Abstract

Objective

To describe the use of NICE, the acronym for the UK National Institute for Health and Clinical Excellence, as both an adjective and noun in peer-reviewed journal article titles.

Design

Systematic review of titles retrieved by electronic database searches.

Data sources

Ovid databases (MEDLINE, All EBM Reviews, EMBASE, ERIC, CINAHL and PsycINFO) covering the formation of NICE in 1999 to February 2008.

Review methods

Independent review of eligible titles by both authors and resolution of disagreements based on consideration of full text articles.

Results

2274 articles were retrieved that included reference to NICE in their titles. Of these, 167 (7.3%) used NICE as an adjective, most commonly in conjunction with the terms ‘work’, ‘not so’ (NICE), ‘nasty’, ‘mess’ and ‘try’.

Conclusions

The work of NICE has been widely referenced in peer-reviewed journal article titles, sometimes with apparent humorous intent when used as an adjective. Well-chosen names may increase the recognizability of public health organizations and help to communicate their roles.

Introduction

Investigators in public health research use a number of rhetorical devices to draw attention to their work, particularly in the titles of their papers, which include literary allusions,1 humour and acronyms.2 Acronym-named randomized controlled trials are cited twice as frequently as their non-acronymous equivalents,2 suggesting that this device is useful in promoting research. Notable examples include CASANOVA,3 FANTASTIC4 and PASTA.5

The National Institute for Clinical Excellence, known commonly by its acronym, NICE, was established in 1999 with the aims of improving standards of patient care and reducing inequities in access to innovative treatments.6 We hypothesized that by creating an acronym that was also a commonly used adjective, NICE, perhaps inadvertently, had encouraged authors of journal articles to use titles in which the organization is referred to as both a proper noun and an adjective.

Our aims were therefore to quantify references to NICE in peer-reviewed journal article titles using systematic review methodology and to determine its use as a noun and as a noun and an adjective in combination.

Methods

Search strategy

We carried out a search using the keyword term ‘NICE’ using the following OVID databases:All titles were independently reviewed by both authors and the results categorized into noun, adjective, or not relevant. This latter included references to ‘Nice’ (France) or ‘nice’ used in its normal adjectival sense such as Are nice dentists purely fictional?7 Disagreements in title choices were resolved by discussion and a final list of eligible results was obtained.

Ovid MEDLINE (1996 to January 2008)
All EBM Reviews—Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA and NHSEED (from 1996 to February week 1 2008)
EMBASE (1996 to 2008 week 06)
ERIC (1965 to January 2008)
CINAHL (1982 to December week 1 2007)
PsycINFO (2000 to February week 1 2008)

Results

A total of 2274 titles were retrieved containing the term NICE. Of these titles, 167 (7.3%) used the capitalized word NICE as both an adjective and proper noun (see Table 1), and the remaining 2107 (92.7%) were deemed to be using NICE solely as a noun. The most frequent adjectival use of NICE was in relation to work. Eighteen titles (10.8%) included the term ‘work’ of which 15 used it in the term ‘NICE work’. Ten provided ‘not so NICE’ descriptions, and, by contrast, nine used the word ‘nasty’ in the title. Eight described a ‘NICE mess’ of which one was ‘Another NICE mess’.8 A further three combined it to give ‘NICE try’. Two ‘NICE behaviours’ appeared in the same edition of the BMJ.9,10 Other nouns described as NICE included a winter conference11 and hips.12 Several phrases were used, including ‘NICE one, Frank!’,13 ‘NICE guys finish first’,14 and ‘NICE to see you … ’15 No titles were identified that used NICE as part of an adverb (e.g. NICEly) or noun (e.g. NICEness, NICEty). Chronic myeloid leukaemia (CML) appeared with an adjectival NICE in four titles.

Table 1

Adjectival uses of NICE in journal titles (N = 167) 1999–2008

Theme Number of citations Example titles 
Work 18 Making NICE work of rationing: it's the productivity, stupid!20 
  NICE work—providing guidance to the British National Health Service21 
‘Not so … ’ 10 Not so NICE for CML22 
Nasty RCN gets nasty over NICE decision23 
Mess Imatinib for chronic myeloid leukaemia: a NICE mess24 
Try NICE try but a long way to go in heart failure25 
Others 119 Sugar and spice and all things NICE26 
  How to limit caesareans on demand—too NICE to push?27 
  A NICE missed opportunity?28 
Theme Number of citations Example titles 
Work 18 Making NICE work of rationing: it's the productivity, stupid!20 
  NICE work—providing guidance to the British National Health Service21 
‘Not so … ’ 10 Not so NICE for CML22 
Nasty RCN gets nasty over NICE decision23 
Mess Imatinib for chronic myeloid leukaemia: a NICE mess24 
Try NICE try but a long way to go in heart failure25 
Others 119 Sugar and spice and all things NICE26 
  How to limit caesareans on demand—too NICE to push?27 
  A NICE missed opportunity?28 

Discussion

NICE and its sometimes controversial guidance16 have been discussed widely in peer-reviewed medical journals since its inception in 1999. Its name has also been used as an adjective in 7% of references to the organization, indicating that authors have taken the opportunity to engage readers with phrases that are sometimes putatively humorous.

Origins of titles

The high prevalence of references to ‘NICE work’ indicates the pervasiveness of George and Ira Gershwin's song Nice Work if You Can Get It (published in 1937). The use of antonymy, by contrasting NICE with nasty, is a common rhetorical device. Oliver Hardy's famous exhortation to his partner, Stan Laurel, ‘Here's another nice mess you've gotten me into’, provided the inspiration for 5% of adjectival NICE titles. The reference to then Health Secretary Frank Dobson in ‘NICE one, Frank!’ may allude to the 1973 tribute song to Spurs footballer Cyril Knowles, Nice One, Cyril (Nice one, son … .). The origins of the phrase ‘NICE guys finish first’ are unclear, although the phrase was used as a chapter title in The Selfish Gene in 1976.17 The entertainer Bruce Forsyth's greeting, ‘Nice to see you, to see you nice’ is likely to have inspired Bosanquet's article.15

Etymology of nice

While memorable, the word nice has equivocal meanings.18 Its Latin root, nescius (from nescire not to know) meant ignorant, and in Middle English described foolish or wanton actions. It is variously referred to in contemporary dictionaries as showing fastidious tastes, having exacting requirements or standards, or possessing great precision and delicacy.19 Perhaps only these most recent definitions might find favour with NICE.

Implications for practice

Acronyms are used extensively in medicine and other biological sciences both for efficiency and sometimes as professional jargon to obscure references to serious and feared conditions. In taking on the role as judge of whether new and often expensive health technologies should be provided by the National Health Service, NICE was inevitably going to make unpopular and controversial decisions that might negatively affect the lives of some patients. It may, therefore, have been prescient of the founders of NICE to have chosen a name that implied that their work was beneficent. Whether the wider potential uses of the acronym—including antonyms—were considered is not clear.

Public health professionals have an important role in communicating effectively. Many public health organizations' responsibilities are not clear from their titles and their documents have won the Plain English Campaign's ignominious Golden Bull awards (http://www.plainenglish.co.uk/goldenbulls.htm). The choice of a clear and memorable title should help others understand an organization's purpose and in subtler ways may have the potential to imply its values.

Conclusions

The work of NICE has been widely cited in peer-reviewed journals and it may have benefited from its potential to be used adjectivally in article titles. Well-chosen names for public health organizations may improve their recognizability and contribute to the important public health role of effective communication.

Contributions

We declare that we participated in the design, analysis and drafting of this work and that we have seen and approved the final version.

Funding

The Medical Research Council (MRC) Social and Public Health Sciences Unit receives funding from the UK MRC and the Chief Scientist Office at the Scottish Government Health Directorates. David Batty is a Wellcome Trust Fellow (WBS U.1300.00.006.00012.01).

References

1
Goodman
NW
From Shakespeare to Star Trek and beyond: a Medline search for literary and other allusions in biomedical titles
Br Med J
 , 
2005
, vol. 
331
 (pg. 
1540
-
42
)
2
Stanbrook
MB
Austin
PAC
Redelmeier
DA
Acronym-named randomised trials in medicine – the ART in medicine study
N Engl J Med
 , 
2006
, vol. 
355
 
1
(pg. 
101
-
2
)
3
The CASANOVA Study Group
Carotid surgery versus medical therapy in asymptomatic carotid stenosis
Stroke
 , 
1991
, vol. 
22
 
10
(pg. 
1229
-
35
)
4
Bertrand
ME
Legrand
V
Boland
J
, et al.  . 
Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting: the full anticoagulation versus aspirin and ticlodipine (FANTASTIC) study
Circulation
 , 
1998
, vol. 
98
 (pg. 
1597
-
603
)
5
Saito
S
Hosokawa
G
Tanaka
S
, et al.  . 
Primary stent implantation is superior to balloon angioplasty in acute myocardial infarction: final results of the primary angioplasty versus stent implantation in acute myocardial infarction (PASTA) trial. Primary angioplasty versus stent implantation in acute myocardial infarction
Catheter Cardiovasc Interv
 , 
1999
, vol. 
48
 (pg. 
262
-
8
)
6
NHS National Institute for Health and Clinical Excellence
A Guide to NICE
 , 
2005
London
National Institute for Health and Clinical Excellence
7
Martinez
H
Are nice dentists purely fictional?
Br Dent J
 , 
1997
, vol. 
183
 
2
(pg. 
72
-
5
)
8
Anonymous. Another NICE mess
Lancet Oncol
 , 
2002
, vol. 
3
 
7
pg. 
385
 
9
Bamji
AN
NICE behaviour: QALYs in the community
Br Med J
 , 
2007
, vol. 
335
 
7619
(pg. 
527
-
8
)
10
Shepherd
CB
NICE behaviour: ME guideline is unworkable
Br Med J
 , 
2007
, vol. 
335
 
7619
pg. 
528
 
11
Hurwitz
B
A NICE winter conference
J Roy Coll Phys London
 , 
2000
, vol. 
34
 
4
(pg. 
389
-
90
)
12
Toms
AD
Jiggins
M
Prosser
G
, et al.  . 
NICE hips: shame about the conclusions
HIP Int
 , 
2002
, vol. 
12
 
3
(pg. 
334
-
7
)
13
Wilson
J
NICE one, Frank!
Pharmaceut J
 , 
1999
, vol. 
262
 
7036
(pg. 
353
-
6
)
14
Kereiakes
DJ
Fry
E
Matthai
W
, et al.  . 
Combination enoxaparin and abciximab therapy during percutaneous coronary intervention: ‘NICE guys finish first
J Invas Cardiol
 , 
2000
, vol. 
12
 
Suppl. A
(pg. 
1A
-
5A
)
15
Bosanquet
N.
NICE
reports
NICE to see you … 
Health Serv J
 , 
2003
, vol. 
113
 
5860
(pg. 
30
-
1
)
16
Waxman
J
We need cancer drugs. NICE must go
The Times
  
8 August 2008
17
Dawkins
R
The Selfish Gene
 , 
2006
3rd edn
London
Oxford University Press
18
Aronson
J
When I used a word … nice?
Br Med J
 , 
2000
, vol. 
320
 pg. 
750
 
19
Merriam-Webster online dictionary entry for “nice”
 
http://www.merriam-webster.com/dictionary/nice (3 June 2008, date last accessed)
20
Maynard
A
Making NICE work of rationing: it's the productivity, stupid
Br J Healthc Manag
 , 
2006
, vol. 
12
 
2
pg. 
62
 
21
Rawlins
MD
NICE work – providing guidance to the British National Health Service
N Engl J Med
 , 
2004
, vol. 
351
 
14
(pg. 
1383
-
5
)
22
Goldman
J
Apperley
J
Clark
R
, et al.  . 
Not so NICE for CML
Lancet
 , 
2002
, vol. 
359
 
9322
pg. 
2036
 
23
Munro
R.
Drug
ruling
RCN gets nasty over NICE decision
Nurs Times
 , 
2000
, vol. 
96
 
35
pg. 
6
 
24
Barbour
V
Imatinib for chronic myeloid leukaemia: a NICE mess
Lancet
 , 
2001
, vol. 
358
 
9292
pg. 
1478
 
25
Owen
A
NICE try but a long way to go in heart failure
Br J Cardiol
 , 
2004
, vol. 
11
 
5
(pg. 
339
-
41
)
26
Anderson
T
Sugar and spice and all things NICE
Pract Midwife
 , 
2007
, vol. 
10
 
5
pg. 
6
 
27
Feinmann
J
How to limit caesareans on demand – too NICE to push?
Lancet
 , 
2002
, vol. 
359
 
9324
(pg. 
2128
-
9
)
28
Lader
M
A NICE missed opportunity?
J Psychopharmacol
 , 
2005
, vol. 
19
 
2
(pg. 
136
-
8
)