NICE and society: Health technology appraisal and the cultivation of social relations

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.