Efficiency, equity, and NICE clinical guidelines

The stated purpose of clinical guidelines from the United Kingdom's National Institute for Clinical Excellence (NICE) is to "help healthcare professionals and patients make the right decisions about healthcare in specific clinical circumstances." However, what constitutes "the right decisions" depends on your point of view. For individual patients the right decision is that which maximises their wellbeing, and this is properly the concern of the clinician. Yet in resource constrained healthcare systems this will not always coincide with the right decisions for patients in general or society as a whole, thereby leading to some understandable tensions. NICE is a national policy making body whose responsibility is clearly broader than the individual patient. This wider viewpoint is reflected in NICE's technology appraisals by the central role afforded to cost effectiveness. We argue that the methods currently used by the NICE clinical guideline programme confuse these two viewpoints

Directly detecting sub-GeV dark matter with electrons from nuclear scattering

Dark matter (DM) particles with mass in the sub-GeV range are an attractive alternative to heavier weakly-interacting massive particles, but direct detection of such light particles is challenging. If however DM-nucleus scattering leads to ionisation of the recoiling atom, the resulting electron may be detected even if the nuclear recoil is unobservable. We demonstrate that including this effect significantly enhances direct detection sensitivity to sub-GeV DM. Existing experiments set world-leading limits, and future experiments may probe the cross sections relevant for thermal freeze-out.Comment: 8 pages revtex4, 5 figures; v2: analysis updated to include constraints from XENON1T; accepted for publication in PR

A weighty interpretation of the Galactic Centre excess

Previous attempts at explaining the gamma-ray excess near the Galactic Centre have focussed on dark matter annihilation directly into Standard Model particles. This results in a preferred dark matter mass of 30-40 GeV (if the annihilation is into b quarks) or 10 GeV (if it is into leptons). Here we show that the gamma-ray excess is also consistent with heavier dark matter particles; in models of secluded dark matter, dark matter with mass up to 76 GeV provides a good fit to the data. This occurs if the dark matter first annihilates to an on-shell particle that subsequently decays to Standard Model particles through a portal interaction. This is a generic process that works in models with annihilation, semi-annihilation or both. We explicitly demonstrate this in a model of hidden vector dark matter with an SU(2) gauge group in the hidden sector.Comment: 5 pages, 4 figures. v2: Matches PRD version. Note: title of PRD version is "Interpretation of the Galactic Center excess of gamma rays with heavier dark matter particles

Disk Evolution in Young Binaries: from Observations to Theory

The formation of a binary system surrounded by disks is the most common outcome of stellar formation. Hence studying and understanding the formation and the evolution of binary systems and associated disks is a cornerstone of star formation science. Moreover, since the components within binary systems are coeval and the sizes of their disks are fixed by the tidal truncation of their companion, binary systems provide an ideal "laboratory" in which to study disk evolution under well defined boundary conditions. In this paper, we review observations of several inner disk diagnostics in multiple systems, including hydrogen emission lines (indicative of ongoing accretion), $K-L$ and $K-N$ color excesses (evidence of warm inner disks), and polarization (indicative of the relative orientations of the disks around each component). We examine to what degree these properties are correlated within binary systems and how this degree of correlation depends on parameters such as separation and binary mass ratio. These findings will be interpreted both in terms of models that treat each disk as an isolated reservoir and those in which the disks are subject to re-supply from some form of circumbinary reservoir, the observational evidence for which we will also critically review. The planet forming potential of multiple star systems is discussed in terms of the relative lifetimes of disks around single stars, binary primaries and binary secondaries. Finally, we summarize several potentially revealing observational problems and future projects that could provide further insight into disk evolution in the coming decadeComment: 16 pages, 7 figures, chapter in Protostars and Planets

Drugs for exceptionally rare diseases: a commentary on Hughes et al

Recently in this journal, Hughes and colleagues discussed special funding status to ultra-orphan drugs. They concluded that there should be a uniform policy for the provision of orphan drugs across Europe; that complete restriction was impractical, and that UK policy should aspire to the values of the EU directive on orphan drugs. We critically assess these arguments, demonstrating that they failed to justify special status for treatments for rare diseases