The problem is that the NICE committee not carefully reading papers and thinking through the methodology, the many flaws and protocol changes. If the NICE guidelines are re-examined it would be good if they were to demand the PACE trial data as defined in the original protocol rather than what was published in the Lancet and other journals. That of course won't happen.
At the least evidence of differences between subjective and more objective outcomes should lead readers to ask questions about the methodology of trials like PACE. But we are in a world where evidence based medicine relies on having a single 'pre chosen' measure rather than being based on a theory of evidence that allows multiple measures to be weighed against each other.
In the end I get the impression NICE is basically a collection of 'experts' who basically assert an opinion which is loosely supported by material they review. The question then becomes who is on the committee. I see no point in trying to get the guidelines reexamined unless the people looking change.
Again, it all boils down to what happens out there in the real world.
Not what should happen. Or what we would like to happen…...
NICE appoint a group of doctors who agree to work on the development of a guideline
They all have a thousand and one other roles and positions and have to fit this (in theory) quite demanding work in with all their other work. I know what it's like…...
They have homework, briefing papers, and some full day or half day face to face discussions at NICE
They don't have time to go through every single clinical trial and discuss the methodology, flaws and weaknesses
They leave this to some academics - who are paid to carry out a systematic review of the literature and produce a long report which they are then supposed to read and discuss
In the case of the 2007 NICE guideline, this work was handed to York University - hence the York Review