NICE and Society: Health Technology Appraisal and the Cultivation of Social Relations

Abstract

This article presents a sociological inquiry into the politics of the UK National Institute for Health and Care Excellence’s (NICE) approach to health technology appraisals. It is based on analyses of documents published by NICE and of a 2005–2008 interdisciplinary debate about the ethics of its activities. Simultaneously, the article brings further perspectives to this debate by clarifying that NICE, through the comparisons central to its approach, arranges a competition in producing health between different treatments applied to their respective particular patient groups. In fostering competition for differentiation, NICE’s approach resembles objectives for shaping social relationships often attributed to neoliberal politics. Yet closer scrutiny reveals that NICE’s creation of positions for, and relations between, patients is simultaneously more problematic. A comparison between NICE’s work and long-standing sociological conceptions of the social relationship offers insight into the quality of the social relations NICE’s approach supports in more general terms.

Green space for public mental health: an ethnographic study of ecotherapy in Wales

“…A definition from a source like this would typically include indications for what groups or diagnosis the intervention was expected to have efficacy for, who would be qualified to deliver such a thing, and what kind of effects would be expected as an outcome, as well as economic appraisals aimed at those commissioning health services. 32 ecotherapy does not currently enjoy this status of endorsement from such bodies in the UK, this is something which makes defining and subsequent setting of parameters for empirical research difficult, but it can also be argued there is a rich and exciting sense of possibility in this messy and open field on the margins of the mainstream. This makes it available for those who would rather reside and find their healing outside of mainstream services -a possibility that may be foreclosed if it is taken into the core of the mainstream and guarded by a range of striated policies, practices and procedures.…”

“…A definition from a source like this would typically include indications for what groups or diagnosis the intervention was expected to have efficacy for, who would be qualified to deliver such a thing, and what kind of effects would be expected as an outcome, as well as economic appraisals aimed at those commissioning health services. 32 …”

Editorial: The Social Life of Healthcare Decisions: Contexts and Consequences

“…For instance, sociologists have examined the changing notions of evidence and related forms of expertise that underpin decisions about healthcare (Timmermans and Kolker, 2004 ), highlighting key shortfalls of evidence-based medicine (Hanemaayer, 2020 ). Sociology has also examined how approaches to recommending which interventions be provided through publicly funded health systems may reshape social positions and relations (Benzer, 2020 ), while economics has grappled with the possibility that policies which increase average health may simultaneously intensify health inequalities in a population (Anand, 2002 ). The coronavirus pandemic has brought some of these issues into sharper focus and created the conditions for new controversies, for example controversies about decisions regarding which patients should receive life-prolonging care when demand exceeds resources (Campbell et al, 2020 ; Sayburn, 2020 ) or about what counts as informed consent (Corrigan, 2003 ) in respect of new types of vaccinations under emergency use authorization.…”