The drugs rejected by the National Institute for health and Clinical Excellence as not cost effective receives much criticism, after all what price can be placed on a longer or better quality of life

It has largely been a troubled first decade for the new organisation, hitting the headlines mainly for the wrong reasons. Perhaps this is understandable due to the sector in which it operates but it has led to growing criticism which has peaked at times when the refusal of key drugs have hit the headlines.

The first teething problems of the organisation were found when deciding on the anti-influenza drug Zamavir. Rejected at first by NICE, the decision was fiercely criticised by some, most notably the manufacturers Glaxo Wellcome, whose chairman threatened to withdraw future research from Britain as a result. NICE later relented and recommended that the drug be available for elderly patients and other people at a greater risk of dying from influenza.

In June 2000 the organisation was back in the headlines, through its refusal to authorise another drug, this time beta interferon for multiple sclerosis sufferers. Once again patient groups complained and again NICE relented.

Two years later, another storm, related to a drug to treat age-related macular degeneration which leads to blindness. NICE initially decided that only those patients who had already lost the sight in one eye were eligible to receive the drug in question, verteporfin, but that was eventually replaced by the organisation issuing no specific advice, thereby leaving it as a grey area.

Many probably know NICE through the arguments over Herceptin, the breast cancer drug. The drug was initially licensed for use in Europe for patients with advanced breast cancer as far back as 1999.

In 2006 Ann Marie Rogers was angry when, following radiotherapy and chemotherapy, Swindon Primary Care Trust refused to pay for the cost of the drug. It was the beginning of her campaign to get Herceptin made available to all women diagnosed with early stage breast cancer. Eventually she won a landmark victory in the courts and the drug was fast-tracked for use on the NHS as a result.

More recent criticism came NICE's way in 2008 in a row over drugs for Alzheimer's patients. NICE had refused to approve the drugs Aricept, Exelon, Reminyl and Ebixa for sufferers in the early stages of the disease, leading to fury from the families of sufferers who were effectively being told they had to wait for their relatives' conditions to deteriorate before they would be given the drug. The fight eventually brought the parties before the Court of Appeal who criticised the original decision.

Also in 2008, NICE ruled that four new drugs, used in fighting kidney cancer, were too expensive. This time the organisation fought back with scathing words for the pharmaceutical industry. Sir Michael Rawlins, chairman of NICE said at the time that it was the industry's fault that the drugs were too expensive, claiming that they could be produced at a tenth of the cost.

NICE eventually backed down on one of the drugs, Sutent, approving it as a 'first line' treatment, but it was rejected as a 'second line' treatment where an initial therapy had failed. The ban remained in place for the other three drugs and the episode led to more questions being asked of how could an organisation; supposedly to be of benefit to patients, deny them a drug, that was a potentially crucial breakthrough in treatment.

Last year MacMillan Cancer Support criticised NICE for rejecting Nexavar, a drug that can extend the lives of people suffering from liver cancer. The cost of the drug, estimated at about £3,000 a month was seen as too high by NICE, despite it being routinely offered to cancer patients elsewhere in the world.

Just last year another storm brewed up over bowel cancer drug Avastin, which in trials was shown to have extended life by up to two years. Despite most of Europe having met the cost of treatment there was criticism of NICE because, despite the drug costing £18,000 for a 10-month course of treatment, the formula used by NICE, the quality adjusted life year, gave the annual cost as £36,000, over the maximum limit of £30,000 so the drug was not approved.