NICE technology appraisals: working with multiple levels of uncertainty and the potential for bias [Book Review]
Medicine, Health Care and Philosophy 16 (2):281-293 (2013)
One of the key roles of the English National Institute for Health and Clinical Excellence (NICE) is technology appraisal. This essentially involves evaluating the cost effectiveness of pharmaceutical products and other technologies for use within the National Health Service. Based on a content analysis of key documents which shed light on the nature of appraisals, this paper draws attention to the multiple layers of uncertainty and complexity which are latent within the appraisal process, and the often socially constructed mechanisms for tackling these. Epistemic assumptions, bounded rationality and more explicitly relational forms of managing knowledge are applied to this end. These findings are discussed in the context of the literature highlighting the inherently social process of regulation. A framework is developed which posits the various forms of uncertainty, and responses to these, as potential conduits of regulatory bias—in need of further research. That NICE’s authority is itself regulated by other actors within the regulatory regime, particularly the pharmaceutical industry, exposes it to the threat of regulatory capture. Following Lehoux, it is concluded that a more transparent and reflexive format for technological appraisals is necessary. This would enable a more robust, defensible form of decision-making and moreover enable NICE to preserve its legitimacy in the midst of pressures which threaten this
|Keywords||Alzheimer’s Complexity Hope Polycentric regimes Regulation Uncertainty|
|Categories||categorize this paper)|
References found in this work BETA
The Social Construction of Reality: A Treatise in the Sociology of Knowledge.Peter Berger & Thomas Luckmann - 1966 - Anchor Books.
The Phenomenology of the Social World*.Alfred Schutz - 2007 - In Craig J. Calhoun (ed.), Contemporary Sociological Theory. Blackwell. pp. 2--32.
The Limits of Rationality an Essay on the Social and Moral Thought of Max Weber.Rogers Brubaker - 1991
Citations of this work BETA
No citations found.
Similar books and articles
Responsibly Managing Uncertainties In Clinical Ethics.L. B. McCullough - 2012 - Journal of Medicine and Philosophy 37 (1):1-5.
The Use of Cost-Effectiveness by the National Institute for Health and Clinical Excellence (NICE): No(T yet an) Exemplar of a Deliberative Process.M. Schlander - 2008 - Journal of Medical Ethics 34 (7):534-539.
The Influence of Anger on Ethical Decision Making: Comparison of a Primary and Secondary Appraisal.Chase E. Thiel, Shane Connelly & Jennifer A. Griffith - 2011 - Ethics and Behavior 21 (5):380 - 403.
A Big Regulatory Tool-Box for a Small Technology.Diana M. Bowman & Graeme A. Hodge - 2008 - NanoEthics 2 (2):193-207.
Pharmaceutical Risk Communication: Sources of Uncertainty and Legal Tools of Uncertainty Management.Barbara Osimani - 2010 - Health Risk and Society 12 (5):453-69.
Fearing Fluffy: The Content of an Emotional Appraisal.Carolyn S. Price - 2006 - In Graham F. Macdonald & David Papineau (eds.), Teleosemantics. Oxford University Press.
Bias in Peer Review.Carole J. Lee, Cassidy R. Sugimoto, Guo Zhang & Blaise Cronin - 2013 - Journal of the American Society for Information Science and Technology 64 (1):2-17.
Moral Appraisals Affect Doing/Allowing Judgments.Fiery Cushman, Joshua Knobe & Walter Sinnott-Armstrong - 2008 - Cognition 108 (2):353-380.
Regulating Health: Transcending Disciplinary Boundaries. [REVIEW]Toby Seddon - 2013 - Health Care Analysis 21 (1):43-53.
NICE Guidelines, Clinical Practice and Antisocial Personality Disorder: The Ethical Implications of Ontological Uncertainty.M. D. Pickersgill - 2009 - Journal of Medical Ethics 35 (11):668-671.
How Clinical Trials Really Work Rethinking Research Ethics.Debra A. DeBruin, Joan Liaschenko & Anastasia Fisher - 2011 - Kennedy Institute of Ethics Journal 21 (2):121-139.
Greek Syntax Michèle Biraud (ed.): Études de syntaxe du grec classique: Recherches linguistiques et applications didactiques. (Actes du premier Colloque International de Didactique de la Syntaxe du Grec classique. 17, 18, 19 Avril 1991, Université de Nice. (Publications de la Faculté des Lettres et Sciences Humaines de Nice, N.S.7.) Pp. 180; various syntactic diagrams. Nice: Association des Publications de la Faculté des Lettres de Nice, 1992. Paper. Michèle Biraud: La Détermination du nom en grec classique. (Publications de la Faculté des Lettres et Sciences Humaines de Nice, N.S. 6.) p. 347. Nice: Association des Publications de la Faculté des Lettres de Nice, 1991. Paper. [REVIEW]S. C. Colvin - 1993 - The Classical Review 43 (02):318-320.
Those Who Have the Gold Make the Evidence: How the Pharmaceutical Industry Biases the Outcomes of Clinical Trials of Medications. [REVIEW]Joel Lexchin - 2012 - Science and Engineering Ethics 18 (2):247-261.
Science, Politics, and Morality: Scientific Uncertainty and Decision Making.René von Schomberg (ed.) - 1993 - Kluwer Academic Publishers.
Added to index2011-12-25
Total downloads9 ( #454,901 of 2,152,503 )
Recent downloads (6 months)1 ( #399,611 of 2,152,503 )
How can I increase my downloads?