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British Geriatrics Society
The National Institute for Health and Clinical Excellence (NICE) has developed a consultation document on the social value judgements that affect the development of its guidance on the promotion of good health and the prevention and treatment of ill health. The consultation document describes the social value judgements that the NICE Board believes should guide NICE’s decision making – it will not be issued as guidance for the wider NHS. The consultation document was issued on 4 April and consultation closed on 30 June. It can be found on the NICE website. Responding to the consultation, the BGS broadly agrees with the recommendation proposing that interventions should not be supported if evidence is either absent or too weak for reasonable conclusions to be reached with certain reservations. It also welcomes the guidance confirming that there is no case for discrimination on the basis of gender, sexual orientation, ethnicity, or against patients whose conditions may be in part self-inflicted. The BGS agrees that issues of income, social class or status should not be used in setting health care priorities other than in a general move towards reducing health inequalities. The BGS is concerned, however, about the conclusions from the Citizens Council regarding age. While the suggestion that health should not be valued more highly in some age groups than others is reassuring, the conclusion that age discrimination is not only permissible but appropriate, where age is an indicator of benefit or risk in the context of older people, contravenes the values of the Society and one of the core principles of the National Service Framework. The Society believes decisions of this type should be based around clinical need and appropriateness. For NICE to imply that age discrimination is appropriate on the basis of cost effectiveness and quality of life, seemingly ignores the fact that both of these are notoriously difficult to measure; and are both intrinsically open to ageism depending on how they are interpreted. Age per se is rarely a factor in the benefits or risks of interventions, although frailty and multiple co-morbidities associated with advanced age do influence risk and benefit evaluations. There is an additional concern that evidence of benefits for certain interventions in frail older people may be lacking due to the under-representation of this group in randomised controlled trials. In this way covert discrimination may occur through non application of potentially beneficial interventions. As most end events of clinical trials occur in older age (e.g. deaths, strokes, etc.) the older patient usually stands to gain the most in terms of risk reduction from a given intervention. The Society welcomes the suggestion that conditions associated with stigma should be given some degree of priority. Older people with mental health problems are one such group which is particularly pertinent when evaluating interventions for dementia including cholinesterase inhibitor therapy. Home | NICE Index | Site Map |
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