Evidence based voting

April 24th, 2010 by Ben Goldacre in bad science, politics, structured data | 53 Comments »

Ben Goldacre, The Guardian, Saturday 24 April 2010

What can science and evidence bring to an election? First there are the micro-issues: we can assess the validity of claims made by politicians by seeking out the evidence. David Cameron, for example, claimed that UK cancer services were bad because fewer people die of cancer in Bulgaria than in the UK, which many have already debunked: he used death data from a country with inferior monitoring standards, and a far lower life expectancy, but more than that, he used death data, which is driven not just by treatment success, but also by the number of new cases to start with, which can vary widely for all kinds of reasons.

Still on cancer, but in a neglected example, Cameron also said: “I have a man in my constituency [with] kidney cancer who came to see me with seven others. Tragically, two of them have died because they couldn’t get the drug Sutent that they wanted.” This was odd, because Sutent is actually available on the NHS for kidney cancer, having been approved by NICE in February 2009 (despite costing £54,366 per “quality adjusted life year”, while NICE generally draws the line at £30,000).

Where did Cameron get the idea it was rejected? I don’t know. On the 9th of April the Daily Mail published a bizarre article claiming that 15 cancer drugs (including Sutent) had been rejected by NICE. They provided a list. Bizarrely, 10 of the 15 drugs on that list which the Mail say NICE rejected have actually been approved by NICE. The head of NICE wrote to all three parties on the 9th of April explaining that this article was bizarrely wrong. His letter is posted in full on the NICE website. (NICE did reject Sutent for people with a poor prognosis who are unsuitable for immunotherapy, but only there because they weren’t given any evidence on its use in that group).

As a side issue, of course, it’s always unwise to claim that someone would be alive today if they had a specific treatment, in any situation. The mighty statistician Prof David Spiegelhalter has run through the maths on his Understanding Uncertainty website, and even if you are in the better prognosis group, for whom we do have evidence, you only have a 58% chance of surviving longer after receiving Sutent, and the median survival is 37 months with the drug and 27 months without it. Worth it, of course. I’m just saying.

Alongside the science of individual claims, it’s also worth looking at what the parties say about science itself. Here, only the Liberal Democrats’ manifesto stands out, promising funding like the others, but also making pledges on the use of independent scientific advice in policy (in contrast to the David Nutt affair), and even coming out in favour of open-access academic publication.

But more than anything, this election offers a new opportunity: beyond expecting our politicians to follow the evidence, we can be evidence based ourselves, in our voting decisions, and hold ourselves to the same high standards. VoteMatch can match your views against the party manifestoes. SkepticalVoter knows if your MP believes in the homeopaths’ magic beans. Using TheyWorkForYou I can see that my last MP (Andrew Smith, Labour, Oxford East) voted very strongly in favour of the Iraq war, very strongly against an inquiry into it, very strongly in favour of ID cards, and so on. It’s grim reading. PoliticsPosters will print that on a poster, so you can make sure your neighbours know too.

Websites like these recognise that disseminating data in a meaningful form is as important as gathering it in the first place. Your MPs voting record, and their attendance in parliament, have always been publicly available, but until recently it was an effort to find, so only journalists and lobbyists knew the ugly details. That has changed. In the past we relied on hunches and reputation, but now – uniquely – we have the option to leave tribalism behind, and deploy our vote using data.


++++++++++++++++++++++++++++++++++++++++++
If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

53 Responses



  1. jdc said,

    April 24, 2010 at 2:30 pm

    My votematch result: 67% LD, 61% Lab, 59% Green. Unless my LibDem PPC believes in magic beans, I think he’ll get my vote.

    In order to get a rough idea of the way my local PPCs think when it comes to science, evidence, and policy I emailed each of them five questions (some loosely based on questions suggested on the Skeptical Voter website and some simply copied and pasted from their site) and posted them on my blog.

    So far, only the Green and Labour candidates have responded but I hope that the Conservative and Lib Dem PPCs will also reply.

    Shameless blogpimp: Skeptical Voters.

  2. coling said,

    April 24, 2010 at 3:28 pm

    One of the things I get really annoyed about are some party’s position on referendums for everything vaguely controversial.

    David Cameron specifically mentioned the lack of a referendum on the EU Constitution. I’m sorry, but I really don’t wont the uneducated masses (and I include myself in that group) to vote on something based on red-top headlines and deep seated prejudice. I go to the effort of electing (or trying to elect) people who are specifically paid (and supplemented by expenses!) to read, understand and evaluate the complicated guidelines and policy to make such decisions for me. If there was to be a referendum, I’d like people to have to sit a test on the topic and only be allowed to vote if they demonstrate a suitable knowledge of the subject matter (i.e. only allow “Evidence based voting”!).

    This is of course totally impractical, but it does highlight the absurdity of calling for referendums on complex topics. I was glad Nick Clegg basically agreed when he said something along the lines of if there is a referendum then “have a referendum on the big question of whether or not to be in Europe” rather than the intricate details of the constitution itself.

  3. emen said,

    April 24, 2010 at 5:33 pm

    Hang on a second.

    “David Cameron, for example, claimed that UK cancer services were bad because fewer people die of cancer in Bulgaria than in the UK, which many have already debunked: he used death data from a country with inferior monitoring standards,”

    – many have already debunked?

    I follow your first link to the “debunkers”, and I find that the tool Jeremy Laurence applies for the debunking is a 18th century rule of philosphy: the rule of the lesser miracle:

    “which would be the lesser miracle – that Britain’s NHS has a worse record for cancer survival than Bulgaria, or that Bulgaria is less reliable at collecting cancer statistics than Britain? Eurostat health data for 2007 does indeed show that Bulgaria had 170.3 cancer deaths per 100,000 population whereas the UK had 178.1 deaths. Cameron chooses to see this as evidence of Britain’s dismal performance.

    “But it is the very fact that the figures show Britain performs worse than Bulgaria that calls the data into question.”

    In other words, if some statistics show that the UK’s cancer survival rates are worse than Bulgaria’s, the statistics are simply not true, end of story.

    Is that what you call “evidence-based”?
    I call it prejudice and ignorance.

    I have never been to Bulgaria, let alone use their healthcare services, and it MIGHT indeed be the case that they miscounted, or that Bulgarians die of other illnesses before they have a “chance” to die of cancer.
    But I wouldn’t dismiss the performance of Eastern-European or Asian healthcare systems so readily when compared to the NHS.

    Jeremy Laurence continues to say:

    “I look forward to the day when, under a future Tory government, NHS patients begin demanding cancer treatment in Bangladesh because of the poor quality of services back home.”

    You would be surprised to find out that British people of Asian origin already go to India to have their tumour treated there, not to mention the thousands of UK-resident Eastern-Europeans who fly home for their antenatal appointments, have their hernia repaired, tonsils removed etc – because it is quicker and more reliable there.
    I have no official data, (I doubt there is any) this is people that I personally know or have heard of – but enough to doubt it would be such a big miracle for the Bulgarians to perform better on the cancer front.

    Or consider my story: I had a tumour, the NHS told me it was cancer, a dangerous sarcoma. Counting from the day my GP referred me to a specialist, the NHS waited for four and a half months and did NOTHING. (The tumour turned out to be benign, which might be one of the reasons why I’m still here.)
    According to NHS clinical guidelines, no mistakes were made.

    Now apply to this the rule of the lesser miracle: which is more likely, that the NHS really is THIS useless when it comes to cancer, or that I’m lying?

    You decide.

    When you HAVEN’T GOT cancer, it is the simplest to convince yourself that if you DO get seriously ill, the NHS will be there for you – after all, this is a rich country, with super monitoring, super evidence-based guidelines, super committed staff, and however many scare stories the newspapers blow out of proportion, the NHS can’t be that bad, really.

    And when you HAVE got cancer, it will be too late.

  4. gf said,

    April 24, 2010 at 8:46 pm

    @coling

    Why not have tests before people can vote in elections too?

    In fact, why not require all MPs to have a science PhD?

    In fact, why not just give up all of our freedoms and let “qualified” scientists tell us what to do all the time. They are only basing their conclusions on evidence, after all, while we are just stupid plebs!

    Direct democracy works well, actually; in Switzerland, for example. Why not here? It is only one step of logic beyond representative democracy, which is what we have now.

  5. Fish Custard said,

    April 24, 2010 at 10:08 pm

    Right, direct democracy works well in Switzerland, that’s why they in no way have recently voted in a law specifically targeting a minority group and subjecting them to greater restrictions than the majority. See tyranny of the majority.

  6. Ambulance Amateur said,

    April 24, 2010 at 11:16 pm

    Mine was LD 60%, Green 56%, Lab 43%, Con 26%

    I was surprised at the Green score, but I’d already decided LD.

  7. Ambulance Amateur said,

    April 24, 2010 at 11:17 pm

    Gif

    My LD candidate DOES have a science PhD!

  8. jwm said,

    April 25, 2010 at 1:19 am

    Ah, the Cameron-Bulgaria statement. A classic in Bad Science statements, demonstrating either lack of reasoning and inquiry on his behalf, or willful ignorance in favour of a punchy political line.

    So, superficially the statement is true, with 170/100,000 cancer related deaths in Bulgaria in comparison with UKs 178/100,000. However, there are several confounding facts. UKs life expectancy is 79.4 yrs vs Bulgarias 73yrs, so more people are reaching an age where they are more likely to develop cancer and therefore die from it. An even more interesting statistic is the numbers of “premature” deaths secondary to cancer (deaths in those under 65 due to cancer), Bulgarias is 121/100,000(male) and 70/100,000(female) compared with the UK’s 68/100,000 (male), and 64/100,000 (female)

    Now, Im a male and under 65 so am slightly biased given the above statistics, but if given the choice of avoiding a cancer induced death by dying too early to develop cancer, or avoiding it by being treated succesfully I know which I’m going to choose.

    Now, Im off to tell David about how shocking these private opticians are, because more people are blinded by glaucoma in the UK than in Sudan. Sickening isn’t it?

  9. jwm said,

    April 25, 2010 at 1:28 am

    Emen:

    “You would be surprised to find out that British people of Asian origin already go to India to have their tumour treated there, not to mention the thousands of UK-resident Eastern-Europeans who fly home for their antenatal appointments, have their hernia repaired, tonsils removed etc – because it is quicker and more reliable there.”

    Yes, I would be surprised that antenatal appointments occur quicker in Eastern European countries. Have they developed a way to review a patient at 16 weeks into their pregnancy sooner than those 16 weeks have passed? Do they also have ultrasound machines that can tell sooner than 12 weeks what a babies developing organs will look like at 12 weeks?

    As for tonsilectomies, they’re almost never done here in the UK. Why? Because of the massive evidence base proving very little benefit in removing them (except in a select subset of people). The only benefit of the operation is to the size of the bank balance of the surgeon cutting the offending organ out, a benefit that no doubt flashes in the eyes of private surgeons.

  10. reprehensible said,

    April 25, 2010 at 2:48 am

    Since I get to vote for a new contituency I emailed my Lib Dem candidate regarding their manifesto policies, and the lack of evidence they contained. I am awaiting a reply.

    The Labour candidate, said “I support evidence based policy making but there can be conflicts when the majority view and the evidence base are polarized.” I suppose I should be happy I got an answer, all be it a politicians one.

    After reading Camerons rubbish regarding cancer i’m afraid to admit I gave up and decided not to bother emailing the con-servative candidate. Admittedly even had he said he’d always vote for evidence based policies i never vote for him out of personal principal.

    I am currently intending to spoil my ballot with the words ‘science not spin’

    I actually like what Micheal Marmot had to say regarding this matter…

    “I chaired the World Heath Organisation’s
    Commission on Social Determinants of Health. One
    critic labelled the Commission’s report ‘ideology with
    evidence’. The same charge could be levelled at the
    present Review and we accept it gladly. We do have an
    ideological position: health inequalities that could be
    avoided by reasonable means are unfair. Putting them
    right is a matter of social justice. But the evidence
    matters. Good intentions are not enough.” www.ucl.ac.uk/gheg/marmotreview

    I hope some readers of this blog have a better choice than I do.

    Oh and Ben,regarding NICE, statutory instruments and directions do not allow them to take budgetary impact or affordability into account when advising on cost effectiveness. However in 2003 it became a legal requirement that funding for all positive advice be made available within three months of publication. This has led to pressure on PCT’s to fund new technologies with marginal benefit at the expense of increasing funding to more cost effective areas.

    Your right to say the QALY threshold is about £30k but a president was set to increase it to around £45k for treatments that have effect at towards the end of life as this was considered to be more valued. PCT budgets stretch to maybe 20kper QALY. Probably less now

    NICE is still fundamentally a health assement body not a really rationing body. Its just that it is now expected to assess old technologies also. Unfortunately there’s never been such a thing anywhere in the world, except possibly in Oregon, in theory.

  11. Dudley said,

    April 25, 2010 at 6:06 am

    That VoteMatch site is pretty poor – a series of yes/no questions just isn’t the right way to understand someone’s views on policy. Take the question “Do you think universities should stop charging tuition fees?” A NO answer might indicate that I believe in the privatisation of education (Tory) or that I believe many other structural changes need to be made before draining the higher education system of funding (Green) or that I recognize that the system is overstretched and that the number of students needs to be reduced and funding channelled to the best and the brightest from poorer backgrounds (Me – not in any party manifesto).

    The number of questions being asked – only 30 – doesn’t seem likely to be enough to overcome this assumptiveness.

    A better site is voteforpolicies.org.uk/ – as it deals with manifestos as a whole, it better allows for the imprecision of language.

  12. hgjon said,

    April 25, 2010 at 7:28 am

    Cameron also repeated the spurious claim about the improval of survival rate of infants born below 24 weeks in his interview with Paxman, something that he must surely be aware does not stand up to scrutiny.

  13. Mark P said,

    April 25, 2010 at 11:47 am

    Direct democracy works well, actually; in Switzerland, for example.

    Is this the Switzerland that gave women the vote in 1971? Only in 1990 was the last canton forced to give women the vote, and that in spite of direct democracy!

    Direct democracy works, sort of, in Switzerland because it is rich, socially homogenous and opposed to change. It would fail miserably in most countries.

    It’s a disaster in many other cases. It may well yet cause California to go to the wall, unable to enact any taxation changes.

  14. Bishop Gillian Wakefield said,

    April 25, 2010 at 1:56 pm

    @Dudley

    Thanks for the link. I think both sites are useful, and both sites are flawed. One let’s you prioritise voting criteria and understands that parties may share similar views on certain issues. The other forces you to side with one party or another on an issue by issue basis, but (as long as you remember to expand the windows to show ALL policies) allows you to form a balanced picture about which choice really means.

    Either way, I appear to be Lib. Dem. (as this post would suggest) with Green/Labour/Cons tendencies respectively.

  15. Daibhid C said,

    April 25, 2010 at 2:57 pm

    @jwm:

    “We had our first child on the NHS, and had to wait nine months! Can you believe it?”
    -Hugh Laurie, “A Bit of Fry and Laurie”

  16. medaoh said,

    April 25, 2010 at 5:37 pm

    As a side issue, I was disappointed to see the sainted David Nutt quoted again in this piece as if his name has become a watchword for those with an interest in the probity and independence of government scientific advisers.

    Those with longer memories may recall the last time Nutt’s name was in the national news (see eg Guaridan 13th March 2003)in relation to independence of scientific advisers. At the time he was advising the government on behalf of the Committee on Safety of Medicines, about the safety Seroxat and other SSRIs. At the time he was a share-holder in SKB, the company that manufactures Seroxat, and had shared the platform at SKBs launch of Seroxat for social anxiety in children, with one of his expert and presumably also “independent” witnesses.

    Surely “independent” in this context means “has no ties to parties with an interest in the advice being offered”, and not just “isn’t unduly under the influence of the body seeking the advice”.

    This isn’t just a silly ad hominem argument. The major pharmaceutical companies have worked tirelessly against evidence-based medicine and Nutt has been in their pay for many years. Quoting him as a champion of independence in scientific policy-making is a bit like quoting Gillian McKeith’s opinion as the main reason we should all eat more vegetables.

  17. Sili said,

    April 25, 2010 at 6:49 pm

    Mark P, learn to read for comprehension.

    Fish Custard very clearly does not approve of the Swiss system.

  18. outeast said,

    April 25, 2010 at 7:01 pm

    Sili, MarkP was replying to gf, not to Fish Custard. (FC was also replying to gf, hence the repetition of the same phrase.)

  19. Fish Custard said,

    April 25, 2010 at 7:57 pm

    Fish Custard should have put an @gf in to save confusion :c)

  20. emen said,

    April 25, 2010 at 10:39 pm

    “I would be surprised that antenatal appointments occur quicker in Eastern European countries. Have they developed a way to review a patient at 16 weeks into their pregnancy sooner than those 16 weeks have passed?”

    ha-ha

    The word “quicker” referred to hernia repairs and stuff. (Kidney stones, gall bladders… diagnostic scans, blood tests…)

    But now you bring it up, by the time the NHS start maternity scans at 12 weeks, they would have already done 1-2 scans in some Eastern-European countries to check if there is a live fetus in there, whether it is where it should be etc. And yes: they check and scan for more abnormalities than here. Also you see DOCTORS at these appointments, not midwives with a 15-year-old tape measure fiddling above your stomach.
    (Before you start thinking of the pocket of private doctors, this is FREE, STATE healthcare in these countries I’m talking about.)

    Tonsillectomy: there is “massive” evidence in the UK that the surgical tools used to remove tonsils have sterilisation-resistant bacteria on them. That is one of the main reasons why they don’t recommend it – and no, I didn’t read this in The Sun, my NHS GP was the source of the information.

    “Im a male and under 65…if given the choice of avoiding a cancer induced death by dying too early to develop cancer, or avoiding it by being treated succesfully I know which I’m going to choose.”

    Sure, and let’s hope that you will have the choice of being treated successfully.
    (I told you how I, a woman in her thirties, diagnosed with a sarcoma was “treated”, and according to the doctors, in no way was my story uncommon.)

    I know that you (along with a lot of people in Britain) want to dream on about the NHS – feel free.
    But don’t use big-mouthed, arrogant arguments about other countries’ healthcare systems if you know nothing about them.

  21. skyesteve said,

    April 25, 2010 at 10:51 pm

    @ emen – I think you (and David Camoron)should do more homework…

    As jwm points out, antenatal appointments occur at set stages of pregnancy – so there’s no value in being seen “sooner”.

    As for Bulgaria? Well – health expenditure per capita $250 ($1400 in the UK); “healthy life” expectancy 64.6 years (70.6 years in the UK); overall life expectancy 72.5 years (79 years in the UK); deaths from HIV 12.6 per million (7.7 per million in the UK); cases of TB 20 per 100,000 (5 per 100,000 in the UK); infant mortality 18.5 per 1000 live births (4.9 per 1000 live births in the UK); maternal mortality 15 per 100,000 (7 per 100,000 in the UK); levels of childhood malnourishment 9% (2% in the UK); probability of dying before your fifth birthday 17 per 1000 (6 per 1000 in the UK); probability of dying before your 60th birthday 18.8% (9% in the UK); male suicide rate 25 per 100,000 (11 per 100,000 in the UK); homicide rate 44.5 per million (14 per million in the UK).

    There are good reasons why Bulgarians don’t die of cancer – and they are nothing to do with better cancer detection or care.

  22. SteveGJ said,

    April 25, 2010 at 11:14 pm

    Politics and playing fair with statistics? Are you mad? These guys are out to make their case by whatever means they think they can get away with. If that means quoting numbers out of context, making unfair comparisons and choosing the numbers that they think have the most impact, they will do it. Out only defense is a skeptical approach and some informed debate. They are not in some form of investigation after truth.

    Also, whilst we are at it, let us not forget that Sir Michael Scholar reprimanded Gordon Brown recently over his use of official statistics. Looking back a bit further then David Cameron received a similar warning about knife crime statistics. It’s in the nature of the beast.

    To this you can add the distortion of finances by politicians. Some of this is gentle stuff (calling current expenditure investment for instance). Then there is the use of absolute GDP figures rather than GDP per head.

    Some of it is creative accounting. For instance “off-book” financing such as not including future public sector pension liablities. Then there was PFI – essentially a mechanism to reduce the apparent level of government borrowing but which still left the state with future current expenditure commitments, often at a higher cost than if the borrowings had been made direct. At the limit we get what amounts to dtate-sponsored fraud (very much what has happened in Greece where public books have been thoroughly cooked).

    Of course private companies engage in these tactics too, but at least there is some form of legal structure for the stating of accounts (the company for which I work is weighed down by a pension liability of which shareholders are only too well aware and has had huge impact on both them and employees – and those shareholders included, in turn, a lot of pension funds).

    Also, it’s not just politicians. It’s wise to be a little skeptical about anybody making claims from any group with a vested interest. For instance, it seems to be taken for granted in the UK that the NHS is the only way of delivering state health systems to the point where it is almost an article of faith. However, a survey of other state health systems show that this is far from the case – there are countries who manage to deliver very good state health systems through other means. Some might even argue better than the UK’s. However, try getting a reasoned debate in the UK on this subject.

  23. daven said,

    April 26, 2010 at 12:06 am

    To address the title, there is evidence on which voting systems more fairly reflect the preferences of voting. Some rather good and clear analyses can be found on www.deborda.org/ . Peter Emerson, who resurrected the voting system of the Compte de Borda (French revolution, not ancient Greece) has used the vote to find out where nationalists and unionists in Northern Ireland will compromise if they don’t get their first choice.

  24. emen said,

    April 26, 2010 at 12:18 am

    skyesteve

    1. I have explained this “maternity appointments sooner” problem at 20

    2. See my post at 3: I am not claiming Bulgarian health-care IS necessary better or that they haven’t miscounted their cancer deaths.
    But I disagree that the “rule of the lesser miracle” in this case would be an appropriate approach.

  25. jodyaberdein said,

    April 26, 2010 at 10:03 am

    Which sterilization resistant bacteria would those be then?

  26. emen said,

    April 26, 2010 at 8:56 pm

    I don’t know, I didn’t ask.
    Ask yours.

  27. roobarb said,

    April 26, 2010 at 11:57 pm

    @ emen. Your GP doesn’t have it quite right. Snares used for tonsillectomy are no longer re-used as there is evidence that in vCJD patients the prions can be found in (amongst other organs) the tonsils. Prions are quite resistant to decontamination and sterilization (because they are proteins, not microorganisms, and are certainly not bacteria which are fairly easy to kill) and so this is a sensible precaution.

    But this is equally true in your Eastern European countries, so if single use snares are not used, the risk is actually greater.

    All this has nothing to do whether tonsillectomies are clinically effective, for which see above.

  28. teej said,

    April 27, 2010 at 12:02 am

    I have to agree with Dudley that Votematch is poor. The first statement is “New prisons need to be built to ease overcrowding”. The LibDem response is that prison isn’t working and that they will take steps to stabilise the prison population. I disagreed with the statement and this resulted in me apparently disagreeing with the LibDems when I really don’t. Prison clearly isn’t working but more prisons do need to be built to ease current overcrowding.

    That’s just the first question – most of them had similar problems.

  29. teej said,

    April 27, 2010 at 12:09 am

    Oops. I agreed with the statement.

  30. skyesteve said,

    April 27, 2010 at 9:34 am

    @roobarb (or anyone else who can help) and at the risk of taking this thread off on an unwanted tangent – what IS the evidence that we should be using disposable rather than re-usebale surgical equipment? For example, in our Community Hopsital we have disposable suture sets. These cost something like £20 quid a shot and we may go through many a day. What is the evidence that using them is better than the re-sterilised ones we used for the previous 100 years? They are clearly not cheap and, from what I understand, they are produced for peanuts by children and adults working in horrendous conditions in the Third World, so there’s clearly a bit of an ethical problem with them too. Oh, and they all get dumped in land-fill site which isn’t good for the environment. The latest wheeze in my hospital is that patients have to have disposable, one-patient-only use, wash basins to wash their faces and these too then get dumped in land-fill.
    Is all this justified on the basis of the evidence for the risk of transferring infection (particularly those prions which I know are a bugger to kill)?
    I really don’t have a view but I do think the question needs to be asked and I do think we should have some good, hard evidence to justify our current course of action.

  31. BikerMondo said,

    April 27, 2010 at 9:49 am

    @FC and Mark P Nice to see Reductio ad Hitlerum being used as an argument against the Swiss system of democratic representation.

    Someone please tell me Ben was being sarcastic when pointing to Votematch. Having reviewed it I am disappointed to see some people unquestionly quoting the rubbish that it produces. In addition to Teej and Dudley’s valid comments the method is breathtakingly simplistic and is easily skewed to whatever party you want it to be. How about putting a decimal point into the percentiles it reports – that would make it so much more accurate and valid as an analytical tool. And so much more scientific :-(

  32. Fish Custard said,

    April 27, 2010 at 10:15 am

    @BikerMondo

    Accusations of “reductio ad Hitlerum” are just as often as baseless as accusations of Hitler-type thinking. If that’s not Godwin’s Second Law, it bloody well should be.

  33. BikerMondo said,

    April 27, 2010 at 10:18 am

    FC – Have a at what Reductio ad Hitlerum is before commenting.

  34. Fish Custard said,

    April 27, 2010 at 10:26 am

    @BikerMondo

    It seems I understand it better than you do. Just because it’s fallacious to say something like “Hitler was a vegetarian, therefore vegetarians are wrong”, that doesn’t mean that discussing everything he believed in is always a fallacy: otherwise you’d get “Hitler believed in the Holocaust, but I can’t ever say the Holocaust was wrong because that would always be a reductio ad Hitlerum”.

    Funnily enough, my belief that the Swiss minaret law constitutes an [imo unacceptable] “tyranny of the majority” comes from a political philosophy completely independent of whether Hitler liked minarets, Muslims and majorities or not.

  35. BikerMondo said,

    April 27, 2010 at 10:41 am

    You make the perfect example if reductio. Because the Swiss political system resulted in Minarets being banned the Swiss political system is wrong.

    The point I am making is that dismissing a complete political system on the basis of selective examples of its implications is lazy. I can equally state that FPP is awful because as a result of the majority not having a vote on the issue, the UK became involved in miltary actions the majority did not want. Funnily enought the implications of a few chuches not being built versus the deaths of hundreds of thousands of innocent civilians dying seems to be of a somewhat different order of magnitude.

  36. Fish Custard said,

    April 27, 2010 at 10:54 am

    @BikerMondo

    Being accused of laziness rather than fallacy? I can live with that :-)

    If I wasn’t lazy, I’d’ve posted sixteen paragraphs in comment #6 on my impressions of the pitfalls of “direct democracy”. But since this isn’t talkingaboutvotingsystems.com, I held back and just gave one recent “newsworthy” [or, at least, well-reported] example of why I think it isn’t a Utopian solution. Apologies for the confusion.

  37. BikerMondo said,

    April 27, 2010 at 11:51 am

    @FC – No apology needed.

    I would agree that the Swiss system is not utopian but I should state that I consider FPP to be at the root of the continued failure of the UK political system to engage the electorate or deliver proper government (I will omit my own 16 paragraphs for brevity also ;-) ). Consequently I think my own prejudices meant my response could have been more tempered. :-)

  38. paulhardy said,

    April 27, 2010 at 12:40 pm

    @enem – your argument is disingenuous; David Cameron specifically chose the example of Bulgaria because _he_ believed it would strike the electorate as incredible, and an indictment of NHS funding. Jeremy Laurence then took this and examined it, and you take objection to his assumption that it’s the stats which are wrong not the UK treatment system.

    But he was echoing Cameron’s prejudice. The rule of the lesser miracle is employed specifically to examine that.

    I work in the NHS & don’t believe it’s infallible, irreplaceable, or the best system. But once Laurence demonstrates that Bulgaria outperforms the USA, Belgium, Canada, Denmark, France, Germany, Ireland, Italy, the Netherlands, New Zealand and Austria, and shares this distinction with Algeria, Azerbaijan, Bangladesh, Colombia, India, Iran, Libya, Morocco, Namibia, Saudi Arabia, Ukraine, Uzbekistan, the Yemen, Belize and the Democratic People’s Republic of Korea, then the stats do look questionable. This isn’t an NHS specific defence.

  39. BikerMondo said,

    April 27, 2010 at 12:52 pm

    An interesting site to consider is voterpower.org.uk which does give some indication of whether your vote may make a difference based on the majority enjoyed by the incumbent and the size of the constituency.

    They also publish a mathematical model here which doesn’t use arbitrary multipliers as a compenent of its calculation. Much better to see whether to vote for one of the two parties who are in closest competition for the seat, vote tactically or spoil your ballot paper.

    It is one thing to match your vote to a party or representative but if realistically your vote will count for little unless you live in a marginal constituency then the bigger push should be to changing our antiquated and unrepresentative system into one that gives the voter a representative say in the political process.

  40. roobarb said,

    April 27, 2010 at 1:36 pm

    @skyesteve
    Recommendations about the use of disposables for high TSE risk procedures are available on DoH and MHRA websites. Sorry this is a driveby posting in lunch time so no time to search.

    The use of single use disposable kits for low risk procedures is usually about costs. It’s cheaper to use run-of-the-mill inexpensive items like suture kits once and discard them than to purchase expensive re-useables and to pay to have them decontaminated and sterilized in a compliant facility. Wrong, but there you are.

  41. BikerMondo said,

    April 28, 2010 at 12:11 pm

    An interesting site to consider is voterpower.org.uk which does give some indication of whether your vote may make a difference based on the majority enjoyed by the incumbent and the size of the constituency.

    They also publish a mathematical model which doesn’t use arbitrary multipliers as a compenent of its calculation. Much better to see whether to vote for one of the two parties who are in closest competition for the seat, vote tactically or spoil your ballot paper.

    It is one thing to match your vote to a party or representative but if realistically your vote will count for little unless you live in a marginal constituency then the bigger push should be to changing our antiquated and unrepresentative system into one that gives the voter a representative say in the political process.

  42. Andy Graham said,

    April 28, 2010 at 4:49 pm

    Has anyone had any success finding out whether their local non-MP candidate is a loony via Skeptical Voter? I have asked my local candidates from all parties (there is no incumbant) and had an extremely poor response. Lib dem lady has responded but not updated yet, while the other candidates have ignored me entirely. I did not ask them to “respond indicating whether or not you are a loony” or anything like that. I was polite, Sunday best and everything.

    The problem with candidates who are not yet MPs is that they are difficult to pin down because they have no public voting record. They have no interest in making clear their position because, for most voters, they can’t win a vote but they can certainly lose one (I understand homeopaths vote too). I am therefore concerned that my chosen candidate will secretly be a loony when I vote for them. My solution at this stage is not to vote for a candidate with an unknown loony coefficient, which leaves me not voting unless one of the candidates posts readable answers to the loony-detection questions on the SV wiki by 6 May.

  43. SteveGJ said,

    April 29, 2010 at 6:51 am

    @Andy Graham

    “(I understand homeopaths vote too)”

    Of course the fewer votes they get, the more potent the influence.

  44. jodyaberdein said,

    April 29, 2010 at 6:38 pm

    I have today had a thorough and thoughtful response from the Lib Dem candidate for Sheffield Central, Paul Scriven. Basically yesterday I sent the local candidates who might conceivably get my vote the list of questions from skeptical-voter.org. He’s the only one thus far to reply, although it is barely 24 hours. I’m just waiting for his permission to post his answer on the skeptical-voter wiki.

  45. Bishop Gillian Wakefield said,

    April 30, 2010 at 10:39 am

    @jodyaberdein

    A handful of constituents randomly requesting the opinions of some 6,500 candidates (I’m guessing the figures) on a dozen or so issues related to their understanding of and support for the scientific method seems a bit haphazard to me.

    Some coordination required. (‘I’m just saying’)

  46. emen said,

    May 1, 2010 at 4:30 pm

    OK, then. :-)
    I promise that if I ever again meet a foreigner who went “home” to have some tonsils removed, I’ll ask them whether it was because the waiting list was shorter over there or the NHS simply would not do it.

    Until then, ignore “tonsils removed” from my comment #3.

    I will also ask them whether they agree with you that their countries’ (state) healthcare only do it because the unnecessary procedure will make some doctors richer, or because it is the NHS which is “prioritising” by saying it is not really necessary- because that would be a first.

    In the meantime, have a look at a “real story” on the NHS website, 8 years of waiting, and the NHS finally decided to do it – and surprise, surprise, it worked.
    www.nhs.uk/conditions/tonsillitis/pages/realstories.aspx

  47. skyesteve said,

    May 2, 2010 at 4:34 pm

    @emen – sorry, your point is? Here are the Scottish guidelines for considering tonsillectomy from those lovely people at SIGN:

    www.sign.ac.uk/pdf/sign117.pdf

    Basically referral to ENT is recommended if attacks of tonsillitis are “disabling” and you have 7 or more attacks in one year, or 5 or more attacks per year for two consecutive years, or 3 or more attacks per year for 3 consecutive years.
    Tonsillectomy may be a “simple procedure” technically speaking but it does involve the risks of general anaesthetic, infection and bleeding. As someone who previously worked in an acute ENT ward I can assure you that I have seen people almost bleed to death after tonsillectomy so not something I would subject my child to (or recommend to others) without very good reason.
    That’s why we do fewer and fewer tonsillectomies in the UK these days. It’s got nowt to do with saving cash, cutting waiting lists, etc.
    By the way, unlike the reputation NICE has, SIGN does not have to take fiscal matters into consideration when drawing up their guidelines (at least not when I worked on one of their guideline groups).

  48. maninalift said,

    May 5, 2010 at 9:45 am

    I have to say that I assumed the statistic was basically correct but was rather silly for the reasons expressed already by others (people die of cancer if they don’t die of anything else).

    The trouble is the emotional hold CANCER has. Cameron is for efficiency and not “throwing money at” the NHS and yet has campaign posters saying something along the lines of “lets get cancer drugs for everyone”. Well if ever there was a brute-force approach to medical policy that is guaranteed to swallow all resources with limited impact it is buying every new cancer drug that comes on the market.

    He must know it is a stupid argument but he also knows the political potency of being seen to support caner treatment.

  49. maninalift said,

    May 5, 2010 at 9:47 am

    -please work-
    I have to say that I assumed the statistic was basically correct but was rather silly for the reasons expressed already by others (people die of cancer if they don’t die of anything else).

    The trouble is the emotional hold CANCER has. Cameron is for efficiency and not “throwing money at” the NHS and yet has campaign posters saying something along the lines of “lets get cancer drugs for everyone”. Well if ever there was a brute-force approach to medical policy that is guaranteed to swallow all resources with limited impact it is buying every new cancer drug that comes on the market.

    He must know it is a stupid argument but he also knows the political potency of being seen to support caner treatment.

  50. maninalift said,

    May 5, 2010 at 9:51 am

    On the subject of politically potent but far from proven arguments is the “big, centralised, bureaucratic organisation is inefficient” argument which DC keeps banging on.

    Large organisations inevitably have pockets of inefficiency and it is necessary to have

  51. maninalift said,

    May 5, 2010 at 10:02 am

    On the subject of politically potent but far from proven arguments is the “big, centralised, bureaucratic organisation is inefficient” argument which DC keeps banging on.

    Large organisations inevitably have pockets of inefficiency and it is necessary to have different structures across an organisation for self-examination to eliminate these, however, in my experience by far the greatest source of inefficiency in the NHS comes from the market structure.

    Indeed the more autonomy one gives to unit parts, the more means it is necessary it is to have to direct those parts and the more conflicting forces there are on it’s staff: It is not at all clear that it leads to freedom for medical judgement or from paperwork.

  52. maninalift said,

    May 5, 2010 at 10:03 am

    sorry for the repeated posting – I blame wordpress.

  53. three tigers said,

    May 6, 2010 at 7:20 pm

    Remember here in Switzerland 20.9% of the population are foreigners, in a total population of ~7.2 million. My ex-pat family included, although our kids were born here. The SVP (or Swiss Nazi Party – as I like to call them) did a campaign which would basically not be allowed in the UK for its obvious racism to scaremonger about the minaret initiative. A Swiss lab technician of mine jokingly said he would be happy to vote for it, but only if they include all the bloody churches too and their bells! Many Swiss people are not so rich, or so homogeneous as outsiders think, but many are very conservative, rural farming folk and natural supporters of the SVP (a bit like farmers in the UK being Tories). However, having observed both (and if our Swiss citizenship is approved) being able to vote in both, my vote here would potentially count for more.