In the mid-1990s, expensive new treatments for conditions like multiple sclerosis sparked a “postcode lottery” as some health authorities refused to pay the cost, while others allowed the drugs to be prescribed. . In response to the broader alarm about changing standards in the National Health ServiceIn 1998, the newly elected Labor government announced a body that would provide doctors with the evidence they needed to deliver effective care and control costs. The first president and chief architect of what was then called the National Institute for Clinical Excellence (Nice) was Michael Rawlins, who died at the age of 81.
Rawlins was a dedicated clinical pharmacologist and general practitioner, who had honed his skills to chair the Committee on Drug Safety while maintaining his time on the wards. He kept the perspectives of physicians and patients in mind throughout, and his concern to ensure all stakeholders had a voice in the new body was key to his success. He defended the five principles on which Nice operates: that its orientation must be strong, inclusive, transparent, independent and questionable.
The prospects for Nice were not, at first sight, very promising. When asked if he thought he would work, the health secretary frank dobson replied: “No. But we’ll have a damn good shot. The main obstacles were the doctors accustomed to prescribing as they saw fit; the pharmaceutical industry, which feared an assault on its profits; and the general public, who opposed any form of “rationing” of care. But within a year or two everyone was more or less on the side.
“Mike had an uncanny ability to bring people together so they felt he was a friend to everyone,” said Dame Parveen Kumar, a founding non-executive director of Nice and former president of the British Medical Association and the Royal Society of Medicine. Gillian Leng, Rawlins’s colleague at Nice since 2001 (and later CEO), recalled that his arguments were “so incredibly strong and compelling that people listened”.
While he was generous in allowing everyone to have a say, he was also able to drive decisions. The board’s first task, in 1999, was to appoint an executive director. Rawlins told Kumar and the other members that even though the organization would launch in a matter of hours, he still had no officers, but he did have someone waiting outside who he thought would do the trick, and he gave them 10 minutes to come to an agreement. Fortunately, they recognized the merits of Andrew Dillon, then chief executive of the St George’s NHS healthcare trust, who went on to run Nice for more than 20 years.
Nice’s role was to carry out technical evaluations of new drugs and devices, assess their cost-effectiveness, and write guidelines for physicians (in partnership with specialized medical schools) on best practice. According to Leng: “Today, young doctors see the Nice guidelines as what they should be doing for patients.”
In his first year, Dobson asked Nice to carry out a rapid evaluation of the recently licensed flu drug Relenza, made by the British company Glaxo Wellcome (now GSK). The team concluded that it reduced the duration of symptoms from six days to five, but had no effect on severe illness in older patients and was too expensive to recommend to the NHS during the upcoming flu season. Despite the company’s furious reaction, Nice stood its ground and then-Prime Minister Tony Blair personally backed the decision.
Rawlins remained president of Nice until 2013. He insisted that meetings be held in public and that alternate meetings be held at locations across the country to ensure the organization was genuinely open and inclusive. Unusually for a Blair administration initiative, Nice was enshrined in the statement by Conservative minister Andrew Lansley. Health and the 2012 Social Care Law, and has grown from a few dozen employees to almost 700. In 2005, its mandate was expanded to include public health, and from 2012 also social care for adults and children. Renamed the National Institute for Health and Care Excellence, the body is a key part of the NHS regulatory landscape and has been admired and imitated by many other countries.
Rawlins’s ability as chairman stemmed from his tough but warm personal style and his commitment to mastering the mountains of information the board had to absorb. He had a keen interest in the quality of the evidence, a topic he addressed in his 2008 Harveian Oration for the Royal College of Physicians. “Experiment, observation, and mathematics, individually and collectively, have a crucial role to play in providing the evidence base for modern therapeutics,” he said. “Arguments about the relative importance of each are an unnecessary distraction…interpretation of evidence requires judgment.”
Rawlins was born in Shrewsbury, Shropshire, the first of two children born to the Reverend Jack Rawlins, vicar of Holy Trinity, Northwood, in Stoke-on-Trent, and his wife, Evelyn (née Douglas-Hamilton), a nurse. When Michael was five, his father died, and 10 years later his mother married Hedley Boardman, a GP in Melbourne, Derbyshire, who was very supportive of his stepson’s career. Michael attended Uppingham School in Rutland and enjoyed biology, applying to study medicine at St Thomas’s Hospital in London, where his mother had trained.
As a student, he spent much of his time conducting an orchestra and staging operas; he also played the piano, violin and viola. He trained in clinical pharmacology and general medicine at Hammersmith Hospital, while embarking on a parallel career in research. In 1973 he was appointed Consultant Clinical Pharmacologist at the Newcastle upon Tyne NHS Trust and Ruth and Lionel Jacobson Professor of Clinical Pharmacology at Newcastle University. He stayed for 33 years, setting up a unit to treat drug overdoses and conducting research.
While in Newcastle, he learned of the work of geneticist Nancy Wexler, whose team collected samples from affected communities in Venezuela that ultimately revealed the genetic defect behind the disabling neurological condition of Huntington’s disease (HD). She later went on to collaborate with Wexler, acting as an advocate for Huntington’s patients who face discrimination and stigma. In 2010, he published evidence that HD was almost twice as common in the UK as previously assumed. With Wexler, she attended an audience with Pope Francis in May 2017, during which the pontiff embraced HD sufferers.
He joined a subcommittee of the Committee on the Safety of Drugs in the late 1970s and was appointed to the main committee in 1980, chairing it from 1993 to 1998. He devoted much of his energy to the work of the adverse reactions group of the CSM, known as Argos.
Leaving the CSM to take up his post in Nice, he also joined the Advisory Council on Drug Abuse as Chairman, remaining until 2008. After retiring from Nice, he became President of the Royal Society of Medicine, later returning to the regulatory field as Chairman of the Medicines and Healthcare Products Regulatory Agency (MHRA), from 2014 to 2020. He also chaired the UK Biobank health data resource from 2012 to 2019.
Among many honorary degrees and other honours, he was knighted in 1999 and promoted to GBE in 2017.
Unnervingly, for someone with such a passion for public health, Rawlins was a lifelong smoker. The night before an ambulance arrived to take him to the hospital for the last time, he was sitting up in bed talking to his daughter with a glass of whiskey in one hand and a cigar in the other. In the words of Roger Kirby, current president of MSN, he was “a medical hero, an amazing academic and a fantastic character.”