How NICE may be outflanked

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Abstract
Individual benefit or common good? When many people share common resources, it is rational for each individual to increase personal use of the resources. But if all individuals do this, the resources are overexploited and eventually everyone will be ruined. This is termed the tragedy of commons.3 The NHS is a common resource. A patient acts rationally in seeking an expensive treatment that produces a benefit (even if small), because the cost falls almost entirely on others. But the NHS cannot support overexploitation indefinitely. It already spends £10.3bn (€15bn; $19bn) a year on drugs, and costs are rising rapidly.w1 One way to avoid overexploitation is to appoint a guardian to administer the commons. NICE plays this role but faces many challenges.