6 Aug 2009


We attended a hepatitis workshop in June. In one interesting session, speakers from Taiwan and Hong Kong presented the local guidelines, actual clinical practice and reimbursement system. After the presentation, it was clear that the prescription practice in Taiwan largely followed the guidelines of the expert committee. On the other hand, the management guidelines issued by hepatologists in Hong Kong and the actual criteria for initiating treatment issued by the Hospital Authority showed little concordance. As a result, many patients in need were either untreated or had to buy the drugs themselves.

“You have to talk to the government and fight for your patients,” our friends from Taiwan remarked.

My mentor was frustrated. “I attended a few of those meetings. My conclusion is that those administrators measure productivity by the number of meetings they hold but not by the things achieved.”

The Taiwanese disagreed. “Our professor always mentions that he spent twenty years talking to the government before we have this reimbursement scheme.”

Our friends might be right. However, their officials were not British trained. I could immediately recall the standard procedure by Sir Humphrey Appleby to denounce the significance of any expert report:

Step One: Public interest. Point out the report could be used to put unwelcome pressure on government because it might be misinterpreted. We need to wait for the results of a wider and more detailed survey over a longer time-scale. If such a survey is not being conducted, it is even better.

Step Two: Challenge the evidence. The report leaves important questions unanswered. Much of the evidence is inconclusive. The figures are open to other interpretations. Some findings are contradictory. (These criticisms can be made on any report even without reading it.)

Step Three: Undermine the recommendations. The report cannot be used for long-term decisions. There is insufficient information to support the conclusions. Broadly speaking, the report supports the current practice. (Mind you, most people do not really read full reports and are easily swayed.)

Step Four: Discredit the expert. He is harboring a grudge against the government. He is just attracting publicity. He used to be a consultant of a commercial company. If not, he wants to be a consultant of a commercial company!

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