If you’re suffering from a rare, debilitating disease like MS, or cystic fibrosis, or some forms of cancer, and you need a boutique biologic to save your life, Dr. Steve Pearson has a message for you:

No.

Some drugs are just too expensive, which means some lives are not worth saving.

This is the fundamental premise behind Dr. Pearson’s Institute for Clinical and Economic Review, or ICER—a non-profit, medical review board he founded after working with the UK’s National Institute for Health and Care Excellence, or NICE.  Though there are thousands of British patients who’ve been denied health care deemed too expensive by NICE and many believe it’s anything but.

If you watched in horror over the summer when the parents of 23-month-old Alfie Evans were denied permission by the UK government to take their dying infant to another country for care, the premise of health care regulation and government control that made that story possible begins with NICE.

Billing itself as “an independent and non-partisan research organization that objectively evaluates the clinical and economic value of prescription drugs, medical tests, and other health care and health care delivery innovations,” Dr. Pearson and his ICER team merely make recommendations about drugs and drug prices. They issue a finding on what price they would deem “fair” for a new prescription drug heading to the market, and—using a “Quality of Life Years” evaluation similar to NICE—ICER rules on whether insurance companies should cover an available drug treatment.

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