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Old 11th August 2005, 01:46 PM   #1
Asolepius
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More sCAM from Prince of Wales

Back in April I was interviewed by Freshminds, a market research agency in London. They are writing what they call The Smallwood Report, which aims to assess the cost-effectiveness of CAM. Christopher Smallwood is the lead consultant for this. He was formerly chief economic adviser for Barclays Bank. I have been told about the content of the present draft. As with the patient guide recently issued by HRH's Foundation, the matter of objective evidence is largely ignored in this report, and data are selectively reported. It is clearly intended to influence NHS policy in favour of sCAM. Originally the report was to be funded by HRH's lobby group the Foundation for Integrated Health, but I understand that HRH is funding it directly now. The report is allegedly unscientific, outrageously biassed, and misleading. Certainly the first draft of my interview, which I saw, had to be substantially amended. Freshminds has no experience whatever in health economics or indeed in any health area. This is of course a job for NICE, but the UK government continues to sideline that competent authority and prefers its sycophantic relationship with the Royal Family. The report is scheduled to be sprung on the public and ministers on 12th October. HRH and his gong-chasing cronies must not be allowed to get away with this unchallenged.
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Old 14th August 2005, 05:15 AM   #2
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Bump.
I think some UK readers missed this.
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Old 14th August 2005, 07:01 AM   #3
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Re: More sCAM from Prince of Wales

Quote:
Originally posted by Asolepius
Back in April I was interviewed by Freshminds, a market research agency in London. They are writing what they call The Smallwood Report, which aims to assess the cost-effectiveness of CAM.
A market research agency? Presumably they're assessing it on the basis of "customer satisfaction" or some similar criteria rather that whether it actually has any positive results. What sort of questions did they ask you?
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Old 14th August 2005, 08:51 AM   #4
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Re: Re: More sCAM from Prince of Wales

Quote:
Originally posted by Mojo
A market research agency? Presumably they're assessing it on the basis of "customer satisfaction" or some similar criteria rather that whether it actually has any positive results. What sort of questions did they ask you?
They asked me about methodology for clinical trials of sCAM, and tried to steer the discussion in the direction of using special non-rigorous methods - which I would not of course wear. They tried to push the idea of `effectiveness' as opposed to `efficacy' - a ridiculous notion which includes placebo effect within the overall response to CAM. They also asked whether sCAM research was properly funded. I said there has been a lot of research, but very little using high quality testing of efficacy (there are loads and loads of sociological surveys, on which government money is largely spent - eg `what proportion of GP patients asks for sCAM?' etc etc ad nauseam).

BTW sorry to display my ignorance but what does Soapy mean by `bump'?
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Old 14th August 2005, 09:56 AM   #5
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Quote:
BTW sorry to display my ignorance but what does Soapy mean by `bump'?
Asking questions like that is a show of intelligence ...to *bump* means to post like Soapy Sam did and thus *bump* the thread back up near the top of the web page so others can see it easily.

I wanted to post earlier, but was quite disgusted with it all. I'm in Canada and only can shake my head. I do appreciate your posting this here. It's a real eye opener.

What can anyone do?
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Old 14th August 2005, 11:55 AM   #6
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Old 14th August 2005, 02:41 PM   #7
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Quote:
Originally posted by Eos of the Eons

What can anyone do?
I suspect very little, all nations will have nutcases with money and influence who can push this agenda, it's just a pity that we have to put up with this particular woo just because of his mums "job".

Although given the attitude of the DOH and the opinions of our elected representatives as shown on this thread make me even more depressed.

On the positive side, HRH got a lot of flack in the media last time he tried to promote woo over medicine.
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Old 15th August 2005, 05:33 AM   #8
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Well as we're discussing the Prince of Wales and quakary I thought people might find this article in the Sunday Times interesting:

http://www.timesonline.co.uk/newspap...734484,00.html
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Old 15th August 2005, 05:36 AM   #9
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Quote:
Originally posted by Eos of the Eons
What can anyone do?
Kick up a fuss, that's what we can do (see my new sig!). Send this thread's URL to anyone who might feel strongly - I have received some pretty angry responses so far, from some influential people. This is prime time for embarrassing the government and HRH.
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Old 15th August 2005, 05:53 AM   #10
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Quote:
Originally posted by Mid
Well as we're discussing the Prince of Wales and quakary I thought people might find this article in the Sunday Times interesting:

http://www.timesonline.co.uk/newspap...734484,00.html
Quote:
The Prince of Wales’s Foundation for Integrated Health hopes to have signed up 150 GPs to the new and controversial scheme by October. Those who join will become “associates” of the foundation and are expected to offer a wide range of herbal and other alternative treatments to their patients.
Wow, 150 GPs! Whatever happened to "100,000 medical doctors?"

Mind you, they shouldn't have too much trouble getting "the Queen of England" to sign up as well, I suppose...
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Old 15th August 2005, 06:40 AM   #11
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Re: Re: Re: More sCAM from Prince of Wales

Quote:
Originally posted by Asolepius
They asked me about methodology for clinical trials of sCAM, and tried to steer the discussion in the direction of using special non-rigorous methods - which I would not of course wear. They tried to push the idea of `effectiveness' as opposed to `efficacy' - a ridiculous notion which includes placebo effect within the overall response to CAM. They also asked whether sCAM research was properly funded. I said there has been a lot of research, but very little using high quality testing of efficacy (there are loads and loads of sociological surveys, on which government money is largely spent - eg `what proportion of GP patients asks for sCAM?' etc etc ad nauseam).
http://www.internationalskeptics.com...threadid=60141

Having now received the paper that features in the linked thread, it is another part of the same picture: an appeal to judge the therapy by some measure of overall efectiveness on the basis that this is more "real" that properly done trials.

Interestingly, that paper was funded by a German insurance company. Letting the vipers judge the effectiveness of snakeoil! Maybe they like homeopathy because it is cheap and useless whereas conventional medicine can be expensive and useless for a number of chronic problems.
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Old 15th August 2005, 07:04 AM   #12
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Interestingly, that paper was funded by a German insurance company. Letting the vipers judge the effectiveness of snakeoil!
Maybe they like homeopathy because it is cheap and useless whereas conventional medicine can be expensive and useless for a number of chronic problems.- Badly Shaved Monkey


I have wondered for some time why insurance companies had not concluded this. It seems they have. If the public truly prefer having their hand held to "real" treatment (And if the "real " treatment is useless, then why should they not?) it seems reasonable for insurers to take this course.
In the sort of conditions referred to in the links, it may make no difference.
In type 1 diabetes, to use Rolfe's example, it will.

I can hear the malpractice lawyers sharpening their quills...
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Old 15th August 2005, 07:13 AM   #13
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Quote:
Originally posted by Soapy Sam
I have wondered for some time why insurance companies had not concluded this. It seems they have. If the public truly prefer having their hand held to "real" treatment (And if the "real " treatment is useless, then why should they not?) it seems reasonable for insurers to take this course.
In the sort of conditions referred to in the links, it may make no difference.
In type 1 diabetes, to use Rolfe's example, it will.
Well, to take a cynical (OK very cynical) viewpoint, if insurance companies fund homeopathic treatment of type 1 diabetes, not only is the treatment cheaper, but they're not going to have to pay out for very long either.

OK, they aren't really going to do this, but the interest of an insurance company is not necessarily going to be the same as that of its customers.
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Old 15th August 2005, 02:08 PM   #14
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Quote:
Originally posted by Asolepius
This is prime time for embarrassing the government and HRH.
How exactly does this embarrass the Govt?

Charlie is not part of the government, he is funding this research through his own foundation, he isn't giving Ministers advance copies, they get it at the same time as Joe public.

I doubt that Charlie’s report will actually have much of an impact, the amount of weight which is lent to external reports by govt bodies is minimal, unless the report supports polices which have already be signed up to by ministers.
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Old 15th August 2005, 02:11 PM   #15
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Quote:
Originally posted by Mojo
Wow, 150 GPs! Whatever happened to "100,000 medical doctors?"

Mind you, they shouldn't have too much trouble getting "the Queen of England" to sign up as well, I suppose...
Although Liz is apparently a big fan of sCAM, the chances of her supporting anything done by her some are roughly equivalent to the chances of homeopathy being proved effective.
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Old 15th August 2005, 04:05 PM   #16
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Quote:
Originally posted by brodski
How exactly does this embarrass the Govt?
Well, actually, the UK Gov't has been appearing to be rather sympathetic towards sCAM lately. Except when Tony's got a bit of a dicky ticker, of course. Then, for some reason, he prefers to rely on orthodox medicine.
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Old 15th August 2005, 05:58 PM   #17
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Quote:
Originally posted by Mojo
Well, actually, the UK Gov't has been appearing to be rather sympathetic towards sCAM lately.
Only when it doesn't cost them any money.
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Old 15th August 2005, 06:15 PM   #18
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Quote:
Originally posted by Mojo
Well, actually, the UK Gov't has been appearing to be rather sympathetic towards sCAM lately. Except when Tony's got a bit of a dicky ticker, of course. Then, for some reason, he prefers to rely on orthodox medicine.
What's wrong with Tony's ticker?

When I read your post the first time, I thought you wrote "Except when Tony's got a bit of a tricky dick, of course." Then I thought, "What, they don't have Viagra in the UK?"
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Old 15th August 2005, 07:43 PM   #19
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Quote:
Originally posted by Mojo
Well, actually, the UK Gov't has been appearing to be rather sympathetic towards sCAM lately. Except when Tony's got a bit of a dicky ticker, of course. Then, for some reason, he prefers to rely on orthodox medicine.
I agree with what you say, this Gov't has been pretty soft on sCAM, but I still don't see how the publication of a report funded by an inbread fool will embarras them.
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Old 16th August 2005, 12:33 AM   #20
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Quote:
Originally posted by brodski
I agree with what you say, this Gov't has been pretty soft on sCAM, but I still don't see how the publication of a report funded by an inbread fool will embarras them.
No, that's not what I meant. The report is what they want, but ministers continue to fund HRH's harebrained schemes while sidelining the official competent body NICE. We need to keep up the pressure on the govnt by showing how the material from HRH and his cronies is rubbish. For example, I would love the government chief scientist to come out in opposition, but people in that position are usually too busy chasing gongs. But maybe I do Sir David King a disservice.....
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Old 16th August 2005, 12:40 AM   #21
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Quote:
Originally posted by Mid
Well as we're discussing the Prince of Wales and quakary I thought people might find this article in the Sunday Times interesting:

http://www.timesonline.co.uk/newspap...734484,00.html
The Times server seems to have gone down - can you summarise what the article says?
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Old 16th August 2005, 02:12 AM   #22
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Quote:
Originally posted by Lisa Simpson
What's wrong with Tony's ticker?
He was having inconveniently frequent episodes of what I knew as paroxysmal tachycardia when the doctor told me I had it, but the name seems to have changed. It's a harmless disturbance of the heart rhythm due to some small abnormality in the bundle of His. However, it can be inconvenent when it occurs as you have to sit down and avoid any exertion while it's happening or you can become very breathless and maybe even faint. Stress and coffee seem to exacerbate it in some cases. It can often be controlled by beta-blockers but not always.

I was lucky, with me the episodes got less frequent and I hardly get it at all now. With Blair I gather it was happening quite often, maybe because of his stressful job, and they decided to do a surgical procedure to destroy the little bit of the bundle of His that was causing the problem. Very clever stuff, guiding tiny instruments up the aorta to the heart from an incision in the groin, and pinpointing just the area that had to be cauterised. Quite a nice example of eliminating symptoms by accurate diagnosis of the cause and then eliminating that.

The media sensationalised it quite a lot, playing on the obvious connection in the public's minds between a "heart problem" and ischaemic heart disease, but in fact there was no suggestion at all that he has heart disease of the sort usually associated with middle-aged politicians.

Same with Lizzie. They let her play around with Peter Fisher ("Homoeopath to the Queen", God help us) when there's nothing wrong with her, but if she gets anything real, you can bet your life Peter Fisher won't even get in the door.

Rolfe.
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Old 16th August 2005, 02:29 AM   #23
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Quote:
Originally posted by Asolepius
The Times server seems to have gone down - can you summarise what the article says?
Don't worry, Times site is up again. Good God, how can we stop this man? Michael Dixon is of course famous for nonsensical pronouncements about sCAM, no doubt designed to secure a knighthood. I didn't like the reporter's use of the term `medical traditionalists'. We are talking about rational scientists - much of the trouble with sCAM is its reliance on tradition and not science.
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Old 16th August 2005, 05:09 AM   #24
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Quote:
Originally posted by Asolepius
No, that's not what I meant. The report is what they want, but ministers continue to fund HRH's harebrained schemes while sidelining the official competent body NICE.
Maybe I'm being a bit thick here, but I havn't managed to find any connection between this report and DOH money. If there is a connection between this report and the Govt can you make it explicit please beceasue I realy seem to be missing somthing.

I think that it is worth bearing im mind the comment Geni made earlier, though HMG seem to be all in favour of sCAM on the NHS, funding for sCAM is not partuclarly forthcomming.
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Old 16th August 2005, 06:17 AM   #25
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Originally posted by brodski
Maybe I'm being a bit thick here, but I havn't managed to find any connection between this report and DOH money. If there is a connection between this report and the Govt can you make it explicit please beceasue I realy seem to be missing somthing.

I think that it is worth bearing im mind the comment Geni made earlier, though HMG seem to be all in favour of sCAM on the NHS, funding for sCAM is not partuclarly forthcomming.
No you are not being at all thick - I just haven't told the whole story. Nor did I intend to in this thread, but here goes with a quick summary.

The govt has been feeding funds to HRH's Foundation for years. Recently of course there was the famous patient guide, which despite the requirement issued by Dept of Health when it issued the funds, studiously avoided any discussion of evidence for efficacy. I know this, because I obtained the DoH docs under the Freedom of Information Act. Most posters here also know about the GBP900k shelled out to the Foundation by the govt for `regulation' of sCAM. Although this Smallwood Report is not directly funded by the govt, it will be welcomed with open arms by ministers. This is because a sort of hysteria has arisen over `patient choice' - this is now the engine for driving NHS decisions, not evidence. My guess is that someone reckons it's electoral good news. While all this is going on, NICE is waiting in the wings in anguish (I have this on good authority, but must protect my sources). NICE can only respond to requests for appraisals by ministers, and can't take its own initiatives. This is very convenient for the govt, which can simply ignore NICE and set up HRH and co as the source of all knowledge on sCAM.

I'm not sure how anyone can say that `funding for sCAM is not particularly forthcoming'. The NHS has no idea how much it spends on it. I have been researching this for about 18 months and have got nowhere. There are no decent surveys of spending, simply because it isn't recorded anywhere. The idea of measuring cost-effectiveness when we don't know the cost is nonsense. But Smallwood et al, with no professional track record whatever in health economics, claims to be able to do so. This govt cares so little about objective evidence that if the cat at number 10 says sCAM is cost-effective, they'll believe it. This is a pernicious and dishonest campaign that HRH is waging, for personal reasons. He is abusing an unearned position in public life, for which he is totally unqualified.

While I'm in full flow, HRH has another outlet for sCAM via The King's Fund, of which he is patron. This organisation dishes out money left right and centre, not for research but actually for treatment. One example is acupuncture for hepatitis C - there's a pot of money for patients wanting it. Never mind that there's no evidence for it.
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Old 16th August 2005, 09:22 AM   #26
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The idea of measuring cost-effectiveness when we don't know the cost is nonsense.
As, of course, is the idea of measuring cost-effectivenes without reference to whether treatments are effective.

So I guess they are just going to guess what HRH wants the answer to be and make up some numbers?
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Old 16th August 2005, 10:00 AM   #27
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Originally posted by Mojo
As, of course, is the idea of measuring cost-effectivenes without reference to whether treatments are effective.

So I guess they are just going to guess what HRH wants the answer to be and make up some numbers?
There is every indication from a colleague who has seen the draft report, that they are doing something like that. As a contributor, I have asked to see the draft but have been refused. WRT effectiveness, of course it's very easy to select supportive data from poor quality studies. But I don't think they are using meta-analyses and systematic reviews, which are at the top of the evidence heirarchy.
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Old 16th August 2005, 11:15 AM   #28
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Originally posted by Asolepius

I'm not sure how anyone can say that `funding for sCAM is not particularly forthcoming'.
I got this from speaking to my (now former) MP on this issue, he may of course have been lying or misinformed. In light of new information (or rather information on the lack of information) I withdraw my comment.

As for what to do, write to your MP (and any other MP you think may listen), ask them to write to the DOH on this (letters from MP’s to Ministers get Ministerial responses, Joe public writing to a Minster just gets an official reply), make sure that you follow up any response you get with more detailed questions/ comments, this usually prevents civil service correspondence units from just churning out standard lines. Ask your MP to table PQ's on this issue. Badger the members of the health select committee (names available here )

I'm perfectly willing to rattle off a few letters (in government circles letters are usually given more weight than e-mail fro some reason), and I am happy to post any responses I get here. I others wish to do the same I would recommend not using standard letters, as all you will get back in response are standard letters.


Ok, what major points should I include in my initial letters?
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Old 16th August 2005, 01:39 PM   #29
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Originally posted by brodski

As for what to do, write to your MP (and any other MP you think may listen), ask them to write to the DOH on this (letters from MP’s to Ministers get Ministerial responses, Joe public writing to a Minster just gets an official reply), make sure that you follow up any response you get with more detailed questions/ comments, this usually prevents civil service correspondence units from just churning out standard lines. Ask your MP to table PQ's on this issue. Badger the members of the health select committee (names available here )

I'm perfectly willing to rattle off a few letters (in government circles letters are usually given more weight than e-mail fro some reason), and I am happy to post any responses I get here. I others wish to do the same I would recommend not using standard letters, as all you will get back in response are standard letters.


Ok, what major points should I include in my initial letters?
Great to hear you are taking action! The problem with letters to MPs is that you still get standard ministerial replies. I have been frustrated by their refusal to answer direct questions. Par for the course is 2 pages of waffle which skates around the issues. I found that if I tried to pin them down my MP got exasperated. It really depends on whether your MP cares or not - mine, despite being shadow science minister, doesn't see critical thinking as important. Not surprising as he is very active in the church of England, dad was a bishop etc. Needless to say he has no scientific qualifications. But if every MP got such a letter every week, from different people, we could make a difference. My exchange with Lord Warner via my MP exposed that minister's duplicity on the matter of NICE appraisals, which handed the Tories a government scandal on a plate, but they just were not interested.

BTW does anyone on this forum have Ian Gibson as their MP? He is an honorary member of the Institute of Biology and recommended to me as a possible ally.

WRT questions to ask - well all the usual ones really. Does the government believe that NHS money should be spent only on medicines with proven efficacy and safety? Who does the government think is the competent body for assessing cost-effectiveness? You can ask until the cows come home but you will always get evasive answers. I have achieved more by using the new Freedom of Information Act. Just email the Dept of Health media office, be very specific on what you want, and they have to give it to you. But I'm not saying don't try your MP. As I say, if they all got such requests parliament as a whole would start to take some notice. It's the vanishingly small number of people who care enough to do anything which constrains us so badly.
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Old 16th August 2005, 03:34 PM   #30
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Quote:
Originally posted by Asolepius
Great to hear you are taking action! The problem with letters to MPs is that you still get standard ministerial replies. I have been frustrated by their refusal to answer direct questions. Par for the course is 2 pages of waffle which skates around the issues.
I am actually quite good at getting answers out of ministers ( I spend most of my time at work drafting answers for ministers to give), I also know that any letter from a government body to an MP has to be cleared individually by the relevant minister.

FOI is useful for getting info in the public domain, and it is a pain in the arse for civil servants, but it doesn’t really get much ministerial attention. Five or six letters from MP's in short succession however will get ministerial attention. Tabling PQ's (epically oral PQ's or starred PQ's in the lords) is also quite a good way to stir up departmental action.

What I need though are some "hooks" on which to hang my letters, some salient facts, such as the info you supplied on the fact that the NHS does not track spend on sCAM.

Any more bits like that would be very useful.

Thanks.
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Old 17th August 2005, 02:49 PM   #31
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Quote:
Originally posted by brodski

What I need though are some "hooks" on which to hang my letters, some salient facts, such as the info you supplied on the fact that the NHS does not track spend on sCAM.

Any more bits like that would be very useful.

Thanks.
You sound like just the person we need. Here's a few questions for starters:

1. You can ask Lord Warner why the govt does not follow the recommendations of the 2000 House of Lords Report, and get NICE to appraise CAM.

2. You can also ask him why the govt granted GBP18m to upgrade the London Homeopathic Hospital. I have the business case document for this and there is nothing in it about value for money in terms of patient benefit.

3. You can ask the sec of state for health why the govt thinks evidence of efficacy is not important for the forthcoming regulation of acupuncture and herbal medicine - for which they gave almost GBP1m to HRH's Foundation.

PM me if you like for more. You are absolutely right - we need 5 or 6 letters on a subject to get any attention.
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Old 17th August 2005, 04:17 PM   #32
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Quote:
Originally posted by Asolepius
You sound like just the person we need. Here's a few questions for starters:

1. You can ask Lord Warner why the govt does not follow the recommendations of the 2000 House of Lords Report, and get NICE to appraise CAM.

2. You can also ask him why the govt granted GBP18m to upgrade the London Homeopathic Hospital. I have the business case document for this and there is nothing in it about value for money in terms of patient benefit.

3. You can ask the sec of state for health why the govt thinks evidence of efficacy is not important for the forthcoming regulation of acupuncture and herbal medicine - for which they gave almost GBP1m to HRH's Foundation.

PM me if you like for more. You are absolutely right - we need 5 or 6 letters on a subject to get any attention.

Thanks for these, I will draft a letter in the next couple of days, and see what results I get.
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Old 22nd August 2005, 02:42 AM   #33
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The blogs are alive with stuff on HRH. Here is an example. Has he gone over the top this time? By that I mean, is his public position starting to be eroded at last?
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Old 22nd August 2005, 04:56 AM   #34
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I seriously suspect Charlie is the worst thing that could happen to the sCAM movement, from their point of view.

Let's face it, like him or loathe him, the fellow is...well, he's a Charlie, isn't he?

I think the more rope he has to run with, the harder the jerk will be when he hits the end.
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Old 23rd August 2005, 02:43 PM   #35
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UK forum members - be sure to listen to BBC Radio 4 at 0700 tomorrow (24th). There will be an item about this Freshminds scandal. It will also be carried in The Times.
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Old 23rd August 2005, 02:50 PM   #36
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Quote:
Originally posted by Asolepius
UK forum members - be sure to listen to BBC Radio 4 at 0700 tomorrow (24th). There will be an item about this Freshminds scandal. It will also be carried in The Times.
On the Today programme?
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Old 23rd August 2005, 11:59 PM   #37
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Yes - but it was only a news headline. Maybe it will escalate during the day.
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Old 24th August 2005, 12:30 AM   #38
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Yes - but it was only a news headline. Maybe it will escalate during the day.
I heard this on my way into work - Edzard Ernst was quoted as saying that the report flew in the face of the scientific evidence and some bloke from Freshminds saying that it was unfair to comment on an unfinished report.

btw, BBC Radio 4 is available on the net - start here.
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Old 24th August 2005, 01:36 AM   #39
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Quote:
Originally posted by Dragon
I heard this on my way into work - Edzard Ernst was quoted as saying that the report flew in the face of the scientific evidence and some bloke from Freshminds saying that it was unfair to comment on an unfinished report.

btw, BBC Radio 4 is available on the net - start here.
....and here is the Times article.
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Old 24th August 2005, 02:01 AM   #40
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....and here is the Times article.
Looks like Prof. Ernst has taken the gloves off
Quote:
"These are outrageous estimates without any strong evidence to support them," Professor Ernst said. "The report glosses over the science and its methodology is deeply flawed. It is highly selective in its use of evidence and it looks like the conclusions have been written before everything else. It is based on such poor science it’s just hair-raising. The Prince of Wales also seems to have overstepped his constitutional role"
.
Les, could the witching hour be upon us?
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