Dining in intimidating company the other evening, I found myself seated next to a distinguished medical academic. A man of lifelong Labour persuasion, he was nonetheless fiercely sceptical of the evidence-based approach to NHS drugs policy as represented by the National Institute for Clinical Excellence.
Why? I asked. Partly, he said, because science at its best is not really a matter of evidence, but of instinct and imagination; it is as much inductive as deductive.
Someone gets a theory, then sets out to prove it, not the other way around.
That is as may be; his real complaint was that NICE hadn't really given the 'not proven' anti-flu drug, Relenza, a proper chance. He said these tests tend to be carried out on middle-aged people - basically healthy - rather than on folk in their 70s for whom Relenza is a potential saviour from being carried off by winter flu (not that many of us ever get real flu, as distinct from a cold, my new friend added). This reluctance is because oldsters have ailments, they may have had a coronary or two, and they would need more monitoring.
Relenza would be widely available on the NHS in five years' time, the professor predicted. All of which was light years away from trench warfare in the Commons a few days earlier, where Dr Liam Fox was staging his first state-of-the-NHS debate against Bouncer Milburn.
Not much to report from the trenches that is not painfully familiar. As we noted here last week, Fox and his deputy, Philip Hammond, think Milburn is clever ('not stupid' is how they put it in MP-speak) but trapped by the Dobson legacy. For his part, Bouncer thinks they're all privatisers, mad axe folk with revolving eyes.
Two points emerged worth noting. Nick Harvey, the new Lib Dem spokesman in Charles Kennedy's team, made his official debut. He backed Tory calls for a rational debate on NHS rationing ('There always has been rationing and always will be') and argued for a broader definition of NICE's notion of cost-effectiveness. Getting poor, unhealthy people back to work, for instance, would save housing and unemployment benefit.
He also demanded more money for the NHS. 'It all boils down to a question of resources, ' Mr Harvey told MPs. But he derided the Tory policy of expanding private insurance. That would replace 'rationing by postcode with rationing by tax code', he said. A memorable phrase, but Mr Harvey, a PR consultant by trade, is not a flashy talker. He admitted he had nicked it from a friend.
Philip Hammond chided Mr Harvey for failing to say how much privately funded money would be acceptable for the healthcare budget. Minister John Hutton did the same in reverse: how much would you raise in tax? But the debate's most interesting passage, I thought, was Dr Fox's, because he explicitly challenged the insurance industry to meet the new challenge.
'I have no private health insurance because, like many people, I believe that the private health insurance products on offer are too inflexible and heavily loaded, have too many exemptions and are too expensive. We need far cheaper and more flexible products which are accessible to a much wider range of our fellow citizens at all income levels, ' said Dr Fox.
It's refreshing to hear a Tory politician admitting that many private health 'products' are crap, which indeed they are, though it opened Fox up to the obvious charge that the last time this industry rose to a challenge over private pensions it became a multi-billion misselling scandal. John Hutton duly mocked him - to raise the equivalent of an extra 3-4 per cent of gross national product for health (to average EU levels) would either mean 45 million people spending the£531 a year currently spent by 3.2 million - or making the 3.2 million spend£7,500 a year, he claimed.
Actually, Hutton's figures were as much of a muddle as anyone else's on this occasion, though he has less excuse. He told MPs that current spending on healthcare in the UK is about£48bn (that includes the tiny private sector spend, I assume). This he translated as 5.8 per cent of GNP. Alas, that cannot be so, even though the economy is motoring nicely. It implies that GNP is around£827bn, about£100bn higher than Gordon Brown's estimates. Do theses sums again, chaps.