For such a haven of faceless bureaucrats, NICE has suddenly become the hate figure of the UK.  NICE - or the National Institute for Health and Clinical Excellence - is the gatekeeper of the National Health Service, and it is the ultimate arbiter of the drugs that are prescribed by doctors.

Sometimes drugs are turned down on grounds of cost, sometimes because they just don't work.  For the drug company, a rejection is nothing less than a commercial disaster, especially if the drug concerned is a pioneering one that would have cost at least £150m to get approved.

The patient, too, may see the drug as the great hope.  It happened with the *** cancer drug Herceptin, and it's happening again with the Alzheimer's drug Aricept.  If the drug is the 'answer', then NICE's rejection is nothing less than a callous disregard of human life.

Alzheimer's sufferers and their carers are planning a major protest against NICE's decision with nationwide marches and demonstrations.  The same thing happened with Herceptin, and the government finally wilted to public demand.

In the case of Aricept, the protestors are being joined by the manufacturer, Pfizer, which is calling for a judicial review of NICE's rejection.  If it goes ahead, it will be the first time that NICE has been challenged in court, and itvmay well not be the last.

But how does the patient know that the drug is the solution to his or her ills?  In the case of Aricept, there are a few anecdotal reports that the drug has helped, but a major review that was published in 2004 concluded that it wasn't providing any benefits, even to the early-stage patient.

A similar story can be told about Herceptin.  Many of the protests were encouraged by the drug manufacturer which eventually got its way.

Will the same happen with Aricept? You betcha it will.

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