You make, though, two specific criticisms of us: that we have failed to “demand” higher total spending on drugs; and that we should “open up” our consultation processes to the public. Neither is fair.

Our advice to the NHS, on the use of new and existing medicines, has increased the drugs bill by £1.2 billion per annum. Although some consider this excessive, we remain unapologetic: by our own objective standards we consider this money to be well spent.

From the beginning, NICE has had a policy of ensuring that all our draft guidance is available for comment by anyone with an interest in the outcome, including the general public. Our independent advisory committees take all comments fully into account and often change their views. On broader social issues we also have a citizens council so as to engage with the wider public.

We have not previously, though, allowed the public to attend advisory committee meetings. We accept that opening up meetings of our advisory committees to the public would make it easier to understand how they go about reaching their conclusions. For although we publish an account of the reasoning behind their decisions, we appreciate that the underlying nuances are often impossible to capture in this way.

We are therefore actively considering putting arrangements in place for the public to have access to the meetings of all our advisory committees.

PROFESSOR SIR MICHAEL RAWLINS, Chairman, National Institute for Health and Clinical Excellence

Sir, Upholding NICE’s decision to restrict the only medication available to those in the moderate stages of this terminal disease seems short-sighted and far from cost-effective. Giving people early medication halts deterioration and keeps them functioning at a far higher level for much longer before the inevitable decline. This allows people to manage their lives without having to rely so much on other people’s care.

It is callous to force people to wait until they have lost many abilities before giving them medication that cannot retrieve so much of what has been lost. The Government relies so heavily on the thousands of carers in this country who want their loved ones to be looked after with kindness and dignity.

HAZEL LEVENTHAL, Borehamwood, Herts

Sir, My wife had Alzheimer’s diagnosed at the age of 59. It was only because we had a GP who was aware of the benefits of Aricept that my wife and I were given three and a half years together before she went into a care home.

The drugs that NICE has decided are not cost-effective have given me and my wife, and our children, time that we would not otherwise have had.

BRIAN HARRIS, Horsham, W Sussex