Letter: Under the knife

Sir: It's good to see that our colleagues in surgical specialties are at last having to embrace the concept of "evidence-based medicine" and clinical guidelines, as we physicians have done over a number of years

Guidelines do not remove any element of clinical freedom because in every case one asks oneself, "Do the guidelines apply in this particular patient or are there unique circumstances which need consideration?" My only concern is that the National Institute for Clinical Excellence (Nice) might not be able to keep up with the growing body of evidence from research.

I am sceptical that the guidance from Nice will help keep the cost of healthcare down. If allowed real independence, it will almost certainly endorse treatments such as lipid-lowering drugs in post-myocardial infarction and post-stroke patients. These may seem expensive in the short term (ie a single parliament), but might make real long-term financial savings.

I do hope Nice gets nasty, but it will need the guts to tell the Government that good practice, properly applied, costs money now to achieve benefit in the future; and that we shouldn't be providing a second-class service simply because it's cheaper.