu drug Relenza, then reversed that decision on the basis of what he describes as "flimsy" evidence.
He said: "NICE is a very interesting organisation. They are in many, many ways very open. I know the basis of their decision making, because it's all on the web. I know their decision because they publish it. I know their terms of reference, they're available.
"But when it came to the decision some would argue it was perverse in as much as it seems to go against the evidence that they had. It may be legitimate but it would be very nice to know."
By far the most high-profile drugs examined by NICE are those which are designed to treat the progressive neurological disorder multiple sclerosis.
Although recommendations on beta-Interferon, and Copaxone were expected to be revealed in the latter part of last year, a series of delays has infuriated patient groups.
The institute has now asked for an entirely new set of papers on the drugs' economic costs and benefits - in effect virtually starting a large chunk of assessment process again from scratch.
That means it will not be in a position to make any announcement on the drugs availability until September 2001 at the earliest.
MS Society chief executive Peter Cardy is highly critical: "The real tragedy of the delay which could take us until the end of this year or well into next year before the final determination, is that all the time people with MS are ceasing to be eligible for treatment.
"As they become more disabled so they fall out of the category of people who are treatable with the drugs.
"That I think is shocking, it's a disgraceful indictment of the cavalier way in which NICE has treated people with MS."
However, NICE chief executive Andrew Dillon defended the organisation's record.
He told the BBC: "What we have done so far is already benefiting millions of people, and it is really making a difference to solving the entirely unsatisfactory postcode prescribing arrangements."
Talking about the MS guidance delay, he added: "It is absolutely essential that we have got all the evidence in front of us, to make sure that we take the right decision.
"That's why it's essential that we make sure we have done all the research.
"That's why we have
commissioned some further research on this most sensitive area of cost-effectiveness
before we ask our appraisal committee to give its final advice."