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Opaque transparency

Officials at the National Institute for Health and Clinical Excellence, the guardians of government healthcare cost effectiveness in England and Wales, have found themselves under increasing pressure from stakeholder groups beyond the pharmaceutical industry. Hardly a month seems to go by without the British media focusing on the victims of a decision by NICE to restrict National Health Service coverage as it seeks to determine the wisest use of limited NHS resources.

Last week, three companies and coalitions of healthcare professionals and patient/care giver advocacy groups gave evidence at a hearing called to consider appeals against draft recommendations that would restrict the use of registered Alzheimer's disease drugs. While the various stakeholders had a number of grievances, it was clear that a lack of transparency was at the heart of key issues.

Not surprisingly, industry appellants were Eisai Co. Ltd. (Tokyo:4523; Osaka:4523, Tokyo, Japan), the manufacturer of Aricept donepezil; H. Lundbeck A/S (CSE:LUN; Copenhagen, Denmark), the developer of Ebixa memantine; and Shire Pharmaceuticals Group plc (LSE:SHP; SHPGY, Basingstoke, U.K.), the manufacturer of Razadyne galantamine, formerly known as Reminyl.

Also against the draft recommendations were joint appeals from the Royal College of Physicians (RCP) and the British Geriatrics Society (BGS), and from the Alzheimer's Society, Age Concern, Counsel and Care, the Dementia Care Trust, and the Royal College of Nursing.

Current NICE guidance on the use of three acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine - issued

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