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.