Are NICE guidelines losing their impartiality?

I applaud Taylor & Perera ¹ for their clear discussion of these very important issues. For me the most important sentence in their piece is the last one, that ‘CG178 appears to be open to a critique of bias’. This is not the first occasion that such issues have arisen and I think that it is time for the National Institute for Health and Care Excellence (NICE) to take a long hard look at the relative standards that are set for making recommendations about the use of non-pharmacological and pharmacological treatments. A previous example is seen in CG72 Attention Deficit Hyperactivity Disorder, ² where it would appear that a lower quality of trials was allowed and lower standards of evidence were required to support behavioural approaches than for pharmacological treatments. A similar criticism can be made about CG28 Depression in Children and Young People, ³ and there are no doubt others. Although the ultimate recommendations made in these guidelines may, on one level at least, be sensible, I believe that the evaluation and interpretation of the evidence, including the selection of trials and assessment of their quality as well as their outcomes, should be the same regardless of the mode of treatment. If NICE, who as Taylor & Perera point out occupy an extremely important position in our lives, then decide to interpret or weight evidence differently, this should be clear and transparent. NICE must be above all claims of bias and need to work hard to ensure that they regain this position.