NICE Annual Conference 2019: "Transforming care"

Andy

Andy

Retired committee member
Welcome to the NICE Annual Conference 2019

NICE 2019: Transforming care celebrates 20 years of NICE’s commitment to innovation, excellence and evidence-based health and care.

Bringing frontline staff and leaders from health and care together with the life sciences, healthtech and digital sectors, the event outlines NICE’s essential role supporting the delivery of high quality, fully-integrated, person-centred care.

The plenary and parallel programme will explore topics ranging from how human factors affect patient safety, to proving the value of health apps and ensuring that mental and physical healthcare are truly integrated.

NICE 2019 packs 12 hours of content into just one day:

  • Renowned keynote speakers, including conference host, clinician and broadcaster Dr Phil Hammond
  • Pills or prevention? Discuss whether transformative medicines or public health programmes will ensure the sustainability of the NHS
  • Case studies from the frontline on quality improvement
  • Future-focused parallel sessions exploring how the health and care landscape will be shaped by factors from genomics to Brexit in the coming years
  • Troubleshoot local implementation challenges with the NICE Field Team
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http://www.niceconference.org.uk/about

Professor Sir Simon Wessely, Regius Professor of Psychiatry, King’s College London

In conversation with Phil Hammond

Simon, known for his challenging views on mental health and care, discusses how the NHS can make a reality of integrating physical and mental healthcare and NICE’s role in achieving it.
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"challenging views", is that code for "completely wrong views"? Or perhaps "views that he has no actual proof for"?

Anyway, full agenda here, http://www.niceconference.org.uk/agenda
 
This bit could be interesting (from http://www.niceconference.org.uk/agenda):
Reliable evidence?: The roles of real-world data, patient evidence and randomised trials in judging treatment effectiveness
  • Randomised trials have been the gold standard for evidence of effectiveness, but increasing numbers of patients with multiple conditions and the growing sophistication of real-world data offer new perspectives on how to decide what works and for whom.
Chair: Dr Phil Hammond
Professor Carl Heneghan, Director, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford
Emily Lam, Lay member - Guidelines committee, NICE
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  • Randomised trials have been the gold standard for evidence of effectiveness, but increasing numbers of patients with multiple conditions and the growing sophistication of real-world data offer new perspectives on how to decide what works and for whom.
That sentence is incoherent, and even if it was coherent it is unclear what it is might be supposed to mean.

Who is Phil Hammond? I get the impression he is someone out of his depth.
 
obeat said:
Any point sending Phil the evidence that patients dont benefit from GET?i.e.the patient surveys?
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Not really, he’s been told by patients before and is of the BPS management approach and works with children.
Jonathan Edwards said:
  • Randomised trials have been the gold standard for evidence of effectiveness, but increasing numbers of patients with multiple conditions and the growing sophistication of real-world data offer new perspectives on how to decide what works and for whom.
That sentence is incoherent, and even if it was coherent it is unclear what it is might be supposed to mean.

Who is Phil Hammond? I get the impression he is someone out of his depth.
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I think he is a "celebrity" Dr, possibly GP/ comedian / (former?) radio presenter. He was, I think, sacked from his bbc radio program for something about brexit, possibly not neutral enough. I think that hes written popular books but that might be wrong. He works/worked at the same place as Dr Esther Crawley “treating” children. He interviewed Esther a few years ago where she defended the PACE trial and said kids and parents don’t want medical treatment forCFS or something similar.
 
Jonathan Edwards said:
  • Randomised trials have been the gold standard for evidence of effectiveness, but increasing numbers of patients with multiple conditions and the growing sophistication of real-world data offer new perspectives on how to decide what works and for whom.
That sentence is incoherent, and even if it was coherent it is unclear what it is might be supposed to mean.

Who is Phil Hammond? I get the impression he is someone out of his depth.
Click to expand...

When did the "gold standard" change from double-blinded placebo-controlled randomized trials to just randomized trials? It seems the gold standard has become diluted over time. I'm seeing far too much of this loosening of standards lately, seemingly to make it easier for the psychologisation of medicine.

It seems to go hand-in-hand with evidence-based medicine, favoring finding positive outcomes without paying much attention to falsification and contradicting evidence. Magical thinking is creeping in with a vengeance. Does not bode well.
 
Jonathan Edwards said:
  • Randomised trials have been the gold standard for evidence of effectiveness, but increasing numbers of patients with multiple conditions and the growing sophistication of real-world data offer new perspectives on how to decide what works and for whom.
That sentence is incoherent, and even if it was coherent it is unclear what it is might be supposed to mean.
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I think it might mean that it's time to stop trusting science-fascist experts and start listening to anecdotal evidence from real-world patients. This is not only more respectful to patients' narratives and perspectives and more democratic, it also has the advantage that even if you can't design a questionnaire to get patients to tell you what you want to hear, you can always spin their anecdotes into whatever result you want anyway.

A clue is in the phrase "real-world". Whenever I hear someone say "In the real world ..." it's always a sign that they're going to get onto their subjective hobbyhorse about something.
 
Jonathan Edwards said:
  • Randomised trials have been the gold standard for evidence of effectiveness, but increasing numbers of patients with multiple conditions and the growing sophistication of real-world data offer new perspectives on how to decide what works and for whom.
That sentence is incoherent, and even if it was coherent it is unclear what it is might be supposed to mean.

Who is Phil Hammond? I get the impression he is someone out of his depth.
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He works in E Crawleys CFS clinic
 
Jonathan Edwards said:
That sentence is incoherent, and even if it was coherent it is unclear what it is might be supposed to mean.
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I assume he is referring to big data approaches applied to data we routinely collect rather than running trials. We do collect a lot of data and some of it is contained in a structured form in databases which makes it useful and other pieces can be scraped and structured. This gives us the ability to reason about things like medical records in a way that perhaps wasn't practical in the past.

However, with all these things you need to worry about the quality of the data and that you can get self-fulfilling loops. So for example, if there is a high misdiagnosis rate for ME then the medical records from GPs (and things like insurance cost codes) may not be reflective of the actual disease. If this data is used to decide on treatments then the inaccuracies can become self-reinforcing and maybe stop anyone asking the question - do they really work. Again with ME if a GP suggests CBT a patient has this and gives up then the GP concludes success - a big data approach would learn this result even though it was just that the patient gave up on the doctor (thats not recorded).

So in some areas the data collected may be useful but probably only where diseases are well characterised and understood (hence ensuring good quality data). But for many of the areas and particularly things like ME then the data is poor and conclusions will be poor.

I think we discussed a lot of this with a paper analyzing insurance cost codes.
 
I mixed Hammond up with Goldacre (brain fog), so we just had a nice blast of Fox. :rofl:

It's a very expensive thing to attend as a patient - £150! :eek: I just feel that's more than I can afford to pay (even assuming my Carer gets in free to push my wheelchair).
 
Jonathan Edwards said:
  • Randomised trials have been the gold standard for evidence of effectiveness, but increasing numbers of patients with multiple conditions and the growing sophistication of real-world data offer new perspectives on how to decide what works and for whom.
That sentence is incoherent, and even if it was coherent it is unclear what it is might be supposed to mean.

Who is Phil Hammond? I get the impression he is someone out of his depth.
Click to expand...

He works with Crawley and he is a comedian that write for Private Eye... I have a lot to say about that but need more coffee before I start upload_2019-1-28_22-0-50.png
 
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