The most common reasons for downgrading of ratings were imprecision and risk of bias. The committee noted that imprecision was related to a lack of power in the included studies, which had relatively small sample sizes. The risk of bias was usually related to a lack of blinding or lack of allocation concealment . Given the nature of the interventions, surgery versus waiting list control, lack of blinding was inevitable. Therefore, the committee agreed that despite the risk of bias ratings, the studies were well conducted, and the overall quality was good.
“An unamendable constitution, said Mulford, is the “worst tyranny of time, or rather the very tyranny of time”.” With this background let us proceed to consider the provisions of Art. 368, vis-a-vis Art. 13 of the Constitution. In the Ninth Schedule to the Constitution the Mysore Land Reforms Act, 1961, is included as item 51 and the Punjab Security of Land Tenures Act, is included as item 54. The definition of “estate” was amended and the Ninth Schedule was amended by including therein the said two Acts by the Constitution Act, 1964. It will be convenient to read the material provisions of the Constitution at this stage.
The power to amend being a constituent power cannot in our opinion for these reasons be held subject to any implied limitations thereon on the ground that certain basic features of the Constitution cannot be amended. We fail to see why if there was any intention to make any part of the Constitution unamendable, the Constituent Assembly failed to indicate it expressly in Art. 368. If, for example, the Constitution-makers intended certain provisions in the Constitution, and Part III in particular, to be not amendable, we can see no reason why it was not so stated in Art. 368. On the clear words of Art. 368 which provides for amendment of the Constitution which means any provision thereof, we cannot infer any implied limitations on the power of amendment of any provision of the Constitution, be it basic or otherwise.
Unfortunately, there was insufficient data to model the cost-effectiveness of resective epilepsy surgery in children. The lifetime cost of surgery was higher than for MM (£56,204 and £31,627 respectively) but the QALYs gained were also greater in the surgery arm (15.91 QALYs compared to 13.76 QALYs). Compared with medical management, surgery cost an extra £11,425 per QALY gained, which is below NICE’s £20,000 threshold. Neither of these economic evaluations captured the RCT evidence identified in the clinical review. In addition, the committee noted that some of the data inputs used in these studies might not reflect the majority of epilepsy surgery patients. The target population in these studies would typically be people where the epileptic zone is more difficult to localise as the preoperative assessment tests being evaluated would normally be conducted at the latter stages of the assessment for resective epilepsy surgery pathway.
And that’s not to consider how many other competition authorities around the world may now seek to reshape their own jurisdiction laws in a similar fashion, particularly those who hold the European Commission up as a beacon of light in the world of merger enforcement. So, whilst Illumina may have lost its appeals in front of the French and Dutch national courts, will we now see an expedited appeal to the General Court of the European Court of Luxembourg on the application of the Article 22 EUMR test? Once notified of the request by the European Commission, other Member States have 15 working days to join the referral request. Another 10 working days delay is thereafter injected into the process to allow the European Commission to decide on whether it will accept the referral.
Questions of policy cannot be debated in this Court. The possibility of abuse of a power is not the test of its existence. In Webb v. Outrim ( A.C. 81), Lord Hobhouse said, “If they find that on the due construction of the Act a legislative power falls within s. 92, it los lotharios meaning would be quite wrong of them to deny its existence because by some possibility it may of be abused, or limit the range which otherwise would be open to the Dominion Parliament”. The essence of a written Constitution is that it cannot be changed by an ordinary law.
It is only for amendments or specific matters – and they are only few, that the ratification of the State Legislatures is required. All other Articles of the Constitution are left to be amended by parliament. The only limitation is that it shall be done by a majority of not less than two-thirds of the members of each House present and voting and a majority of the total membership of each House.