Are politicians really stupid?

Or do they think we are? Some of you might remember the stories in The Guardian about the parties’ policies on science, including evidence based medicine (EBM). Before I go on, I just want to thank my MP John Glen for his patience with me, a grumpy old constituent who has imposed disproportionately on his time. This is because of the parliamentary rule that all contacts between government ministers and the public have to go via the relevant MPs. I have observed in the past that MPs have done little more than act as postmen, but John has done a bit more than that, and engaged in useful discussion. I was quite hard on him in a previous post, but credit where it is due.

Anyway, I wrote via John to Earl Howe, Parliamentary Under Secretary of State at the Department of Health, drawing his attention to the pre-election commitments of both coalition partners to evidence based medicine. I then asked how this corresponded with the government’s response to the Science and Technology Committee’s report on homeopathy. Here in full is the reply:

From Anne Milton, Parliamentary Under Secretary of State for Public Health

Thank you for your letter of 2 August to Earl Howe enclosing correspondence from your constituent ……… about the provision of homeopathy on the NHS and the Government’s response to the House of Commons Science and Technology Committee’s Evidence Check into homeopathy. I am replying as the Minister responsible for this policy area.

We considered the report of the Science and Technology Committee very carefully and, though we accept that the majority of independent scientists consider the evidence of efficacy for homeopathy to be weak or absent, we feel that efficacy is not the only consideration in choosing the most appropriate treatment. The recent White Paper, Equity and excellence: Liberating the NHS shows the Government’s aims to put patients at the heart of everything the NHS does and continuously improve issues that really matter to them. This is why we have said that decisions on which treatments to commission and fund have to be the responsibility of the NHS. It is not for the Department of Health to stop the NHS funding homoeopathic treatments in particular and thus interfere in local commissioning and clinical decisions.

With regard to the issue of the labelling of homeopathic products, the Medicines and Healthcare products Regulatory Agency is currently reviewing its policy on the labelling of homeopathic medicinal products.

Please do contact me again if there are any further concerns.

Anne Milton

Well there were several concerns. For a start, as usual this junior minister, if she read my letter at all, clearly misunderstood the difference between opinion and fact in science. So I responded to John Glen and pointed out that the minister had not addressed my question at all, which was that before the election both the Tories and the Lib Dems stated very clearly that non-evidence based medicine would not have a place in the NHS, yet current policy is no different from that of the outgoing Labour government. John phoned me to clarify my argument, and passed it on the Ms Milton. Her reply to that was a masterpiece of obfuscation. Here it is.

Thank you for your letter of 18 October enclosing correspondence from your constituent………..  about the provision of homeopathy on the NHS. I am sorry that Mr ……… felt that my previous reply did not address his concerns.

As Mr ………. is aware, the House of Commons Science and Technology Committee carried out an examination of the evidence to support the provision of homeopathy on the NHS. The Committee’s report was published on 22 February. This Government has considered its findings and recommendations and published a full response.

The Department of Health will not be withdrawing funding for homeopathy on the NHS, nor will the licensing of homeopathic products be stopped. Decisions on the provision and funding of any treatment will remain the responsibility of the NHS locally.

A patient who wants homeopathic treatment on the NHS should speak to his or her GP. If the GP is satisfied this would be the most appropriate and effective treatment then, subject to any local commissioning policies, he or she can refer them to a practitioner or one of the NHS homeopathic hospitals.

In deciding whether homeopathy is appropriate for a patient, the treating clinician would be expected to take into account safety, clinical and cost-effectiveness as well as the availability of suitably qualified and regulated practitioners. The Department of Health would not intervene in such decisions.

The Department’s response to the Science and Technology Committee report explains the reasons behind its decisions in more detail. The response can be found on the Department’s website, http://www.dh.gov.uk, by typing ‘Government Response to the Science and Technology Committee report’ into the search bar and following the links.

With regard to the labelling of homeopathic medicinal products, the Medicines and Healthcare products Regulatory Agency is currently reviewing its policy on this issue.

Please do contact me again if there are any further concerns.

ANNE MILTON

It seems to me that each time one asks a government minister to answer a direct question, making the question as clear as possible, the minister is determined to make the reply as far removed from the question as they can manage. I specifically asked the minister to address the matter of how the current policy relates to the pre-election statements about evidence based medicine. She does not mention that at all in her reply. Instead, she provides a ridiculous discourse on the process by which a patient could obtain homeopathy at public expense. Did I ask about that? No I did not. Indeed her explanation of the process is bizarre. She refers to the Science and Technology Committee report which was part of a long term programme to assess how the government uses evidence. The committee concluded that there was no evidence that homeopathy was effective. The government in its reply did not disagree with that. Yet Anne Milton uses the word `effective’ in relation to homeopathy. She then says that a clinician “would be expected to take into account safety, clinical and cost-effectiveness”. Firstly, there is no effectiveness and that has been agreed. Secondly, the government continues the policy of its predecessors by refusing to refer homeopathy to NICE. Well of course NICE would reject the request because without effectiveness, cost-effectiveness would be impossible to measure. Were I to continue this dialogue, I would ask the minister what she considers to be a “suitably qualified” practitioner. All the bachelor’s degrees in homeopathy have now been stopped at British universities, because they were pretending to be science degrees but with no science. That leaves us with the spurious qualifications issued by such bodies as the Society of Homeopaths, which refused to discipline any of its members who recommended homeopathy for malaria.

There appear to be two possibilities here. Either Anne Milton is very very stupid, or she is not taking the debate seriously, by sending such a disdainful and disingenuous reply. I think the former option is unlikely, but of course we all know that such letters are not written by ministers but by civil servants. Thus they often read much the same whatever the political colour of the signatory.

So is this David Cameron’s `Big Society’? Do I as an ordinary citizen really want to get involved with politicians who are full of fine words before the election and as weaselly as possible after it? I really feel quite angry about all this. I don’t get paid to write to politicians, to ask reasonable questions about issues that are important to the health of society. They do get paid to reply, and I am among the people paying them. I think I am owed more respect than they are prepared to afford me.

I have to reflect that Earl Howe, to whom I originally wrote, was formerly President of my professional body the Institute of Clinical Research. Of all people, I might have expected him to understand why I was asking about clinical evidence. But then, I am sure he never saw the letter.

I know some others have also written to ministers in similar vein, and this pressure should be kept up. You might remember that this blog was originally set up to provide a tool kit for supporting evidence based health care and related causes, and this is one way you can do that.

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20 Responses

  1. majikthyse said:

    Either Anne Milton is very very stupid, or she is not taking the debate seriously…

    Clearly she is not stupid about many things, but she seems to be utterly blind to the reality (un-reality?) of homeopathy. I wonder if that’s because it runs in her family?

    “My hon. Friend may be interested to know that although I trained as a nurse and worked in the NHS for 25 years in conventional medicine, my grandmother trained at the homeopathic hospital in London, and was herself a homeopathic nurse. Later, she became a Christian Scientist. I am therefore not without my own roots in alternative therapies. My hon. Friend may also be interested to know that my grandmother never, until her death at the age of 89, took any conventional medicine.”

    Being brought up believing nonsense can leave powerful, yet erroneous, impressions.

  2. In saying “we feel that efficacy is not the only consideration in choosing the most appropriate treatment”, she is actually saying that, with regard to homoeopathy, EFFICACY IS NOT A CONSIDERATION!

    Sorry for shouting.

  3. To answer the question you raise in your title:

    On the evidence presented here ….

    “YES!”

  4. “safety, clinical and cost-effectiveness…” THE LAST WORD IS THE MOST IMPORTANT, EFFECTIVENESS IS WHAT MATTERS. Ahem.

    Teh Stoopid, it burnz…

    well done by the way, keep digging…!

  5. Yes, they are really stupid. I’m not sure that they are stupid in that they haven’t understood the issues.

    They are, however, crushingly stupid if they think that anyone will be fooled by such pointlessly deliberate obfuscation. We are not. It is clear that their position is completely unjustified, and they are hoping that no-one will notice.

    Which is, frankly, stupid.

  6. This propensity to describe the current state of regulation, rather than why the regulation is as it is, is the same in Victoria. I got very similar responses to my questions about why the laws were as they are rather than what they are.

    I have NO idea what to do about it.

  7. I have had a very similar experience with my MP on the matter of science and HE funding in the UK. His tactic was to assert that there was no bigger advocate for science at Westminster than he, blame Labour, and to conclude by saying that he hoped that I was satisfied. When I said that I was not and asked further specific questions, he re-iterated how importantly he took the subject, blamed Labour and sent me a poorly written “article” full of contradictions and inconsistencies which did not address my questions.

    I am struggling to see the value in replying to someone who so clearly does not want to participate in a constructive dialogue.

  8. Thanks for sharing those replies.

    …we feel that efficacy is not the only consideration in choosing the most appropriate treatment.

    It shows a huge lack of respect for “Big Society” when the government says that people should be allowed to hold on to notions that are demonstrably false?. Do they consider us to delicate to be told what does and doesn’t work? I was hopeful after the evidence check was released, but these letters make it seem like nothing will ever change.

  9. Real is scientific homeopathy. It cures even when Conventional Allopathic Medicine (CAM) fails. Evidence-based modern homeopathy is a nano-medicine bringing big results for everyone

    • As usual I am approving this comment in the interests of free speech. Indeed I am delighted to publish it, as an example of extreme obfuscation! Dear Nancy – this whole thread is about scientific evidence, if you hadn’t noticed. So please provide citations to support your claim.

      • I approved her comment in another blog, but I removed the link in her name. She is essentially spamming. I also reminded her that she was banned from the JREF forum because of multiple postings that were not pertinent to the discussion and were actually just spam links.

  10. Thanks Chris – I don’t believe she is any sort of `doctor’ either, if you Google her profile.

  11. To answer your original two questions: Politicians are not as smart as they should be, but they are well aware that they are smarter than sufficiently many voters.

    In addition, I strongly suspect that many politicians grossly over-estimate their own abilities and/or incorrectly assume that (as good as) all voters are more stupid.

  12. Seems to me the best way to drive change in anything related to healthcare is for Panorama to broadcast a hysterical, generally uninformed programme to get the Daily Mail readers mobilised. GSK are the latest victims re Avandia – maybe we can put paid to homeopathy in the same way…?

    • I am not sure I really want to descend to that level. Panorama used to be quite good until they dumbed it down to 30 mins of emotional headlines and little substance.

  13. Couldn’t resist linking this page – showing Ann Milton refusing to follow evidence – with Ben Goldacre’s latest, showing Andrew Lansley refusing to follow evidence.

    • Thank you for doing so – I reached this article via Ben’s blog, and am pleased to find it very worthwhile reading.

  14. Majikthyse, check the wording of the letter from Bilal Ghafoor (DoH) under comment 33 on http://www.badscience.net/2011/02/andrew-lansley-and-his-imaginary-evidence/#comments and it seems the reason you didn’t get an answer to your question is no one tried to answer it, they just posted the standard response.

    • This is my point. Bearing in mind that I originally wrote to the minister Earl Howe, and I got replies from Anne Milton, it seems clear that such correspondence is delegated to civil servants without the remotest intention of addressing the issues. Neither minister was directly involved. This indicates total disdain for citizens who spend their time in the support of evidence based health care. The government refuses to fund certain treatments that clearly do work, on the basis of cost, yet insists on funding homeopathy, which the government agrees does not work.

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